Reducing the Number of Falls in Older Adults
Growing up our body experience a lot of changes. As we age, our bodies develop in order to be stronger. However, as we get older our bodies start to deteriorate; if not maintained properly it becomes fragile. It is not uncommon for older adults in their nineties to still be walking, but a single slip or fall could take that independence away. “Falls are the most common cause of accidental death among older adults and are associated with increased morbidity and mortality.” (Stubbs, 2011, p.1). With an increasing older adult population there is higher stress on the long term health care system, such as longer term care facilities, slow stream rehab units, and hospitals. As this demand persist, a higher stress on the institutions and their workers may lead to older adult neglect and an overall inferior quality of care. There are several reasons why falls are becoming more frequent for the elderly but they can be prevented by carefully managing the fall risks and creating a prevention program that should be implemented in order to reduce the number of falls in older adults. The population of older adults is rapidly increasing. One common work setting for a registered practical nurse is a long term care facility.
Thus, it is important for nurses to be educated about falls, their risks, and how to prevent them. “Approximately 30 percent of people over 65 fall each year, and for those over 75 the rates are higher. Between 20 and 30 percent of those who fall suffer injuries that reduce mobility and independence and increase the risk of premature death.” (The World Health Organization Europe, 2004). Registered practical nurses often work with older adults that are susceptible to falls, especially in settings that deal with patients who have mental health problems. For example, there is an even higher risk for falls on a dementia unit due to the patients’ impaired cognitive ability. Therefore proper care and safety measures needs to be well thought out, planned and implemented. There are a number of ways in which falls in the older adult can be prevented. The Registered Nurse Association of Ontario (RNAO) gives us Best Practice Guidelines (BPG) that we can follow in order to implement falls prevention methods. BPG outlines ways to assess the clients using nursing and health care practices, identifying recommendations that will address the needs of the client and develop a plan to implement the recommendations associated with the clients condition (RNAO, 2005). According to the RNAO BPG on Prevention of Falls and Fall Injuries in the Older Adult, upon admission it is important to assess the risk for falls and history of falls in the past (RNAO, 2005). Interventions include involving the client in activities to help them recover from a fall and maintaining proper body mechanics to perform daily living activities (RNAO, 2005). Following up with the client’s progress, the nurse can recommend assistive device that can help the client, such as hip protector and proper foot wear (RNAO, 2005).
“Footwear influences balance and the subsequent risk of slips, trips and falls” (Menant, Steele, Menz, Munro, & Lord, 2008). Falls consequently cause pain, thus patients pain and its level of debilitation should also be assessed and maintained. For pain management, the nurse must document the level of pain that the client experiences and what medications can help alleviate their pain (RNAO, 2005). Lastly, the nurse should educate the client about the risk and consequences of falling so that they would take cautions in their daily activities. The changes in mobility can have an effect on one’s self esteem and self image which may hinder the client’s compliance to their treatment. For example, if the client does not want to use a wheel chair or walker, the client’s family should be involved in educating their loved one with the risk of falls. Sometimes the patient is adamant to preserve their independent status as an adult which may consequently cause them to overestimate their abilities to do things normally but in reality they are placing themselves at risk for falls.
If the client refuses assistance from the nurse, the family can intervene and assist them instead. A family’s word is sometimes stronger than the one coming from a health care professional. There are other intraprofessional contributors besides nurses, personal support workers and physicians that are involved in maintaining safety practices and a safe environment for older adults. Physiotherapists help educate older adults on how to prevent a fall as well as how to recover from a fall. “Physiotherapists are highly skilled and autonomous health professionals who provide safe, quality client-centered physiotherapy through a commitment to service availability, accessibility and excellence” (The Canadian Physiotherapy Association, 2009). With the help of physiotherapists, older adults who suffer from falls could have a chance to perform normal activities of daily living with the help of rehabilitation. After rehabilitation, clients will be educated in preventing a fall from happening again.
Physiotherapists explain what precautions the client can take and also how to move their body properly and more efficiently (CPA, 2009) One particular occupation in the health care setting is one that is not usually well recognized as part of the health care team but plays a significant role in client safety; the custodians. They are the one who clean the floor and make sure that there are no obstructions around when client is mobile. They also make sure that the floor is not wet or slippery, which decreases the risk of slips and falls. When cleaning the client’s room, they make sure that there are no loose wires hanging around or on the floor that a client can trip on. Physiotherapists and custodians are a couple of examples of intraprofessional health care team workers that contribute to the safety of older adults.
It is unfortunate that falls still happen since most accidents can be prevented. However, by utilizing the best practice guidelines the number of falls within the older adult can be decreased. Falls cannot be completely eliminated due to the fact that the mental and physiological status of patients is out of the hands of health care workers. However, the healthcare team can tailor the care around the patients’ needs in order to decrease the risk for falls by implementing a plan that includes techniques to prevent falls.
Reference
Menant, J., Steele, J., Menz, H., Munro, B., & Lord, S. (2008). Optimizing footwear for older people at risk of falls. Journal Of Rehabilitation Research & Development, 45(8), 1167-1181. Registered Nurses’ Association of Ontario. (2005). Prevention of Falls and Fall Injuries in the Older Adult.(Revised). Toronto, Canada: Registered Nurses’ Association of Ontario. Retrieved from: http://rnao.ca/sites/rnao.ca/files/Prevention_of_Fall_and_Fall_Injuries_in_the_Older_Adult.pdf. STUBBS, B. B. (2011). Falls in older adult psychiatric