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Elderly Care India Home Health Care

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India Home Health Care provides an extensive care plan for the elderly. Taking care of elderly parents or grandparents is not an easy task, especially when it comes to health. Ensuring that all their needs are taken care of in terms of their health and well-being can be quite tricky and not at all times can this be done without adequate help or support. – PowerPoint PPT presentation

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Title: Elderly Care India Home Health Care


1
(No Transcript)
2
INDEX
  1. How to Care for Aging Parents
  2. How to care for your parents from a distance
  3. 10 Tips to Take Care of Aging Parents
  4. How to keep Homebound Seniors Active
  5. An Elderly Parent transforming from Hospital to
    Home
  6. Coping with Care giving for Ailing Elderly Parent
  7. Arthritis Causes Symptoms
  8. Caring for an Alzheimers Patient
  9. Risk of Fall in Elderly
  10. Fall Prevention in Elderly

3
HOW TO CARE FOR AGING PARENTS
4
How to Care For Aging Parents
  • As we all get older we need to have serious
    discussion among our close family members
    (spouse, kids, siblings) about taking care of our
    Aging Parents. As they reach 70s and 80s we need
    to check their physical and mental well-being
    and make sure they are leading an
  • independent living with excellent quality of
    life.
  • If we dont plan properly we all will end up in
    confusion, sadness, helplessness, frustration,
    exhaustion when we have to deal with inevitable
    health related challenges. With solid family
    support, professional support and good
    communication we can renew the sense of love,
    compassion and tenderness in to any family with
    Aging Parent.In order to do that effectively
    adult children should take care of the following
    diligently
  • 1. Find out their (Aging Parent) needs Find out
    from your Parent
  • what they want whether
  • They want to stay at home
  • Move close to their kids
  • Move to a Senior independent living community
    with common dining hall, cleaning facility,
    medical facility etc.
  • Old age home /Nursing home.
  • When you notice poor eating habits, poor
    hygiene, neglecting their home, forgetfulness,
    dif?culty driving then you need to counsel them
    to get help
  • 2. Find out your Parents assets Find out your
    Parents assets including pension amount, the
    health insurance policies, and free medical
    facilities from the organization where they used
    to work etc.

5
  • 3. Decide whether you want to be their Caregiver
    It may
  • Put emotional toll on you
  • You may have to quit the job
  • You may lose your bene?ts for your retirement.
  • Consider professional help
  • Make a Caregiver budget
  • Make your own retirement plan
  • Understand the costs of keeping your Parent in
    their home
  • ( May need home health Nursing care or Medical
    Care Taker care if they have medical problem or
    just an assistant to do their day to day chores)
  • 4. Make a joint decision Discuss with your
    Parents, spouse, siblings and Children and make
    a joint decision about the location of the stay.

5. Financial Planning Based on the above make a
budget to take of care of your Parent with the
contribution from your siblings to relieve the
entire ?nancial pressure on you.With careful
planning we can provide conducive atmosphere for
our Parents to Age gracefully.
6
HOW TO CARE FOR YOUR PARENTS FROM A DISTANCE
7
How To Care For Your Parents From A Distance
Taking care of aging parents from distance is not
only dif?cult but also is a cause of concern for
many working professionals not only living abroad
but Valso in a different city as their parents
in India.
Parents may require care or help during
temporary health situation like surgery or even a
chronic health condition. Other family members
and relatives may step in at this time and help
out for a while but most of the time they may
have to leave before the patient recovers
completely. India Home Healthcare provides
reliable and coordinated care which is tailored
to the patients requirement. The staff, not
only stay in touch with the physician or surgeon,
but also with the family members to update the
progress of the patient. The online patient
portal which gets updated regularly lets the
family members anywhere to log in and follow the
progress of the patient. This can also be used to
take any second opinions if needed. Parents who
have been active, healthy and working towards our
well being all their life either at a job or
taking care of family, show a change in their
health status soon after retirement or once they
think they are getting old. This is sometimes
called empty nesters syndrome where the
parents start showing these symptoms when the
family members (children) move out of the house
and start setting up their own families abroad or
even in a different city in India. The
psychological factors of well being in old age
are overlooked easily even by the family members.
8
Depression due to loneliness and decreased
sociability in old age is real and may have
signi?cant effect on the health status. Even when
there is no clear diagnosis of depression, it
will affect the individualshealth more than we
can imagine. According to a study conducted by
Singh and Misra in 2009 on 55 elderly people,
there is direct relationship between loneliness
and old age depression. India Home Health care
provides care givers who provide companionship
to the elderly patients, not only to keep them
active and alert but also help them overcome
activities which are dif?cult for them like
evening walk to the park. These activities are
needed to re- integrate them back in to the
community and maintain the quality of life they
deserve and want. The care givers also help to
maintain a healthy diet plan and monitor even
commonly found and commonly neglected disorders
like hypertension and diabetes which are usually
the risk factors for many diseases in
elderly. India Home Health Care also provides
monthly care plans which include regular doctor
visits, nurse, dietitian and physical therapist
visits every month to prevent and detect any
disorders in the early stages.Aging
surely involves many degenerative processes, but
it need not include diseases. Adjusting to the
changes that accompany old age require ?exibility
and new coping skills. India Home Healthcare
helps not only the parents in the aging process
but also family members who can be reassured that
their parents are in the best hands.
9
10 TIPS TO TAKE CARE OF AGING PARENTS
10
10 Tips to Take care of the Elderly
  • We are on this earth today because of our
    parents. They taught us the lessons of life, to
    succeed and to get a respectful social image.
    Children need parents help till they get
    settled in their life in all the aspects.
  • The same way parents also need support when they
    become aged.
  • And it is childrens responsibilities to give
    them a respectful retirement life.
  • Here are 10 tips to make our parents happy during
    their evenings of life.
  • Avoid loneliness Spend some time with parents,
    talk to them, keep them involved in family
    affairs, get their suggestions and work
    accordingly.
  • Dietary Needs Their intake will be less because
    of poor appetite but we have to insist them to
    have balanced diet regularly.
  • Medical Needs Take care of their health issues,
    physical and psychological. Talk to them if they
    need any medical assistance, provide them the
    required assistance. Risk of fall will always be
    there because of general weakness and fragile
    bones. We can avoid this by providing extra
    support.
  • Regular Exercise Spare some time especially for
    your parents and take them for a morning or
    evening walk, they will be happy to spend time
    with you.
  • Finance Parents were independent their whole
    life to take care of their own and the familys
    ?nancial needs but to meet their old age needs,
    they should have some insurance policies which
    make them feel con?dent.
  • Never be rude At this age there is a tendency to
    repeat the same thing again and again but we
    should not behave rudely. The children must have
    patience to understand the situation.

11
  • Listen and solve their problems Children should
    listen to their problems patiently and try to
    solve them.
  • Make them feel special By celebrating their
    Birthdays and Wedding anniversary.
  • Help them for even small things They need help
    for each and every small thing like getting a
    glass of water, reading newspaper for them. Ask
    them what they need and deliver it.
  • Allow grand children to play with them This is
    the best way to keep them happy always. It is
    like letting 6 and 60 year old children play
    together
  • .
  • These are the few simple methods to keep our
    aging parents happy so they can live with
    dignity and respect.

12
HOW TO KEEP HOMEBOUND SENIORS ACTIVE
13
How to keep Homebound Seniors Active
  • Seniors as they get older may feel comfortable to
    stay at home. Some of them will be independent
    within their familiar surroundings but may feel
    bored at home. Some of them need minimal to
    moderate help to do their day to day activities
    because of their health condition. Some of them
    may need total assistance and may be bed bound
    due to severe disability due to the
    deterioration in their health condition. In all
    the above three situations one may feel lonely,
    boredom and depressed if they dont have a proper
    inspiring companion or caregiver.
  • In order to keep the Senior Citizen active we can
    formulate certain recreational activities to
    keep them physically and mentally ?t and keep
    them happy. We can try the following methodology
    whichever works depending upon the individuals
    interest
  • 1. Seniors who are independent
  • Explore the world via the world wide web-
    Computer games, facebook/twitter/emails/Skype to
    stay connected with friends and families and
    make new friends with similar interests, whatsapp
    with friends and family, listen to the
    lectures/discourses/talks/songs of their
    interests in the computer or laptop with
    speakers attached
  • Start a Book Club Read books with big fonts or
    magnifying glass or digital books with large
    fonts and discuss with the club members through a
    Skype call or conference call about the
    characters in the book that they are focusing
    on.
  • Puzzle, board games (chess, snake and ladder,
    Chinese checker, scrabble), solitaire, jigsaw
    puzzle, carom board, cards etc.
  • Work from home if they are still able to do that
    for couple of hours a day
  • Write a letter or call someone and speak to them
    on several topics that are interesting for them.
  • Tinker- Able to ?x little things at home and have
    a sense of ful?lment
  • Painting, drawing, home indoor gardening,
    listening to the music
  • Hire a care giver/companion to give company and
    have a partner to play several indoor games.
  • Start a new hobby

14
2. Seniors who need minimal to moderate help for
day to day activities
  • Caregiver to help in personal hygiene, walking,
    dining, bathing etc.
  • Formulate a recreational activity that gives
    interest to that Senior.
  • For e.g. To listen to a good music for one hour
    in the morning, then do exercises for all the
    joints followed by walking inside the house with
    the help of a walker or a cane, then do a little
    writing or drawing or painting for another hour,
    then listen to a book or a magazine read by
    their care giver, then play chess or carom
  • for another hour in the evening and go in the
    backyard or outside in
  • the wheelchair to get some fresh air and watch
    their favorite program
  • in the television
  • 3. Seniors who are bed bound and need total
    assistance
  • Bed should be closer to the window so that they
    can see outside for birds, people, traf?c,
    workers doing some painting or road repair work
    so that they stay connected to the outside
    world.
  • Keep a big clock and a large print daily calendar
    for them to look
  • Put soft music/lectures/discourses/talk for them
    to listen
  • These are the few tips to maintain a healthy,
    happy quality of life among the home bound
    Senior citizens.

15
AN ELDERLY PARENT TRANSITIONING FROM HOSPITAL
TO HOME
16
An Elderly Parent Transitioning From Hospital To
Home
  • Despite the obvious relief of getting your
    elderly parent discharged from hospital after an
    illness or a surgery, it can be quite stressful
    to transition them back to life at home. The
    situation becomes more complicated when your
    parents live alone. With the hospitals focusing
    on reducing the length of stay, the burden of
    rehabilitating the patient falls more and more on
  • the family.
  • People are getting discharged with greater need
    for support and care at home. Even though you
    might love your parent and might want to take
    care of them to the best of your ability, it is
    becoming dif?cult for the majority.
  • With demanding careers and taking care of your
    own home and children, it can be a daunting task
    to care for your loved one when he/she is
    recuperating. However, having a clear plan in
    place for life after discharge will be immensely
    bene?cial to you and your family.
  • Ideally, a smooth transition should ensure that,
  • The patient is clinically safe
  • There are no risks or threat of getting
    readmitted to the hospital for the same problem
    or other complications
  • The patient is con?dent of getting back to normal
    routine Here are some simple solutions to
    achieve these goals
  • Assess your home environment Before the
    discharge do a quick home check and look at it
    through the eyes of your fragile parent. Make a
    list of questions that you need to answer before
    the discharge, for example Will there be a need
    for a hospital bed or oxygen supply? What
    consumables like diapers, gloves, etc. need to
    be kept in stock?
  • Be part of the discharge planning process Speak
    to the physician and the hospital nursing team
    about your concerns. Understand how you could
    help and the speci?c tasks your parents would
    need assistance for. Get a rough estimate of how
    long the recuperating period might be.

17
  • Make the necessary changes at home If your
    parent needs a hospital bed or other equipment,
    you might need to choose a room for them with
    enough space. Ensure that there is enough
    lighting, especially the path from the bed to
    the bathroom. Consider the possibility of
    installing grab bars in the bathroom. If you
    plan to involve additional caregivers, plan on a
    comfortable space to accommodate them.
  • Get support for the health care tasksThis is the
    actual bulk of care-giving at home. It requires
    your physical presence and assistance in getting
    your
  • parent back on his/her feet. Daily tasks like
    feeding, medication administration, monitoring
    for complications or infections need to be
    performed consistently.
  • Evaluate if you can perform these tasks and how
    much time you can devote to being the primary
    caregiver. If it is not a responsibility that you
    can handle, engage a home health care provider.
    Before choosing a provider, do a research on the
    providers in your locality, understand their
    credentials, evaluate the care packages they
    offer, short list and interview them.
  • Involve the home health care provider in the
    care, even before the discharge from the
    hospital. This helps them in understanding the
    speci?c condition of the patient and therefore
    to draw the care plan that he/she needs. Check
    the daily tasks that they need to perform, the
    signs of complications that they need to watch
    for and provide them with a list of emergency
    contacts.
  • Availing support from professional healthcare
    companies is therefore a valid option, as it
    allows the elderly patient to recuperate in their
    known surroundings, while reducing the pressure
    on you and your family. Home healthcare has
    shown better results in patient recovery by
    reducing the recuperation period by an average
    of 15.

18
Dr.AnithaArockiasmay, Head of Clinical Operations
at India Home Health Care, Indias largest home
healthcare provider, has experienced the impact
of home healthcare on the patients recuperation
and transition to home. We have served a number
of patients, where they were clinically
stable but not fully recovered from the illness.
Shortly after discharge to their home under our
care, a signi?cant improvement was seen. It was
surely a combination of many factors, one being
the comfortable and known home surrounding, and
another one being the professional care given by
the family in support with our care
provider. This transition is not just about
your parent, it is also about you evolving from
being a child to a care giver. No doubt, it is a
challenging and critical phase in your life. To
make it a rewarding and ful?lling experience,
understand your options and limitations. Ensure
that you have a solid plan in place and execute
it ef?ciently.
19
COPING WITH CAREGIVING FOR AILING PARENT
20
Coping With Caregiving for Elderly Parent
In our Indian communities, caring for elderly
parents is considered a core traditional value,
that we take pride in. Irrespective of the
westernisation of our societies, majority of
Indians choose to care for their parents at
home. With the age expectancy of our population
increasing and the number of children in a
family decreasing, the length of time that the
parents are cared for and the intense pressure
that results out of it, has increased quite
signi?cantly.
The demands of being the care giver can be quite
high. It needs a lot of dedication, time and
effort. The critical challenge, for many, is
juggling a busy career, caring for their own
kids and home plus the aged parents. The
pressure from all sides can lead to a condition
known as the Care Giver Burnout, which is de?ned
as the physical and emotional strain that
results from taking care of someone. Though it is
a rewarding and ful?lling experience for many,
it can take a toll on the quality of life for
the entire family. It could result from not
sleeping enough, working too much, having too
many tasks to attend to and just not having
enough time to care for yourself. Add to it the
?nancial implication or the emotional turmoil of
watching the parent suffer from a degenerative
condition like Alzheimers or the unresolved
family issues that resurface, these are enough to
leave anyone overwhelmed with the
situation. The demands of being the care giver
can be quite high. It needs a lot of dedication,
time and effort. The critical challenge, for
many, is juggling a busy career, caring for
their own kids and home plus the aged parents.
The pressure from all sides can lead to a
condition known as the Care Giver Burnout, which
is de?ned as the physical and emotional strain
that results from taking care of someone. Though
it is a rewarding and ful?lling experience for
many, it can take a toll on the quality of life
for the entire family.
21
  • Care Giver Burnout can manifest as
  • Depression I am not interested in any of this
  • Anxiety I cannot step out of the house, what
    if my mother needs me?
  • Guilt Am I doing enough?
  • Exhaustion I am just too tired to eat
  • Inability to concentrate I completely forgot
    my spouses birthday
  • Loss of sleep What if she tries to get out of
    the bed and falls down?
  • Excessive irritability I just need to be left
    alone
  • Physically, it can be present as headache, body
    ache, weight loss, weight gain or insomnia.
    Though our body is capable of handling stress
    for a short time frame, it loses the ?ght after
    some time and the stress starts wreaking havoc
    on our systems.
  • This is more common in women, as they are mostly
    more hands on than men. While men tend to
    involve with the coordination of care, driving
    to and from hospitals and taking care of the
    ?nancial matters, women tend to be the personal
    care givers and keep the relationship going
    within the family members, while attending to
    their own children and maybe careers.
  • The warning signs of Care Giver Burnout need to
    be taken seriously as the quality of the care
    you provide to your parent is directly
    proportional to your well being. You need to
    take care of yourself as the stress can only be a
    detrimental factor in these situations. Let us
    now, look at a few tips to overcome the Care
    Giver Burnout.
  • 1. Give yourself priority You should get away
    from the guilt and need to understand that you
    need regular breaks to keep you going. Do things
    that you love during those breaks. Set your mind
    free and come back refreshed. Simple relaxation
    techniques like meditation, going for short
    walks are great stress busters.

22
  • Seek Help There are organized providers that
    provide at home healthcare. At home healthcare
    providers, give the same quality of care that
    you get in hospitals in the comfort and
    convenience of your homes. India Home Health
    Care Pvt. Ltd.(IHHC) is one such provider which
    takes care of the elderly through a wide range
    of care plans that is developed and customized
    to your parent.
  • Dr.AnithaArockiasamy , Head of Clinical
    Operations, IHHC points out that Over 30 of
    our patients come to us after trying to care for
    their parents by themselves.
  • By the time they approach us, they are exhausted
    physically and mentally. They feel like they are
    ?ghting a losing battle. However, once they
    engage with us, they realise that they have a
    team that works with them for their parent and
    that they have someone with confer with. They
    understand that they can delegate the hands on
    care and get their life back. While starting a
    service for an elderly parent, India Home Health
    Care administers a questionnaire for the
    patients family to deduce how much of
    psychological support they need, which helps in
    stemming the Care Giver Burnout.
  • Garner support Accept help and support from
    other friends or family. Discuss the issues you
    have at hand and the speci?c tasks that they
    could help with. If you are open and honest
    about the situation, you will be surprised by
    the positive responses you will get. Create
    partnerships with other siblings. Even if they
    live far away, speak to them to relieve you for a
    few weeks.Try con?ding in friends, unloading can
    make you feel a lot better.
  • Accept the reality Things can go wrong and you
    cannot control everything. As is often said,
    there is no such thing as a perfect care giver.
  • Do not feel guilty if you fall short of things,
    at times. Your house need not be perfectly kept
    at all times.
  • Take care of your health Going for regular
    physical check-ups is even more important when
    you are a care giver. Make sure you get enough
    sleep, eat well and exercise regularly so that
    you feel ?t and ?ne.
  • Remember that your parent wants you to be happy
    and healthy, above everything. It will hurt them
    to watch you weaken while taking care of them.
    So watch out for those warning signs, learn to
    lighten the stress and the risk of burnout.

23
Arthritis Causes Symptoms
Arthritis is a nagging problem when managed
diligently can be controlled effectively. The
person who is affected can lead a normal
qualitative life when he understands his/her
problem better. There are many types of
arthritis namely Osteoarthritis, Rheumatoid
arthritis, psoriatic arthritis, gout etc. Among
these, osteoarthritis and rheumatoid arthritis
are more common. Osteoarthritis is due to
degenerative changes in the joints due to wear
and tear resulting in joint in?ammation, pain,
swelling, restriction of joint mobility thereby
affecting the basic function like sitting,
standing and walking, Knees are the most common
joints that are affected. Then, comes the hips,
small joints in the hands, and ankles. With
proper medical consultation and physiotherapy
these individuals can lead a pain free normal
life.
Rheumatoid arthritis is a condition with severe
joint in?ammation with remissions ad relapses.
The cause is unknown. It can start with any
joint. Usually this is symmetrical. Both the
knees will be affected and then both the ankles,
both the hands, both the elbows, both the
shoulders and then the spine will also be
affected. If not treated properly the joints can
result in crippling deformities. These patients
should consult a Rheumatologist periodically to
control the joint in?ammation with proper
medications along with a comprehensive
physiotherapy care.
Page 23
24
ARTHRITIS CAUSES AND SYMPTOMS
Page 22
25
Physiotherapy plays a vital role in the
management of arthritis. If there is a joint
swelling it is better to apply a soft gel type
ice pack wrapped over a thin cloth for 10 to 15
minutes. Any acute pain and swelling in the joint
will respond better to cold pack. This is
followed by gentle isometric exercises. For
example if there is a pain and swelling in the
knee, knee pressing exercises can be done by
keeping a turkey towel role under the knee. As
the pain and swelling comes down the exercises
can be progressed. In the case of sub-acute and
chronic joint pain, heat therapy is ideal.
Electric hot pack or hot water bag can be
applied at home after ?nishing the simple
exercises. Exercises should be done methodically.
When exercises are done methodically the muscles
in and around the arthritic joints will get
strengthened and improve the blood circulation
thereby do the repair process resulting in pain
reduction. The strong muscles will stabilize the
joints and improve the endurance too.
26
CARING FOR AN ALZHEIMER'S PATIENT
27
Caring For An Alzheimers Patient
  • Alzheimers disease is an illness of the brain.
    It is caused by a large number of brain cells
    dying which leads to loss of memory and the
    ability to think clearly. This often leads to
    the entire family getting affected and not just
    the patient. Since Alzheimers patient becomes
    forgetful and disoriented which gets worse as
    the disease progresses, it is often a close
    family member that steps in as the primary
    care-giver. Caring for an Alzheimers patient is
    hard because the family member also needs to
    deal with the personality changes that happen
    due to the disease and the dependency increases
    as the condition progresses.
  • The following points can help the primary
    caregiver to understand their loved one better
    and to care for them more ef?ciently
  • Maintaining a stable daily routine in a familiar
    environment can bring down the patients stress
    levels to a great extent
  • Keeping them amidst family members and reminding
    them about the past will be essential to keep
    them engaged with the present
  • Keeping the surrounding area free of fall risk
    will be critical to prevent falls and further
    complication
  • Nutritious food at regular time is essential for
    maintaining good health.
  • Caring for yourself is a necessity as it brings
    you relief. You could do this by taking
    assistance from friends, other family members,
    opting for partial/full home care assistance,
    getting exercise and eating well.

28
RISK OF FALL IN ELDERLY
29
Risk Of Fall In Elderly
  • An old woman aged 70 years fell on her face
    during early morning hours causing severe bruise
    and swelling in her cheek. When you assess this
    particular lady you gather so many pre-existing
    fall risk factors for her.
  • Apatient with rheumatoid arthritis for 25 years,
    taking psychiatric medications for many years,
    diabetic, post R breast removal cancer prevention
    medicines, thyroid medicine with inactivity
    resulted in muscle weakness, poor balance and
    giddy/dizzy/syncope spell due to multiple
    medicines. This is a perfect example of a few
    risk factors for falls in elderly.
  • Out of 1.27 billion people in India, 60 and over
    population contribute 7.7. Falls are the major
    problem and in medical terminology it is known as
    Geriatric Giants.
  • What are the reasons for the fall in elderly?
  • There are two main reasons. They are intrinsic
    factors and extrinsic factors.
  • 1. Intrinsic factors
  • 1 .Balance and Gait (ambulation)
  • Legs and spinal muscle weakness due to stroke,
    parkinsons, arthritis, neuropathy,
    neuro-muscular disorder, vestibular disorder etc.
  • Medications (Polypharmacy)
  • Taking more than 4 medicines and sedatives
    increases risk of fall.
  • a. Vision Visual impairment like glaucoma,
    macular degeneration, retinopathy, bifocals etc.
  • b. Visual motor reaction time is extended
  • Cognition Dementia, confusion etc.
  • Cardio-vascular causes
  • Orthostatic hypotension, carotid sinuses syndrome
    neuro-cardiogenic syndrome, cardiac arrhythmias,
    valvular disease etc.

30
  • 2. Extrinsic factors
  • Poor lighting
  • Stairs with inadequate handrails.
  • Rugs and ?oor surfaces with low friction.
  • Loose clothing
  • Poorly ?tting footwear
  • Lack of equipment (assistive devices) like
    walking sticks, walking frames, Zimmer frames,
    etc to assist them in ambulation
  • Consequences of fall
  • Black eyes and soft tissue injuries suggest that
    the faller was not conscious as they fall.
  • Fracture Dislocation 5 of falls end up having
    a fracture out of which 1 will be fracture neck
    of femur.
  • Disuse atrophy and muscle wasting during recovery
    period.
  • Long term bedridden patients develop pneumonia,
    pressure sores, dehydration and hypothermia.
  • Psychological Fear of falling falls under the
    Psychological category.
  • Interventions
  • Multi-disciplinary approach to assessment and
    treatment results in best outcome. Provisions of
    safety devises such as grab handles, high
    friction/non

31
FALL PREVENTION IN THE ELDERLY
32
Fall Prevention In The Elderly
  • Falls are one of the most common fears of the
    elderly. Although any one could fall, the chance
    of falling gets higher and the after-effects of
    the falls become more serious with age. Falling
    causes injury, loss of mobility and
  • even death. However, it is not something that
    should give you sleepless nights as these can be
    prevented, once you evaluate your personal risks
    for fall and learn about ways to overcome those.
  • Falls are common in the elderly age group because
    of normal changes related to aging such as poor
    balance, impaired vision, reduced mobility or
    side effects of medication. As we age, our
    reaction time to avoid hazardous situations
    declines as the nerves that conduct impulses from
    the brain to the muscles weaken with age.
  • By incorporating a few changes in your lifestyle,
    you can bring down the chances of falling quite
    drastically.
  • Here are some tips to get started upon
  • Exercise regularly It is important to keep
    moving as regular exercise keeps your muscles
    stronger and nerves more alert. Yoga and other
    forms of exercise like Tai-chi are often
    recommended for seniors as they focus on muscle
    strength and balance.
  • Check your vision Poor eyesight puts you at a
    high risk for falls. Plan to visit your
    Ophthalmologist for a vision check at least once
    a year. With age, the chance of developing
    glaucoma or cataract becomes quite high. This is
    more signi?cant if you have diabetes or
    hypertension.
  • Review your medication with your physician The
    changes in the different systems as people age,
    affect how the body is able to absorb, use and
    eliminate the excessive medication. The same
    medicines which you took earlier may have
    different effects with age. Some of them may
    cause excessive sleepiness or muscle weakness
    which again puts you at a risk for falling. So
    make it a point to discuss the medication you
    take, including the non-prescription ones, with
    your physician and understand their side-effects.

33
  1. Use Mobility Aids If you have problems with
    balance and coordination, your doctor will
    prescribe mobility aids like canes or walkers.
    These devices help you keep moving safely.
  2. Make your home safer Assess your homes for
    potential hazards and address them. Simple
    things like the way your furniture is arranged,
    avoiding use of rugs or mats on the ?oor, de
    cluttering the ?oor, making sure the path from
    the bedroom to bathroom is well lighted have a
    great effect on your safety within the house.

6. Enrol in a regular health assessment
program There are a few healthcare providers who
provide at home health assessment including
checking your immediate environment for potential
hazards and work with you to make your health
better and home safer. This helps in promoting
independent living
Who is India Home Health Care and how can we
help? India Home Health Care Pvt. Ltd. is a
leading at home health care provider based in
Chennai and Bangalore. We offer quarterly visits
by doctors and monthly or bimonthly visits by
Registered Nurses to assess the health status of
the elderly. We have developed a detailed health
assessment tailored to the Indian population.
Our Registered Nurses are trained professionals
with experience in hospital setups and are
therefore well equipped to handle any situation
at the patients home. Each visit is structured
to identify any changes in the health status, in
addition to reviewing the medication intake and
check the environment of the patients home to
assess the safety from a health perspective.
34
FALLS IN ELDERLY - PHYSIOTHERAPISTS PERSPECTIVE
35
Falls In Elderly- Physiotherapist Perspective
  • An 85 year old lady fell down while draping her 7
    year old Grand Daughter with a blanket and
    didnt have pain or discomfort in her body
    immediately. After couple of days she was having
    pain in her back for which she went for an
    orthopaedics consult followed by MRI which
    revealed multiple crush fracture in the lumbar
    and dorsal spine. She had complete rest with back
    brace for few weeks followed by comprehensive
    physiotherapy. Overall it took six months for
    her to recover from the day of fall and affected
    her quality of life especially to lead an active
    and independent life.
  • About one third of people over the age of 65 and
    almost half of people over the age of 80 will
    fall at least once a year. Doctors, Nurses, para-
    medical persons, family member ,and friend etc
    can identify fall risk person in their life and
    refer them to Physiotherapist for further
    management.
  • Physiotherapists can help reduce a persons risk
    of falling by
  • Assessing a persons risk of falling.
  • Helping his home as safe as possible.
  • Educating that person about the medical risk
    factors linked to fall
  • Designing individualized exercises and balance
    training.
  • Working with other health care professionals and
    community services to create programs for people
    who want to reduce their risk of falling.
  • Physiotherapist can do a thorough evaluation
    which includes
  • Areview of ones medical history
  • Areview of ones medication
  • Asimple vision test
  • Ahome safety assessment
  • Asimple screen of ones thinking abilities.

36
  • Assessment of any nervous system disorders such
    as stroke, Parkinson, etc
  • Measure ones leg strength using simple tests
    such as timing how long it takes you to rise
    from a chair.
  • Determine how quickly and steadily one can walk.
  • Assess ones balance for instance , by having
    one stand on one leg or rise from a chair and
    walk
  • Use special test to measure the balance
  • Based on the evaluation results, Physiotherapist
    will design an exercise and training program to
    improve ones balance and strength. Arecent
    systematic review of many published studies
    found that exercise based programs in the home
    or in group settings are effective in preventing
    falls. These programs are especially effective
    when balance exercises are performed in a
    standing position without using much arm
    support.
  • Balance Exercises
  • Balance training has been shown to be an
    important and effective part of falls
    prevention. Ones Physiotherapist will design
    exercises that challenge his ability to keep his
    balance including such
  • exercises as single leg standing
  • Walking and Moving
  • When people walk very slowly or unsteadily, they
    are at risk for falling.
  • His Physiotherapist can improve his walking
    ability by making him do such activities as
  • Dance steps
  • Walking in circles

37
  • Doing more than one thing at the same time safely
  • Older adults who have dif?culty walking and
    talking at the same time are at high risk of
    falling. To help increase their safety during
    activities ones Physiotherapist can design
    a,dual task, training program. This kind of
    training will challenge one to maintain a walking
    speed while he do another task such as counting
    backwards, engaging conversation or carrying a
    bag of groceries.
  • Strength Training
  • Strengthening exercises are a key element of fall
    prevention when they are done in conjunction
    with balance training. Ones Physiotherapist will
    design strengthening exercises that focus on his
    leg and the muscles used in maintaining posture.
  • Aerobic Training
  • Walking is one of the safest way of aerobic
    training. Physiotherapist will formulate walking
    program according to the patients capacity.
  • Education Fear Management
  • Physiotherapist will talk to the patient how best
    to manage his own risk of falling and to build
    his self esteem to overcome the fear of falling.
  • Community Program
  • Physiotherapist can participate with local groups
    in organizing different fall prevention
    activities at the community level like in the
    malls,
  • senior citizen centres, clubs etc.

38
THE ROLE OF NURSES IN THE ELDERLY FALL
PREVENTION CARE PLAN
39
The Role Of Nurses In The Elderly Fall
Prevention Care
  • ANurse has got a major role in preventing falls
    in Elderly population. From the time of
    admission to the hospital to the time of
    discharge she can categorize the patients in to
    low risk, moderate risk and high risk. From that
    category she can formulate a care plan to prevent
    fall in the hospital, at home and in the
    community.Falls can be due to multiple reasons.
  • Patients who take benzodiazepines, antipsychotic,
    diuretics, anti-depressants, narcoleptics,
    opioids, insulin, oral hypoglycaemic, anti
    -coagulants, cardiac and hypertensive will lead
    to disorientation, giddiness and fatigue.
  • Patients who have dementia, hip fracture,
    Parkinsonism, stroke, osteoporosis, arthritis
    and depression should not be left alone. Patients
    who have urinary and faecal incontinence need
    bladder and bowel habit retraining, diaper care
    to prevent rash/pressure sore.In addition
    patients who have visual impairment, functional
    disability and prior history of fall should have
    appropriate intervention to prevent further
    falls.
  • Nurse can initiate fall prevention care plan for
    the above mentioned patients as follows
  • Toileting needs To ask the patients every one to
    two hours whether he/she needs to use the
    bathroom, answer call light promptly, remind the
    patient to ask for assistance and reorient to
    call night if necessary, eliminate side rails
    and asses need for bedside commodes and
    individual toileting schedule and/or bowel and
    bladder training.
  • Sync opal Episodes To evaluate postural
    hypotension and/or cardiac arrhythmia and
    consult with physician, review medications with
    pharmacy consultant and physician, consider ?uid
    volume de?cit then evaluate intake and output,
    teach the patients to change the position slowly,
    especially from lying to sitting to standing,
    maximize the patients time out of bed as much
    as clinically possible to increase tolerance,
    keep the bed in the low position, assist with
    all transfers, consider use of TED hose and
    perform a
  • nutrition consultation.

40
  • Environmental hazards Eliminate potential
    hazards such as uneven surfaces, debris or water
    on the ?oor, keep the light and water within the
    reach, keep eyeglasses within reach and ensure
    adequate lighting .
  • Weakness/Unsteady gait Evaluate for possible
    therapeutic interventions, remind patients to
    request assistance, keep call light within reach,
    confer with rehabilitative services and the
    interdisciplinary team and assist the patient to
    obtain and wear appropriate, non-skid shoes.
  • Sensory/perception de?cits Frequently reorient
    the patient to the environment, keep furniture
    and other objects in the same position, evaluate
    presence and adequacy of glasses and hearing
    aids, assess the environment to maximize safety,
    consult with vision/hearing specialist as
    needed, refer to occupational therapy and
    consider a conference with rehabilitative
    services.
  • Knowledge de?cit Ensure assistive equipment is
    used appropriately, be sure the patient is
    comfortable with adaptive and assistive devices,
  • ensure the resident is able to use the call
    light. If the light is dif?cult to press,
    consider a foam pad call light or other adaptive
    call lights and ensure frequent visitors are
    aware of the use of assistive devices.
  • Once the care plan is formulated among the three
    categories (low risk, moderate risk and high
    risk) then appropriate staffs are delegated to
    perform the task. In all the categories the
    nurse should maintain the safe unit environment
    which includes removal of excess
    equipment/supplies/furniture from rooms and
    hallways, coil and secure excess electrical and
    telephone wire/cords, clean all spills in
    patient room or in the hallway immediately and
    place a signage to indicate wet ?oor danger.
  • For low risk individuals apart from maintaining
    above mentioned
  • safe unit environment the following safety
    interventions should be taken
  • Orient the patient to surroundings, including
    bathroom location, use of call light.
  • Keep bed in lowest position during use unless
    impractical (when doing a procedure on a
    patient)
  • Keep the top two side rails up.
  • Secure locks on beds, stretcher and wheelchair.

41
  • Keep ?oors clutter/obstacle free (especially the
    path between bed and bathroom/commode)
  • Place call light and frequently needed objects
    within patient reach.
  • Answer call light promptly
  • Encourage patient/family to call for assistance
    as needed.
  • Assure adequate lightening especially at night.
  • Use proper ?tting non-skid footwear.
  • For moderate risk individuals apart from
    maintaining safe environment as mentioned
    earlier and follow low risk intervention plus
  • institute ?agging system.
  • Institute Flagging system
  • Apply fall risk arm band
  • Falling star (yellow) outside the patients door
  • Falls risk sticker on the medical record and
    monitor and assist patient in following daily
    schedules
  • Supervise/assist bedside sitting, personal
    hygiene and toileting as appropriate.
  • Reorient confused patient as necessary.
  • Establish elimination schedule and use of bedside
    commode if appropriate.

42
  • For high risk individuals apart from maintaining
    safe environment
  • as mentioned previously follow low and moderate
    fall risk interventions plus institute ?agging
    system
  • Apply fall risk arm band.
  • Falling star (red) outside the patients door.
  • Falls risk sticker on the medical record.
  • Remain with patients while Toileting
  • Observe 6o minutes unless patient is on activated
    bed or chair alarm.
  • When necessary transport throughout hospital with
    assistance of staff or trained care givers.
    Consider bedside procedure.
  • Evaluate need for following measure going from
    less restrictive to more restrictive
  • Moving patient to room with best visual access to
    nursing station.
  • Activated bed/chair alarm
  • 24 hour supervision
  • Physical restraint only with authorized
    prescribed order
  • Once the patient is ready to go home the nurse
    should make a home safety assessment by
    following above mentioned guidelines and then
    transfer the patient to a safe home with proper
    caregiver if necessary. At community level the
    nurses can address the senior citizen group on
    fall prevention

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