Chapter 12: Falls in Older Adults

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Chapter 12 Falls in Older Adults
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Learning Objectives

• Acknowledge the complex health and cost issues
  related to falls for older adults.
• Describe older adults with a predisposition for
  falls and falls with injury.
• Identify intrinsic and extrinsic risk factors for
  falls in older adults.
• Incorporate a patient-specific fall risk
  assessment into an individualized plan of care.
• Recognize medications associated with falls in
  older adults.
• Identify patients at risk for restraints.
• Discuss nonrestraint interventions to prevent
  falls.

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Falls in Older Adults

• Preventable
• Life threatening
• Not a normal consequence of aging
• Geriatric syndrome
• Frequency increases with age and frailty
• May be first indicator of acute problem
• May stem from chronic disease
• May be a marker for progression of age-related
  changes in vision, gait, strength

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Falls in the Hospital Setting

• Common problem for hospitalized older adults
• Up to 50 of hospitalized patients in the U.S.
  are at risk for falls of those, 50 are injured
• Most common adverse incident in hospitals 3-5
  falls per 1,000 bed days (about 1,000,000
  inpatient falls every year)
• Fall represent a national measure of quality and
  safety in the National Database of Nursing
  Quality Indicators (NDNQI).

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Falls in the Hospital Setting (contd)

• Implications of Falls
• 20-30 suffer moderate to severe injuries
• 10-20 suffer fractures
• Repeated falls lead to ADL and IADL deficits,
  high risk for further hospitalization,
  disability, institutionalization, and death
• Cost of fall injuries by 2020 expected to be
  54.9 billion

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Falls in the Hospital Setting (contd)

• Risk Factors (Table 12-1, p. 460)
• Intrinsic related to the patients physiology
  and physical changes. ex)cognitive/sensory
  impairments, impaired mobility, frailty, meds..
• Extrinsic related to the physical environment.
  Ex) stairs, poor lighting, restraints, cluttered
  environment, side rails, unsuitable footwear
• Fall Risk Assessment
• Tinetti Performance-Oriented Mobility Assessment
  (POMA)
• Timed Get Up and Go Test

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Falls in the Hospital Setting (contd)

• Fall Prevention and Safety Promotion Strategies
• Surveillance
• Nonrestraint fall prevention interventions
• Avoid Physical restraints and Chemical restraints

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Torso support
Leg restraint
Roll belt
Hand mitten
Soft belt
Seating restraint
Wheel chair positioner
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Falls in the Community Setting

• Risk Factors (p. 460)

Intrinsic Factors Extrinsic Factors
Age Gender Race Cognitive function Physical function Physical status Disease states Medications Environmental hazards Nonsupportive footwear Recent hospitalization Wheelchair use, reckless wheelchair use
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Falls in the Community Setting (contd)

• Fall Prevention and Safety Promotion Strategies
• Fall risk assessment
• Evaluate functional status ADLs, appropriate use
  of adaptive equipment such as canes or walkers,
  and fear of falling
• PT evaluation for safe footwear and adaptive
  devices
• OT evaluation for safe living environment loose
  cords, rugs, lighting

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Falls in the Community Setting

• Fall prevention (contd)
• Exercise programs Tai Chi
• Multifactorial intervention tailored to
  individual cognitive and physical ability
• Regular eye exams
• Postural hypotension or other cardiovascular
  conditions
• Calcium and Vitamin D

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Falls in the Community Setting (contd)

• Medications
• Beers Criteria identifies medications and doses
  that may be harmful to adults age 65
• Less is more Start low and go slow
• Regular medication review
• Discontinue unnecessary therapy
• Medications implicated in falls
• benzodiazepines, sedatives and hypnotics,
  antidepressants, antipsychotics (neuroleptics),
  antiarrhythmics, digoxin, diuretics, alcohol

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Falls in the Community Setting (contd)

• Modify the environment
• Small children, pets
• Minimize clutter
• Throw rugs
• Stairs
• Hand rails
• Check flooring
• Educate client and family
• Pressure-sensitive bed alsrms

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Falls in the Community Setting (contd)

• Community Resources for Fall Prevention
• Los Angeles Falls Prevention Coalition
• StopFalls Network California
• Centers for Disease Control
• National Institute on Health and Agings Age Page
  
• Hartford Institute for Geriatric Nursing
  guidelines

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Summary

• National healthcare organizations have tools and
  resources nurses can use to provide health care
  to older adults
• Fall risk assessment during routine care may help
  older adults maintain functional status and
  improve quality of life.
• Reducing falls lowers healthcare costs due to
  fewer emergency room visits and hospital stays.
• Environmental and multifactorial assessments and
  interventions can make the difference between
  safety and falling.

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Question

• If the nurse is assessing for extrinsic factors
  for falls, which of the following should be
  included?
• throw rugs
• ataxia
• cognition
• dizziness