Safety & falls spring 2014 abridged

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Safety & Falls

NURS 4100 Care of the Older Adult Spring 2014Joy A. Shepard, PhD(c), MSN, RN, CNE, BC

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Objectives Describe the effects of aging on safety Discuss the significance of the

environment to physical and psychological health and well-being

List the impact of age-related changes on the function and safety of the environment

Describe adjustments that can be made to the environment to promote safety and function of older persons

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Objectives Identify hazards in the home and ways to

minimize them Discuss factors that contribute to falls,

consequences of falls, and ways to prevent falls in the older adult

List ways to promote safe driving in older adults

Explore the unique challenges of natural disasters to the older adult population

Discuss assistive technology

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Introduction Older persons: same hazards as other

adults Risks compounded by:

Age-related factors Increased vulnerability

Nursing assessment: review of safety risks

Interventions: address threats to safety

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Aging Risks to Safety Accidents 6th leading cause of death in

older adults Older women: higher rate of injuries

than any other adult female age group Death rate highest for 85+ age group

(p. 206) Falls are most common cause of injury/

death in seniors

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High Risk of Infections in Older Adult Population

Age-related changes Altered antigen-antibody response High prevalence of chronic disease Atypical symptomatology: delayed dx of infection

and higher rate of mortality Greater incidence nosocomial infections

Pneumonia & influenza: 7th leading cause of death in older adults (Table 1-3, p. 9)

Hand hygiene, sanitation, vaccinations Influenza – annually Pneumonia – every 5 yrs

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Question Because illness in older adults is

complicated by the normal changes of aging and multiple chronic conditions, many older adults do not display the usual signs and symptoms of illness. Atypical presentation of illness in older adults includes all of the following EXCEPT:

(A) Anorexia (B) Cough (C) Confusion (D) Falls (E) Incontinence

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Safety Risks Involving Medication Use in the Elderly

Altered pharmacokinetics Self-administration problems High volume of drugs used with older

adults (polypharmacy) Risk for adverse effects and accidents Higher rate of hospital admission

related to inappropriate drug administration

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Question Medications act differently in older adults

than in younger adults for all of the following reasons EXCEPT:

(A) Older persons tend to have increased total body fat and decreased lean mass

(B) Older persons tend to have increased body water and decreased total body fat

(C) The kidneys become less efficient with age (D) The liver decreases in size and function with

age (E) The gastrointestinal system slows with age

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Question Is the following statement true or

false?

Altered pharmacokinetics, self-administration of drugs, and the high volume of drugs consumed by older adults can lead to increased risks to safety.

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Importance of Environment to Health and Wellness

Microenvironment: Immediate surroundings Macroenvironment: Elements in larger

world Environment – continued development,

stimulation, and satisfaction to enhance well-being

Environmental needs and Maslow’s theory (lower-level needs must be met first)

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Maslow’s Hierarchy of Needs

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Safe Environment

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Impact of Aging on Environmental Safety and Function

Limitations posed by chronic disease: special environmental problems for older adults (Table 17-2, p. 208)

Older adults: safe, functional, comfortable, personal, and normalizing environment to compensate for limitations

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Factors Affected by Lighting

Function Orientation Mood Behavior

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Using Lighting to Promote Safety

Several diffuse lighting sources No fluorescent lighting Control bright lights and direct sunlight

(glare) Nightlights: promote visibility &

orientation Keep charged flashlight at bedside Natural light: maintain body rhythms

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Several Diffuse Lighting Sources

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Temperature and the Older Adult

Body temperature: tactile sensitivity, vigilance performance, and psychomotor tasks

Older adults: lower than normal body temperatures

Maintain adequate environmental temperature

Recommended room temperature: 75°F

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false?

Room temperatures less than 70°F can lead to hypothermia in an older adult.

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Risks Associated With Carpeting

Static electricity and cling

Difficult wheelchair mobility

Cleaning Odors Pests Falls

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Furniture

Furnishings: Appealing Functional Comfortable

Appropriate furniture

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Falls

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Falls & the Older Person Falls: major health problem for

older adults in all settings Leading cause of injury deaths

for people 65 and older Most frequent reason for

trauma admissions among the elderly

Major cause of disability and a major cost

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Falls: Serious Problem Serious problem need for ongoing

prevention Main cause of injury in the home Most falls occur in home during normal

routines Serious implications for older person Leading cause of accidental death in

US (for older adults) Deaths from falls increase with age

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How Big is the Problem? Annually: 1/3 adults age 65 and older sustain serious falls

Leading cause of injury deaths Most common cause of nonfatal injuries Hospital admissions for trauma

Deaths, emergency room visits, hospitalizations 20% of hospital and 40% of nursing home admissions

related to falls $20 billion annually Projected > $34 billion (2020) Rates of fall-related deaths among older adults rose

significantly over the past decade. http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html

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Falls: Outcomes 20-30%: bruises, hip fx, or head traumas

Injuries can make it hard to get around Limit independent living Increase the risk of early death

Most common cause of traumatic brain injuries (TBI) TBI accounts for 50% of fatal falls among older

adults. Majority of fx in elderly caused by falls Fear of falling – limit activity

http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html

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Fractures: Age-Related, Serious Consequence of Falls

Most common fall-related injuries Osteoporotic fx of hip, spine, and forearm (wrist)

Risk sustaining a hip fx increases with age A person 85 yrs 10 times more likely to sustain hip

fx Hip fx: greatest number of deaths After hip fx

20% of older people die within 1 yr 25% remain in institution for at least 1 yr Many never return home Only 33% regain prefracture functional level

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Risk Factors for Falls (Box 17-2, p. 215)

Most falls occur near beds, bathrooms, & hallways. Some of the most common reasons for falls in the hospital are:

Fall history (at least one previous fall) Age Mental status: confusion, disorientation Sensory deficits (poor eyesight, hearing) Impaired ability to walk and move, weakness, poor

coordination Effects of medications: such as sedatives, tranquilizers, and

pain medication (benzodiazepines, psychotropics, opioids, anticholinergics)

Special toileting needs: urgency of urinating, diarrhea Unsafe clothing (improper footwear, long robes or pants

legs); clutter

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Fall Risk Assessment Prevention begins with

assessment Commonly used fall risk

instruments in acute/ long-term care Fall Assessment Tool Hendrick II

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Fall Risk Reduction Interventions (p. 217)

Prevention of falls in the clinical setting is one of the key goals of gerontological nursing practice*** Recognize older persons who are at risk for falling Identify and correct fall risk factors

Improve balance, gait, and mobility Improve functional independence Environmental modifications Medication review

Evaluate outcomes Revise plan as needed

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How Can Older Adults Prevent Falls? (p. 217)

Exercise regularly Functional footwear (rubber-soled, low-heeled

shoes; no floppy slippers or slick socks) Avoid clothing that drags on the ground Remove hazards that can lead to falls Improve lighting in the home Review medications–both prescription & OTC–

to reduce side effects and interactions Check vision at least once a year

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Home Safety

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Falls: Environmental Hazards

Falls occur most frequently at home One-third of falls: hazards in the home Most common hazard for falls: tripping

over objects on floor Other factors: poor lighting, loose rugs,

no grab bars, poorly located/mounted grab bars, & unsturdy furniture

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Injury Prevention Tips Conduct walk-through of home

Identify possible fall hazards Nurse home visit

Identify risk factors Recommend appropriate actionsHome Safety Tips & Tools Home Inspection P.1Home Inspection P.2

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Outdoors Cracks/ uneven

edges Handrails High doorway

thresholds Shrubbery Walk areas clear

of clutter

Walk areas clear of snow & ice

Adequate lighting

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All Living Spaces Color change: changes in

surface types, levels Nonskid tape: rugs, carpet

edges No throw rugs No oversized furniture &

objects Phone extension at each

level of home Emergency numbers

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All Living Spaces Electrical outlets Reduce clutter Lighting: adequate illumination, control glare Nightlights/ motion-sensitive lighting throughout

home. Contrast Working smoke alarms – every floor Electronic emergency response system (e.g.,

Lifeline Medical Alert) Installing Smoke Alarms in Your Home

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Kitchen Commonly used items

within easy reach Sturdy step stool Appliance cords out of

way No floor polish or wax;

wet floors

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Living, Dining & Family Rooms

Electrical & telephone cords out of way

Furniture: easy to move around (especially low coffee tables)

Chairs & couches: easy to get in/ out No caster wheels on furniture Television remote control & cordless

phone

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Bedroom Bedside light

Switch easy to turn on/off

Touch lamp Nightlight Telephone

within reach of bed

Bed height: easy to get in/out

Firm chair with arms

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Stairways, Hallways & Pathways

Clutter-free Carpet: secured NO throw/ scatter rugs! Tightly fastened hand rails for stairs

Entire length Both sides

Handrails: 34” high; diameter 1.5”

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Stairways, Hallways & Pathways

Brightly colored tape (red, orange) to steps

Stair dimensions: 7.2” riser heights, 11-12” tread width

Adequate lighting

Light switches: each end

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Bathrooms Small light on at all

times Lever-shaped

faucet handles Grab bars/ safety

rails: strong enough to hold weight

Walls around tub Liquid soap

dispenser

Floor surface free of clutter Nonslip surfaces

Nonskid mats Appliqués bathtubs

Shower or bath seat

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Bathroom Innovations

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Bathrooms Portable, hand-held

shower head Bath/ shower seat Raised toilet seat Nonskid mats or carpet Minimal electrical

appliances

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Hand-Held Shower Head; Bath Seat and Nonskid Mat

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Raised Toilet Sheet With Arms

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Automobile Safety

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Transportation & Safe Driving

Driving: important IADL Essential to obtaining necessary

resources Lack of accessible transportation:

Social withdrawal Poor nutrition Neglect of health care

MVC and elderly Tragic case of George Russell Weller

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Giving up driving: many negative ramifications

Factors related to safe driving for older adults: Age-related changes in driving skills Vision changes Cognitive impairment Medical illnesses/ functional impairments

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Assessment of functional capacity: Slower response/ reaction times Slower movement Poor coordination Poor judgment Denial or lack of awareness

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Loss of Driving Privileges Decision to give up

driver’s license Feelings of isolation Lonely, anxious

“Individuals may not be licensed if they suffer from a mental or physical problem that might keep them from driving safely” (NCDOT)

http://www.ncdot.org/dmv/driver_services/drivingpublic/applying.html#Step%204

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Action Strategies for Driving Cessation (Negative)

Imposed Report person to division of motor

vehicles for possible license suspension Use of deception or threats such as false

keys, disabling the car, saying car was stolen

Attempts to order or control, such as provider writing a prescription

Commands from children to stop driving

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Action Strategies for Driving Cessation (Positive)

Involved Family members and individual come to mutual

agreement Dialogue ongoing from earliest signs of cognitive

impairment Arrangements made for alternative transportation

when needed & acceptable to individual Any abrupt change in an older person’s behavior

(such as nearly running into a lamp post with a car) should be evaluated by his or her health care professional

Giving up keys

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Safe Driving Tips (Elderly) Drive on familiar roads & streets Wear seat belt Avoid heavy, fast-moving traffic Drive short distances Keep eyes on road Avoid driving at night Avoid left-hand turns Avoid driving in poor weather (heavy rain,

ice, snow)

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Avoid Heavy Fast-Moving Traffic…

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Avoid Left-Hand Turns

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Avoid Driving at Night

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Avoid Driving in Inclement Weather…

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Safe Driving Tips (Everyone)

Avoid distractions (especially cell phone) Follow 4-second rule Obey traffic & motor vehicle laws, signs,

signals Adjust speed to road/ weather

conditions Expect the unexpected Always drive defensively Driving safely

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false?

Rather than cease driving altogether, some older adults may find it useful to restrict their driving to daylight hours, noncongested areas, and good weather

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Situational Stressors & Safety

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Effects of ChangingLife Situations

Change is usually stressful, regardless of whether change is perceived as positive or negative

Changing life situations for older adults can affect safety and security by posing unfamiliar routes, routines, and persons in the environment

Clients with dementia Routine and familiarity very important Too much change – confusing and disorienting Stress of coping with sudden or significant change

can make symptoms worse

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Influences of Changing Health and Disability on Safety and Security

Vulnerability to Natural Disasters Older people: great

risk during/ after disasters

Disaster planning to support older people

Older people: Less likely to seek

help Not as much

assistance

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Assistive Technology

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Advantages/ Role of Assistive Technology

Maintain independence Decreased need

for personal care Promote function

and adaptation Increase QOL

Ability to live safely at home

Smart House Monitors Senior Safety

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Common Applications Assistive Technology

Position and Mobility Walkers, canes, motorized chairs, mobility

devices, straps Environmental Access

Modifications to buildings, increased accessibility, Braille

Environmental controls Switches that control the surroundings such as

touching a switch for lights, TV, phone, opening doors via mouthstick or key pad

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Nursing Diagnoses

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Nursing Diagnoses (pp. 206-7)

Risk for Injury Risk for Infection Activity Intolerance Sensory/ Perceptual Alterations Ineffective Tissue Perfusion Deficient Knowledge Ineffective Management of Therapeutic

Regimen

Health & Medicine

Safety & falls spring 2014 abridged