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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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Question Is the following statement true or
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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Bathroom Innovations
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Bathroom Innovations
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Bathroom Innovations
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Bathroom Innovations
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Bathroom Innovations
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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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Transportation & Safe Driving
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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Transportation & Safe Driving
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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Question Is the following statement true or
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