NURS 6540: Advanced Practice Care of Frail Elders | Week 5

According to the Centers for Disease Control and Prevention (2013), falls are the leading cause of injury and death among those 65 and older. As patients age, basic activities that were once a routine part of daily life become increasingly difficult, posing health risks. This was the case for 79-year-old Claire Broome. While simply putting on a pair of pants, she slipped on her hardwood floors. This unexpected fall caused her to fracture her hip (Cameron, 2011). For geriatric patients like Broome, fall prevention is an integral part of care, and many patient falls can be prevented. As an advanced practice nurse caring for this patient population, you must recognize factors that put patients at greater risk and provide the appropriate patient education.

This week you explore fall-risk assessment tools, practice guidelines, and strategies for preventing and reducing falls in geriatric patients. You also examine atypical presentations of disorders, including strategies to overcome the atypical presentations. NURS 6540:Week 5: Common Geriatric Syndromes – Falls

Learning Objectives

By the end of this week, students will:

• Evaluate the effectiveness of fall- risk assessment tools
• Analyze strategies to reduce the risk of falls for geriatric patients
• Apply key terms, concepts, and principles related to the common geriatric syndrome of falls
• Analyze atypical presentations of disorders in geriatric patients*
• Analyze strategies used to overcome atypical presentations of disorders in geriatric patients*

*This Learning Objective supports assignments that are assigned this week, but due in Week 8.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings – NURS 6540:Week 5: Common Geriatric Syndromes – Falls 

Resnick, B. (Ed.). (2016). Geriatric nursing review syllabus: A core curriculum in advanced practice geriatric nursing (5th ed.). New York, NY: American Geriatrics Society.

• • Chapter 34, “Falls” (pp. 259-263)

This chapter examines the prevalence and causes of falls in the older adult population. It also presents clinical guidelines for assessing, managing, treating, and preventing falls in older adults.

Holroyd-Leduc, J., & Reddy, M. (Eds.). (2012). Evidence-based geriatric medicine: A practical clinical guide. Hoboken, NJ: Blackwell Publishing.

• • Chapter 9, “A Balancing Act: Preventing and Treating Falls” (pp. 105–123)

This chapter identifies risk factors associated with falls in older adults. It also examines interventions for treating and preventing falls in order to improve outcomes for older adults.

Don’t miss underlying reason for elder’s fall: Perform a functional assessment. (2010). ED Nursing, 13(5), 58–59.

This article examines causes of falls in older adult patients and identifies methods for treating falls in older adults.

Panel on Prevention of Falls in Older Persons, American Geriatrics Society, and British Geriatrics Society. (2011). Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. Journal of the American Geriatrics Society, 59(1), 148–157.

This article presents guidelines for preventing falls in older adults. It also identifies recommendations for screening and assessing falls in older adults.

Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. Journal of the American Geriatrics Society, 59(1), Panel on Prevention of Falls in Older Persons, American Geriatrics Society, and British Geriatrics Society. Copyright 2011 by John Wiley & Sons, Inc. Journals. Reprinted by permission John Wiley & Sons, Inc. Journals via the Copyright Clearance Center.

Kanis, J. (n.d.). WHO Fracture Risk Assessment Tool. Retrieved August 4, 2014, from http://www.shef.ac.uk/FRAX/

This website provides the calculation tool for the fracture risk assessment. It also identifies risk factors that increase a patient’s susceptibility to fractures.

Discussion: Fall-Risk Assessment

Fall risks are very high for the geriatric population. According to the Centers for Disease Control and Prevention (2013), one out of every three adults aged 65 years and older falls each year. This can be attributed to factors such as changes in aging, other health issues, environment, and effects of prescribed drugs. When caring for geriatric patients, it is important to screen them for risks and perform fall-risk assessments. These assessment tools help to determine the level of risk for patients so that preventive measures can be taken. The implications of falls are very serious and range from fractures to mental health disorders and even death. In this Discussion, you explore risk assessment tools for use with patients at your practicum site.

To prepare:

• • Review the Kanis article in this week’s Learning Resources.
  • Consider a geriatric patient at your practicum site who is at risk for falls. Coordinate an opportunity to assess this patient with your Preceptor.

Note: When referring to your patient, make sure to use a pseudonym or other false form of identification. This is to ensure the privacy and protection of the patient.

• In addition to the Fracture Risk Assessment Tool (FRAX), select one of the following tools to assess this patient for falls:
  • Tinetti Performance Oriented Mobility Assessment (POMA)
  • Systems Approach
  • Berg Balance Scale
  • Elderly Mobility Scale
  • Timed Unsupported Stead Stand (TUSS)
  • Six-Minute Walk Test (6MWT)
  • Hendrich II Fall Risk Model
• Consider why you selected the assessment tool for this particular patient.
• Assess the patient using the tool you selected under Preceptor guidance. Reflect on the assessment, including any issues with the patient and/or the effectiveness of the tool.
• Think about strategies and interventions to reduce the risk of falls for frail elders.

By Day 3

Post a case study description of a geriatric patient from your practicum site who is at risk for falls. Describe this patient’s FRAX assessment. Then, describe the other assessment tool you used in the fall-risk assessment and explain why you selected the tool for this particular patient. Explain the patient assessment, including any issues with the patient and/or the effectiveness of the tool. Finally, explain strategies to reduce the risk of falls for your patient.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days in one or more of the ways listed below. Respond to colleagues who selected a different assessment tool than you did.

• Suggest alternative tools for assessing your colleagues’ patients.
• Recommend additional strategies to reduce the risk of falls for your colleagues’ patients.
• Share insights based on your own experience and additional literature search.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! NURS 6540:Week 5: Common Geriatric Syndromes – Falls 

 

 

ADDITIONAL INFORMATION 

Common Geriatric Syndromes – Falls

Introduction

Falls are one of the most common geriatric syndromes. Falls result in serious injury, disability, and death. Seniors who have had a fall may also have a higher risk of falling again. Falls are also associated with increased long-term care costs as well as increased use of nursing home beds and other health services.

Falls are one of the most common geriatric syndromes.

Falls are one of the most common geriatric syndromes. Falls are a leading cause of injury and hospitalization in older adults, and they’re also a common cause of death.

Falls increase with age, but they’re more common in women than men—and this may be due to the fact that older people have weaker muscles, which makes them more likely to fall over when they’re trying to stand up from sitting or lying down.

Falls can have serious consequences.

Falls are one of the most common causes of injury for older adults, and they can have serious consequences. A fall can result in broken bones, head injuries and even death. In fact, falls are the leading cause of fatal injuries for people over 65 years old.

The risk of falling increases with age:

• People over 65 are at least five times more likely to suffer a fall than someone who’s younger than 65 years old

• The risk is highest among those who have other health problems or disabilities (such as arthritis)

There are many potential causes of falls in older adults.

Falls are a common occurrence in older adults, and there are many potential causes. Some of the more common causes of falls include:

• Weakness or loss of balance due to aging or illness

• Loss of sensation (such as proprioception) due to injury or medication use

• Vision problems that interfere with walking safely through a doorway or down stairs (or stairs at all)

Some risk factors for falls are modifiable.

The risk of falls increases with age. The older you are, the greater your risk for falling.

However, there are some factors that can be modified to reduce your chances of falling:

• Being physically active and maintaining good balance can help prevent falls by strengthening muscles and improving coordination.

• Smoking may make you more likely to fall because it weakens the muscles that support balance and makes it harder for you to get up after a fall.

The best way to detect a fall risk is to do a fall risk assessment using standardized screening tools

There are several screening tools that can help you determine if your patient is at risk for falls. The most common of these are the Barthel Index, which measures general health and mobility, and the 10-item Fall Risk Assessment Tool (FRAX). These tools have been shown in research to be reliable across different populations and settings; however, they aren’t always easy for clinicians to use.

To conduct a standardized screening tool assessment on your patients with suspected geriatric syndromes:

• Collect data from all sources available about the patient’s health status (e.g., their medical records). Then ask them about symptoms associated with each syndrome listed below:

A physical therapy evaluation can help identify strengths and weaknesses that may be contributing to falls

Physical therapists can help identify risk factors for falls. They can also help develop a plan to reduce future falls by developing strategies to improve mobility, strength and balance or coordination. Physical therapists often work with people who have gait training (walking) exercises that are designed to strengthen muscle groups that support walking safely.

Physical therapists also use their knowledge of posture and gait patterns when evaluating patients’ balance as well as their ability to perform daily tasks at home. This may include setting up an individualized program that addresses any deficits in postural control while using adaptive equipment such as walkers or wheelchairs if necessary; these strategies will allow you to participate more fully in activities without incurring further injuries due to poor posture or impaired movement patterns

The patient can reduce the risk of falls by using assistive devices

While it’s certainly important for older adults to stay active, it is also critical that they use assistive devices and make sure they have their balance.

• Use a cane when walking long distances or if you have trouble walking at all. You can buy one online or from an office supply store in your area.

• If you need assistance getting around, consider using a walker or mobility scooter as well as a stair lift (if it fits your needs). The most common types include: Stair lifts — These come in either manual (manual) or electric models, depending on what kind of person you are and how often you’ll use them; both work by lifting one foot up while pushing down on it with another foot—making them easier than normal stairs because they don’t require stepping over each step separately! They’re also great for people who have difficulty bending over too much because no matter how much weight he/she puts on his/her knees while walking normally might cause pain later due to wearing out cartilage tissue over time.”

Falls can be prevented through a combination of risk assessment, medical care, and lifestyle adjustments.

Falls can be prevented through a combination of risk assessment, medical care, and lifestyle adjustments. The patient can reduce the risk of falls by using assistive devices (e.g., walker or cane), staying in good shape, making changes to their home environment (e.g., placing grab bars), and getting regular checkups with their doctor.

The physical therapist can help identify strengths and weaknesses that may be contributing to falls by asking questions about activities the person does most often at home—such as walking around the house or sitting down at meals—and conducting an evaluation using standardized assessments such as the Katz Scale for Functional Independence Measurement (KS-FIM).

Conclusion

Falls are one of the most common geriatric syndromes, but they can be easily prevented with a combination of risk assessment, medical care and lifestyle adjustments. If you suspect that your loved one has fallen, consult a physician immediately.