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 – Discussion: Fall-Risk Assessment Paper

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 – Discussion: Fall-Risk Assessment Paper

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 – Discussion: Fall-Risk Assessment Paper

ADDITIONAL INFORMATION;

Discuss common geriatric syndromes

Introduction

Geriatric syndromes are common among nursing home residents, but many of them are often misdiagnosed. The following list outlines some of the more common geriatric syndromes that you may encounter in your nursing home career:

Delirium

Delirium is a state of confusion and disorientation that occurs in the elderly, often as a result of an underlying medical condition. It is not dementia, which is characterized by memory loss along with other cognitive difficulties.

Signs and symptoms of delirium include:

• Hallucinations (seeing or hearing things that aren’t real)

• Confusion/disorientation (feeling like you’re lost)

• Aggression toward caregivers or others nearby if they try to help you calm down

Falls and Fear of Falling

There are many reasons why older adults may be afraid of falling, including:

• The fear of falling can lead to a cycle of fear and avoidance. If you’re fearful of falling, it’s likely that you’ll avoid certain situations or activities that would put you at risk for injury if you fell. The more often a person falls in these situations, the more their fears grow and they become dependent on them as an escape mechanism from their anxiety.

This cycle can be reversed by taking steps such as identifying triggers that bring on feelings like being nervous or dizzy when using stairs (for example), discussing them with your health care provider who can help provide strategies for managing those feelings while still enjoying life’s other pleasures like shopping at a mall!

Incontinence (UI)

Incontinence (UI) is a medical condition that occurs when a person cannot control urination and/or bowel movement. In some cases, it can be caused by a variety of factors including age, medications, or even incontinence surgery.

While there are many different types of incontinence treatment options available for patients who suffer from this condition, most people will benefit from some combination of medication and catheterization along with physical therapy. If you’re concerned about your ability to manage your urinary flow with these methods alone then talk to your doctor about other options like surgery or bladder retraining exercises.

Dementia

Dementia is a group of symptoms that include memory loss and difficulties with thinking, problem-solving or language. It’s not a disease, but rather a collection of symptoms.

The term “mild cognitive impairment” is often used interchangeably with the term “early dementia.” However, mild cognitive impairment refers specifically to a condition that’s more likely to improve than worsen over time.

Institutionalization

Institutionalization refers to the placement of an individual in a hospital or other institution. It can be caused by the environment, or by the people who live there.

Some common causes of institutionalization include:

• The lack of stimulation and interaction with others (including family members) that may lead to depression, loneliness and loss of identity

• Physical disabilities that make it difficult for them to leave their homes without assistance

Depression

Depression is a common mental health issue among the elderly. It occurs in about 15 percent of people who are age 65 and older, and it can be caused by physical illnesses or other factors such as memory loss or cognitive impairment. Depression can also be a symptom of Alzheimer’s disease (AD), which affects more than 5 million Americans over the age of 65 each year.

Depression is often treated with medication and/or therapy, but some people may benefit from additional treatment options, such as meditation therapy or mindfulness training both of which have been shown to improve mood significantly among those with mild levels of depression.

Nursing home residents are at increased risk for certain conditions, called geriatric syndromes.

Nursing home residents are at increased risk for certain conditions, called geriatric syndromes. These include:

• Delirium: A state of confusion and agitation characterized by an inability to focus on people, place and time. The delirious patient may have trouble distinguishing between real events and those imagined by him/herself or others.

• Fears of falling: Patients with dementia may have a strong fear that they will fall if left alone in their room or even if they move around freely in the facility; this can lead to increased anxiety when it comes to going out into public areas where there are stairs or ramps that lead up toward other floors within buildings such as elevators (elevator phobia).

• Incontinence: Many older adults who have physical disabilities struggle with incontinence issues due to weakening muscles around the pelvic area which causes urine leakage during bowel movements or sexual intercourse this can be extremely embarrassing for patients experiencing these types of problems because they don’t want anyone else finding out about them!

Conclusion

It is important for caregivers to be aware of the geriatric syndromes their loved ones are at risk for, so that they can provide the best possible care. This article has provided an overview of these conditions and how they may present in nursing home residents.