Prevention of Falls in the Hospitalized Elderly Patient - Book Report/Review Example

? Nursing Prevention of Falls in the Hospitalized Elderly Patient (College) Prevention of Falls in the Hospitalized Elderly Patient Introduction Falls in hospitalized elderly population has become a problem of serious concern in these days. There are many studies that look into the economic cost of falls, factors that trigger such falls, the steps that can be adopted to control the falls, the possibility of fall in different ethnographic groups, and successful prediction of the possibility of fall in elderly using various tools. Despite all these efforts over these years, estimates prove that still a significant number of elderly falls are reported in hospital settings. This work intends to look into the various works and studies on the reasons behind falls in hospitalized elderly population and various methods devised by various scholars to predict the possibility of falls and to control it. Thereafter, the study intends to propose a new, multifaceted approach based on the light of the analysis. Literature Review The economic cost and demography of falls Many scholars acknowledge the fact that elderly falls are a significant clinical issue and an outgrowing economic burden. For example, Sartini, Cristina, Spagnolo, Cremonesi, Costaguta, Monacelli, Garau & Odetti (2010) identified the fact that the average cost for fall-related hospitalization is Euro 5479.09. In addition an article that appeared in the US Newswire dated 13 March 2008 looks into the financial aspects of elderly fall. According to the revelation in the article, 35% of American people aged 65 and over fall every year. The study makes the alarming observation that about 16,000 elderly people died of fall between 1999 and 2005. In addition, the annual expenditure on treating the elderly for fall-related issues is calculated at more than $ 19 billion. Also, it is predicted that this amount would reach about $ 44 billion by the year 2020 (U.S Newswire, 13 March, 2008) The importance of devising a suitable strategy is clear. Another study by Mamun and Lim (2009) looked into demographic information, circumstances and time of fall, and medication use in a group of 298 hospitalized elderly patients who fell. The study found that the average age of the elderly people who fell was 75.8 years. In addition, more than 60% of them were males. Moreover, it was observed that most of the fallers had a history of fall. In other words, the ones who had a history of fall are more likely to fall again. Similarly, Gowans (2008) looked into the commonality of elderly falls and opined that 35% of the people above 70 will fall every year. In addition, there comes the opinion that females are twice as likely as men to have osteoporosis, and hence, to break a bone when fall. Thus, all these scholars consider elderly fall as an important issue that deserves attention. Causes of falls A look into literature proves that all researchers generally agree on the reasons behind falls in hospitalized elderly. Some common reasons found in the studies are the use of medication that affects the central nervous system, dementia, impaired vision, medication, environmental hazards, poor balance, poor cognition, and environmental hazards. A significant finding by Mamun & Lim (2009) was that elderly people who are on hypnotic drugs, cough medicine, and anti-platelets are at a higher risk of fall. Also, there is the conclusion that possibility of falls can be reduced through the timely use of analgesics like paracetamol to reduce pain. Similarly, the study by Nabeshima, Hagihara, Hayashi, Nabeshima, S & Okochi (2007) based on the theory that falling in elderly people is the result of the interaction of various risk factors identified various risk factor combinations that lead to fall in elderly people. It was identified in the study that a combination of risk factors like non-bedridden condition, dementia, and medication like tranquilizers or sleeping drugs is the most risky combination. Another significant study that looked into the reasons and solutions of elderly fall is the one by Tremblay and Barber (n.d.). The study too identifies the fact that the risks of falling increases as people grow older. According to them, the main reasons behind elderly fall are osteoporosis, lack of physical activity leading to decreased muscle tone and strength, impaired vision, medication, and environmental hazards. According to Sherrington, Lord, Close, Barraclough, Taylor, OaRourke, Kurrle, Tiedemann, Cumming & Herbert (2010) factors like male gender, prescription of medication targeting central nervous system, history of falls, difficulty in communication and cognition, and poor balance and mobility are highly indicative of a possible fall. At this juncture, it seems necessary to look into the various issues identified by the National Ageing and Research Institute in collaboration with Falls Risk for Hospitalized Older People (FRHOP) in a multidisciplinary assessment. The issues are delays in filling in parts of the assessment, confusion over the coordination of the assessment, and confusion over the implementation of intervention. Now, it becomes evident that these issues need to be considered while devising a new approach. Ways to prevent falls Vind, Anderson, Pederson, Joqensen & Schwarz, (2009) looked into the possibility of reducing falls through multifactorial fall prevention interventions. However, the study conducted among elderly Danish people proved that the multifactorial fall prevention program that included personal guidance, geriatric assessment, and physical exercise has little effect. However, another similar research by Salminen ,Vahlberg, Sihvonen, Piirtola, Isoaho, Aarnio, & Kivela (2008) through a 12 month multifactorial fall prevention program which included individual geriatric assessment, individual guidance on fall prevention, home hazards assessment, physical exercise in groups, lectures, psychosocial activity groups, and home exercises found that the isometric muscle strength of female participants significantly improved through the program though it was found that that males require more rigorous exercise. Gowans (2008) provides a number of suggestions to prevent falls. The first one is to improve ones balance through practice and balance exercises including Tai chi. The second suggestion is to raise muscle strength through weight-bearing exercises and resistance training. The third suggestion is to consume enough protein to keep muscle from going smaller and weaker. The next point is to ensure enough vitamin D that will help in increasing the number and size of muscle fibers in legs. Also, there is the suggestion that one should be aware of the effects of medicine they intake as some medicines are more likely to cause fall (Gowans, 2008). There are various tools that are developed over these years to screen risk factors and to assess the possibility of fall in elderly people. Some of them are TUG Test, St. Thomas Risk Assessment Tool, Falls Risk Assessment Tool, Fall Risk Assessment for Hospitalized Older People, Peter James Center Fall Risk Assessment Tool, Prevention of Falls in the Elderly Trial, Falls Assessment Proforma, and Predict _FIRST. However, the effectiveness of these tools varies greatly. A study by Milisen, Staelens, Schwendimann, De Paepe, Verhaeghe, Bares, Boonen, Pelemans, Kressig & Dejaeqer (2007) looked into the effectiveness of St. Thomas Risk Assessment Tool (STRATIFY) in predicting the possibility of fall in elderly inpatients. It was found in the study that STRATIFY fails to predict the risk of fall in the patients aged 75 and more. Similarly, another study by Wijnia, Ooms & Balan (2006) looked into the effectiveness of STRATIFY in predicting the possibility of fall in nursing home patients. This study too revealed that STRATIFY fails to reasonably predict the risk of fall. Based on the understanding that the existing fall risk assessment tools like SATRATIFY AND PJC-FRAT are not effective, Sherrington, Lord, Close, Barraclough, Taylor, OaRourke, Kurrle, Tiedemann, Cumming & Herbert (2010) started a new study intended to find out an effective tool for fall risk assessment. The study points out that the existing tools only classify individuals as ‘high risk’ or ‘low risk’ groups instead of looking at absolute possibilities of fall. The solution suggested by Tremblay and Barber (n.d.) to prevent osteoporosis is to ensure sufficient calcium intake, Vitamin D intake, and Protein intake. In addition, regular exercise, properly fitting dress, and shoes are also recommended. In the case of impaired vision, the suggestion is that one should ensure regular checkup by an ophthalmologist. Other points are using color and contrast to define balance-aiding objects, using color strips where there is a change in floor level, and regular cleaning of eye glasses to ensure maximum visibility. In order to prevent falls due to medication, it is suggested that the patient should be made well aware about the possible side effects of the medication. In the Critical Care Nursing Quarterly, Bonuel, Manjos, Lockett, and Bechnell (2011) claim that the approach that incorporated five principles elements; collaborative interdisciplinary practice, active leadership engagement, use of technology to support, carefully executed communication strategy and house-wide change witnessed considerably reduced elderly falls (Bonuel, Manjos, Lockett, and Bechnell, 2011). From the above analysis, it becomes evident that in order to implement a proper plan that effectively prevents the fall of hospitalized elderly people, it is necessary to absorb various points from the studies of various scholars. In other words, what is required is a multifaceted approach. How to prevent falls in the hospitalized elderly? The need of a multifaceted approach The first step, as evident from studies, is to utilize a Fall Risk Screening Tool that effectively identifies risk of fall. The factors that are usually obtained through assessment and that require management are impaired balance, reduced mobility, muscle weakness, lack of exercise, cognitive impairment, dress and footwear, dizziness, medication, impaired vision, and environment (Mamun & Lim, 2009; Nabeshima, Hagihara, Hayashi, Nabeshima, S & Okochi, 2007). To address the issue of reduced balance and power of legs (Nabeshima, Hagihara, Hayashi, Nabeshima, S & Okochi, 2007), patients should be made to exercise regularly (Salminen ,Vahlberg, Sihvonen, Piirtola, Isoaho, Aarnio, & Kivela, 2008). When weight training and resistance training are used as a part of exercise, they also help in improving muscle size and strength (Gowans, 2008). It is necessary to ensure that the patient gets adequate amounts of protein, vitamin D, and calcium. While vitamin and protein help improve muscle strength and size, calcium is necessary to reduce the weakening of bones (Tremblay and Barber (n.d.). The next work is to be done by the ophthalmologist as impaired vision is the reason behind falls in many cases. Eye problems of the elderly people including age-related problems should be addressed and maximum visibility should be ensured (Tremblay and Barber (n.d.). For the remaining part, a staff in the multi-disciplinary team should be engaged. The responsibility of that staff includes ensuring that the patient wears a dress that does not hinder movement, ensuring that the shoes of the patient do not cause balance-loss, regularly observing patient for any significant change in the health of the patient, and ensuring close observation if a patient shows high risk of fall by making necessary changes. The next responsibility of the staff is to monitor the medication taken by the patient (Bonuel, Manjos, Lockett, and Bechnell, 2011). There are more responsibilities vested in the coordinating staff. It is for the staff to see that the surroundings of the patient are kept risk-free. Factors like poor lighting, lack of balance-aiding objects, and un-sturdy furniture should be avoided to reduce the risk of fall and injury. Moreover, it is for this coordinating staff to see that the various members in the multi-disciplinary team perform their part of the task without delay (Bonuel, Manjos, Lockett, and Bechnell, 2011). In addition, it is the responsibility of the coordinating staff to see that the various intervention practices are done timely and appropriately. References Bonuel, N., Manjos, A., Lockett, L & Bechnell, T. G. (2011). Best practice fall prevention strategies. Critical Care Nursing Quarterly, 34, (2), 154. Gowans, A. (11 August 2008). “The third age; falls, fractures are very common with the elderly”, Columbia Daily Tribune. Milisen, K., Staelens, N., Schwendimann, R., De Paepe L., Verhaeghe, J., Bares, T., Boonen, S., Pelemans, W. Kressig, R. W & Dejaeqer, E. (2007). “Fall prediction in inpatients by bedside nurses using the St. Thomas Risk Assessment Tool in Falling Elderly Inpatients Instrument: A Multicenter Study”. Journal of the American Geriatrics Society, 55, (5), 725. Mamun K & Lim J. (2009). “Association between falls and high-risk medication use in hospitalized Asian elderly patients”. Geriatrics and Gerontology International, 9, (3), 276. 30 National organizations issue call to action for Congress to fully fund falls prevention programming in CDC budget. (March 13, 2008). U.S Newswire. Nabeshima, A., Hagihara, A., Hayashi, K., Nabeshima, S & Okochi, J. (2007). “Identifying interacting predictors of falling among hospitalized elderly in Japan: A signal detection approach”. Geriatrics and Gerontology International, 7, (2), 160 Sherrington, C., Lord, S. R., Close, J. C., Barraclough, E., Taylor, M., OaRourke, S., Kurrle, S., Tiedemann, A., Cumming, R. G & Herbert, R. D. (2010). “Development of a tool for prediction of falls in rehabilitation settings (Predict_FIRST): A prospective cohort study”. Journal Compilation Foundation of Rehabilitation Information. J Rahabil Med, 42, 482-488. Salminen M., Vahlberg, T., Sihvonen, S., Piirtola, M., Isoaho, R., Aarnio, P & Kivela, S. L. (2008). “Effects of risk-based multifactorial fall prevention program on maximal isometric muscle strength in community-dwelling aged: a randomized controlled trial”. Aging Clinical and Experimental Research, 20, (5), p. 487-493. Sartini, M, Cristina, M. L., Spagnolo, A. M., Cremonesi, P., Costaguta, C., Monacelli, F., Garau, J & Odetti, P. (2010). “The epidemiology of domestic injurious falls in a community dwelling elderly population: an outgrowing economic burden”. European Journal of Public Health, 20, (5), 604. Tremblay, K. R & Barber, C. E. “Preventing falls in the elderly”. Colorado State University. Retrieved from http://www.ext.colostate.edu/pubs/consumer/10242.html Vind, A. B., Anderson, H. E., Pederson, K. D., Joqensen, T & Schwarz, P. (2009). “ An outpatient multifactorial falls prevention intervention does not reduce falls in high-risk elderly Danes”. Journal of the American Geriatrics Society, 57, (6), 971. Wijnia, J. W., Ooms, M. E & Balan, R. V. (2006). “ Validity of the STRATIFY risk score of falls in nursing homes”. Preventive Medicine, 42, (2), 154-157. Read More