Running head: SENIOR HEALTH PROMOTION PROJECT

Senior Health Promotion Project

Bon Secours Memorial College of Nursing
Nursing 4113: Gerontological Concepts and Issues
Browning Dailey
November 18, 2014

Running head: SENIOR HEALTH PROMOTION PROJECT

Senior Health Promotion Project
My client, J.D. is an 82 year old female who is widowed and lives at home with
her son and daughter in law who both work full time during the day. Her current health
conditions include osteoarthritis, rheumatoid arthritis, osteoporosis, spinal stenosis,
orthostatic hypotension, supraventricular tachycardia, and pulmonary hypertension. She
takes numerous medications daily including a benzodiazepine and a diuretic. J.D.
recently fell in her home on two separate occasions with resulting broken nose and
fractured hand. J.D has a walker for mobility assistance; she does not feel compelled to
use it when she is in her home. According to the assessment data collected, I felt the
client would benefit from fall prevention teaching.
Healthy People 2020 has developed specific objectives for older adults. Injury
prevention is a highlighted aspect of these objectives. According to statistics, one out of
every three older adults falls each year some resulting in disabilities such as fear related
to falling again, sedentary lifestyle, impaired function, and decreased quality of life
(healthypeople.gov). For people who are unable to rise or get help, falls can result in a
long lie of twelve hours or more which can affect recovery and include complications
such as hypothermia, pneumonia, and pressure ulcers (Barker, 2014). Unfortunately
many falls can also lead to death. Addressing risk factors for falls can help prevent
unintentional injuries in older people (healthypeople.gov).
My client has many factors involved in risks for falling; the main problem is her
inability to move with balance, coordination, and steady gait. I chose the following as a
nursing diagnosis; impaired physical mobility/risk for falls related to decreased strength
and balance and increased musculoskeletal discomfort as evidenced by impaired

Running head: SENIOR HEALTH PROMOTION PROJECT

coordination, unsteady gait, and limited ROM. J.D has chronic musculoskeletal pain
which has a lot to do with her inability to ambulate with ease. She is currently seeing a
physical therapist and a chiropractor to help her gain strength and balance and alleviate
some chronic pain. Short term outcomes for this client include her ability to identify the
factors that increase her potential for falls and the ability for her and her family members
to make the necessary changes to the environment to increase safety. These outcomes
ensure the client understands her risks and demonstrates her knowledge of how to create
a safe home for preventing falls (Ralph & Taylor, 2014). The ultimate long term outcome
for J.D. is to keep the environment safe and remain free from falls and injury indefinitely.
The client and family can periodically re-evaluate the environment, as a reminder they
may reference the materials provided in teaching to ensure safety.
The teaching plan for my client was developed mutually by myself and J.D.. The
best way for someone to learn is contingent on the subject matter being taught in a style
that they prefer (Berman, 2011). J.D. is both an audio and visual learner. We decided the
best thing to do would be to review written reference material together and then have her
explain out loud to me what she had just been taught and the relevance to her own
personal situation. We also decide it would be a good idea to involve her daughter in law
in the plan since she would be helping to execute changes in the environment such as
increasing lighting and removal of throw rugs, cords, and clutter.
On the second visit to my clients home, we began our teaching session on fall
prevention. J.D. enjoys socializing; therefore I made sure to block a lot of time to keep
the teaching session enjoyable as well as informative. I began by reviewing J.D.s
assessment data and explaining what her risk factors were for possible falls; chronic

Running head: SENIOR HEALTH PROMOTION PROJECT

musculoskeletal pain, unsteady gait, history of falls, shortness of breath from pulmonary
hypertension, and medications such as Ativan and Lasix. In return I had J.D explain to me
in her own words why those factors created a potential risk for her. I also explained that
evidence shows, people over the age of 65 are at greater risk for falls and if they have a
history of injurious falls like hers, they should have a follow up assessment to identify
and address risk factors (Barker, 2014). Once J.D. demonstrated a good knowledge of her
own risk factors, I presented her with a handout from stopfalls.org, providing simple
suggestions for reducing risks and creating a safe home environment. Interventions for
reducing falls should include, exercise, vision screening, review of medications, and
environmental enhancement (Barker, 2014). I included her daughter in law in the
discussion of enhancing the environment, making sure J.D. had adequate lighting, night
lights, clear pathways, no throw rugs, no visible cords, hand rails in bathrooms and on
stairs, and easy access to everyday items such as clothing and kitchen items. We decided
at the next visit, the house would be free of clutter and proper lighting would be in place.
Proper hand rails were already in place and there were no visible throw rugs or cords.
Next J.D. and I discussed the importance of continuing her physical therapy sessions and
use of her assistive devices including her walker and her cane. I emphasized sitting on the
side of her bed for a few minutes before rising in the mornings and wearing shoes with
firm non-skid soles. J.D. is up to date on her eye exams and has good eye sight. Last we
discussed a few of her medications; I cautioned her that Ativan could cause her to be
drowsy and extra caution should be taken when using this medication. I also talked to her
about taking her Lasix in the morning so she would not have to get up in the night and go
to the bathroom in the dark. Visual cues such as leaflets can help remind clients of their

Running head: SENIOR HEALTH PROMOTION PROJECT

risks and reduce misunderstanding of proper precautionary measures (Barker, 2014). I

thought it would be best to give the stopfalls.org handout to J.D. because it was
comparable to her level of education and she is a visual and auditory learner.
J.D. successfully achieved both short term outcomes. She was able to describe her
risk factors related to potential falls at the close of the teaching session. When I returned
to J.D.s house several days after our teaching session, her daughter in law had installed
proper lighting and cleared clutter from any pathways. The long term outcome for J.D. is
indefinitely to remain free from falls. J.D. and her family members were instructed to
frequently evaluate the environment for possible hazards using the stopfalls.org handout
as a guide. She will continue to go to physical therapy, get annual eye exams, and use her
assistive devices. All of the outcomes for J.D. are related to primary prevention because
they are seeking to prevent an occurrence of falling and injury.
I feel that my teaching was fairly effective because J.D. achieved both short term
outcomes and she and her family seemed to take it seriously. They were fearful of another
falling incident occurring and motivated to learn. In the beginning J.D. said, I dont
think I need to use that walker in the house. By the third day, she was more on board
with using her assistive devices. She said, I dont want to end up in the hospital because
I didnt use my walker, thats just silly. I dont like being away from home. To revise the
project, I would take two days to get the assessments done, it took nearly four hours and
my client was pretty tired by the end. Also, since she was a visual and auditory learner, it
might have been good to find a video to play for her as a teaching tool.
All in all I felt good in the nurse-teacher role with J.D. She was a great client to
assess and teach because she showed me a great deal of respect as a nurse. She was also

Running head: SENIOR HEALTH PROMOTION PROJECT

motivated and ready to learn how to improve her quality of life and prevent injury from
occurring. I realized from this experience how important it is to take your time and be
thorough with elderly clients in order to give the best therapeutic nursing care and make
the greatest impact with teaching.

Running head: SENIOR HEALTH PROMOTION PROJECT

References
Barker,W. (2014). Assessment and prevention of falls in older people. Nursing Older
People, 26(6), 18-24

Healthy People 2020. Older Adults. Objectives: Retrieved from:Healthypeople.gov

http://www.healthypeople.gov/2020/topics-objectives/topic/older-adults/objectives
Ralph, S. S., & Taylor, C. M. (2014). Sparks and Taylor's nursing diagnosis reference
manual (9th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health.