Keeping older adults safe at home

Edelman, MaryAnn MS, RN, CNS; Ficorelli, Carmel T. MSN, RN, FNP

Fall risks add up

About one of every three older adults who lives in the community falls once
every year. Falls are the primary cause of injury-related deaths in this
population, and many of these deaths occur after months of medical care
and treatment.
Many older adults have sensory impairments, including impaired hearing and
vision, that contribute to fall risk. Their ability to adjust to night vision is
decreased, and they need up to three times the amount of light that younger
adults need to see well.
Older adults may experience altered depth perception that can put them at
risk for falls. Functional limitations that impede their mobility and ability to
engage in activities of daily living also increase the risk of falls and may
ultimately contribute to placement in a long-term-care facility.

Assessing older adults

Optimal nursing care can help keep older adults on their feet and in their
own homes. A comprehensive nursing assessment can minimize their risks
for injury, hospitalization, or long-term-care placement.
Conducting a focused geriatric assessment as part of the standard
assessment can also improve older adults' quality of life and keep them as
independent as possible for as long as possible.
Best practices for fall risk assessment include the Hendrich II fall risk model
(which includes the get up and go test), the Katz Index of Independence in
Activities of Daily Living, and the Housing Enabler (in home settings). These
assessment tools involve obtaining a thorough health history (including
chronic diseases, elimination patterns, and medications) and physical
assessment, including mental status and gait. The Hendrich II fall risk model
considers being male an independent risk factor for falls.
Falls may be related to conditions in the home that can be classified as
unsafe. Identify actual and potential safety risks both inside and outside the
home for patients living independently in the community, such as scatter
rugs that don't have slip-resistant backing and garden hoses that stretch
over walkways. The Housing Enabler Rating consist of three parts: a
descriptive part (for example, mobility aids and diagnoses); an assessment
form for functional limitations (such as severe loss of sight or hearing,
incoordination) and dependence on mobility aids such as wheelchairs; and

an assessment form for environmental barriers such as narrow paths (less

than 1.3 m wide), and irregular or unstable walking surfaces.

Intervene effectively
After completing the home safety evaluation, follow up with patient-specific
interventions to help older adults address modifiable risk factors and stay
safe. For instance, all rooms should be clutter-free and brightly lit. Teach
patients to wear shoes with nonskid soles.
To help keep older adults independent and relieve some stress on caregivers
and family, consider recommending a medical alert system. These systems
immediately notify caregivers or family members of a fall. Some medical
alert systems have features such as an auto-alert that automatically
notifies emergency services if a fall is detected.
Educate patients about their medications and make sure they understand
the importance of telling all healthcare personnel, including pharmacists, all
of their prescribed medications.

Other concerns
A supportive environment encourages physical and mental activity and social
interaction. These activities may help slow cognitive, physical, social,
affective, and functional decline.
Physical activities such as walking, aquatic exercise, or tai chi reduce the risk
of falls by improving strength, balance, coordination, and flexibility. If the
patient can't or won't perform these exercises independently, the healthcare
provider may refer him or her to a physical therapist.
Whether the patient's living situation is safe depends on many factors,
including the ability to use the telephone, travel safely outside the home,
and safely take medication. The availability of family or neighbors to provide
social or financial support is also a consideration.
As always, individualize decisions about how to balance safety and
independence based on each patient's unique situation. Planning ahead is
the key to helping older adults live their lives to the fullest.

Assessing older adults for fall risk

Assess your older adult patients for fall risk factors that are intrinsic, such as:
* advanced age, especially age greater than 75
* a fall in the recent past
* coexisting conditions that are associated with falls, including dementia,
depression, hip fracture, arthritis, type 2 diabetes, Parkinson disease, and
osteoporosis
* a functional disability or impaired gait, balance, or vision
* use of an assistive device or a physical restraint
* altered level of consciousness or impaired cognition
* use of medications associated with a high risk of falls, such as alprazolam
and amitriptyline
* use of medications associated with a high risk of injury from a fall, including
anticoagulants such as aspirin, warfarin, or clopidogrel
* urge incontinence
* use of inappropriate footwear or lack of footwear.
Routinely assess and document the patient's environment for fall risk factors
that are extrinsic, then take corrective actions. Make sure that:
* floors are dry and level
* lights, including night lights, are bright enough and functional
* furniture, such as tables and beds, are sturdy and in good repair
* grab rails and grab bars are placed appropriately in the bathroom
* adaptive aids work properly and are in good repair
* bed rails used for transitioning or support are sturdy
* patients' clothing doesn't cause them to trip
* I.V. poles used for support while ambulating are sturdy
* I.V. tubing doesn't cause the patient to trip.

Taking medications safely

Give your patients these tips to help them stay safe:
* Make a list of all the medicines you take, including over-the-counter
products and dietary supplements. Show it to all of your healthcare
providers. Keep one copy in your medicine cabinet and one in your wallet or
pocketbook. The list should include the name of each medicine, healthcare
provider who prescribed it, reason it was prescribed, amount you take, and
time(s) you take it.

* Read and save in one place all written information that comes with the
medicine.
* Take your medicine in the exact amount and at the time prescribed.
* Call your healthcare provider right away if you have any problems with
your medicine or if you're worried that it might be doing more harm than
good.
* Use a memory aid to take your medicines on time. Some people use meals
or bedtime as reminders to take their medicine. Other people use charts,
calendars, and weekly pillboxes. Find a system that works for you.
* Don't skip doses of medication or take half doses to save money. Talk with
your healthcare provider or pharmacist if you can't afford the prescribed
medicine. There may be less costly choices or special programs to help with
the cost of certain drugs.
* Avoid mixing alcohol and medicine.
* Take your medicine until it's finished or until your healthcare provider says
it's okay to stop.
* Don't take medicines prescribed for another person or give yours to
someone else.
* Don't take medicine in the dark.
* Check the expiration dates on your medicine bottles. Your pharmacist can
probably tell you how to safely get rid of medicine you no longer need or
that's out of date. The pharmacist might be able to dispose of it for you.
* Make sure you store all medicines and supplements out of sight and out of
reach of children. Don't take your medicines in front of young children.

Summary
This article entitled Keeping older adults safe at home discusses the risks
and reasons why older adults are prone to falls that could lead to injuries.
This article also said that decrease in sensory perception impaired hearing
and vision could lead to fall. Their ability to adjust to night vision is
decreased, and they need up to three times the amount of light that younger
adults need to see well.
This article on the other hand provided information about assessing older
adults at home so that precautionary and safety measures could be initiated
for the elderly at home. It included The Housing Enabler Rating for consist of
three parts: a descriptive part (for example, mobility aids and diagnoses); an
assessment form for functional limitations (such as severe loss of sight or
hearing, incoordination) and dependence on mobility aids such as
wheelchairs; and an assessment form for environmental barriers such as
narrow paths (less than 1.3 m wide), and irregular or unstable walking
surfaces.
After completing the home safety evaluation, follow up with patient-specific
interventions to help older adults address modifiable risk factors and stay
safe. For instance, all rooms should be clutter-free and brightly lit. Teach
patients to wear shoes with nonskid soles.
To help keep older adults independent and relieve some stress on caregivers
and family, consider recommending a medical alert system. These systems
immediately notify caregivers or family members of a fall. Some medical

alert systems have features such as an auto-alert that automatically

notifies emergency services if a fall is detected.
This article also included that elderly needs exercise to strengthen their
muscle strength in order for them to perform ADLs may it be independently
or with minimal assistance and could reduce risk of falls.

Reaction
I could relate to this article that is written by Mary Ann Edelman because one
of my patient at the orthopedic ward is also a geriatric patient. She sustained
an injury after a fall at their home. This article discussed that sensory
impairment is one of the reasons why elderly are at risk for falls. And this is
really true because my client has cataract and she claimed that she already
has blurry vision that is why sometimes she is having difficulty in seeing
objects and understanding the depth of an object.
Assisting and always being there for our elderly loved ones is really
important since they are already having difficulty in doing things on their
own. Im not saying that we will do the things for them that they do on a
daily basis but as a future nurse, we should let them do these things to
promote independence but we must make sure that they are in a safe
environment to prevent accidents such as falls.