Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Safety & Falls
NURS 4100 Care of the Older Adult
Spring 2014
Joy A. Shepard, PhD(c), MSN, RN, CNE, BC
1
Objectives







Describe the effects of aging on safety
Discuss the significance of the environment
to physical and ...
Objectives









Identify hazards in the home and ways to
minimize them
Discuss factors that contribute to falls,
...
Introduction




Older persons: same hazards as other
adults
Risks compounded by:






Age-related factors
Increase...
Aging Risks to Safety








Accidents 6th leading cause of death in
older adults
Older women: higher rate of injurie...
High Risk of Infections in
Older Adult Population


Age-related changes










Altered antigen-antibody response...
Question








Because illness in older adults is complicated by
the normal changes of aging and multiple
chronic ...
Safety Risks Involving
Medication Use in the Elderly







Altered pharmacokinetics
Self-administration problems
Hig...
Question










Medications act differently in older adults than in
younger adults for all of the following reaso...
Question




Is the following statement true or false?
Altered pharmacokinetics, selfadministration of drugs, and the hi...
Importance of Environment to
Health and Wellness






Microenvironment: Immediate surroundings
Macroenvironment: Elem...
Maslow’s Hierarchy of Needs

12
Safe Environment

13
13
Impact of Aging on Environmental
Safety and Function
Limitations posed by chronic disease:
special environmental problems ...
Factors Affected by Lighting
Function
 Orientation
 Mood
 Behavior


15
Using Lighting to Promote
Safety








Several diffuse lighting sources
No fluorescent lighting
Control bright lig...
Several Diffuse Lighting Sources

17
Temperature and the Older
Adult








Body temperature: tactile sensitivity,
vigilance performance, and psychomotor
...
Question




Is the following statement true or
false?
Room temperatures less than 70°F
can lead to hypothermia in an ol...
Risks Associated With
Carpeting









Static electricity
and cling
Difficult wheelchair
mobility
Cleaning
Odors
P...
Furniture


Furnishings:
Appealing
 Functional
 Comfortable




Appropriate
furniture
21
Falls

22
Falls & the Older Person








Falls: major health problem for
older adults in all settings
Leading cause of injury ...
Falls: Serious Problem










Serious problem  need for ongoing
prevention
Main cause of injury in the home
Most...
How Big is the Problem?


Annually: 1/3 adults age 65 and older sustain serious falls













Leading cause...
Falls: Outcomes


20-30%: bruises, hip fx, or head traumas






Most common cause of traumatic brain
injuries (TBI)
...
Fractures: Age-Related,
Serious Consequence of Falls


Most common fall-related injuries




Risk sustaining a hip fx i...
Risk Factors for Falls
(Box 17-2, p. 215)


Most falls occur near beds, bathrooms, & hallways. Some
of the most common re...
Fall Risk Assessment
Prevention begins with assessment
 Commonly used fall risk instruments
in acute/ long-term care
 Fa...
30
Fall Risk Reduction
Interventions (p. 217)


Prevention of falls in the clinical setting is
one of the key goals of geron...
How Can Older Adults
Prevent Falls? (p. 217)










Exercise regularly
Functional footwear (rubber-soled, low-he...
33
Home Safety

34
Falls: Environmental Hazards






Falls occur most frequently at home
One-third of falls: hazards in the home
Most co...
Injury Prevention Tips


Conduct walk-through of home




Identify possible fall hazards

Nurse home visit
Identify ris...
Outdoors








Cracks/ uneven
edges
Handrails
High doorway
thresholds
Shrubbery
Walk areas clear of
clutter





...
All Living Spaces











Color change: changes in
surface types, levels
Nonskid tape: rugs, carpet
edges
No thro...
All Living Spaces








Electrical outlets
Reduce clutter
Lighting: adequate illumination, control glare
Nightlig...
Kitchen
Commonly used items
within easy reach
 Sturdy step stool
 Appliance cords out of
way
 No floor polish or wax; w...
Living, Dining & Family Rooms
Electrical & telephone cords out of
way
 Furniture: easy to move around
(especially low cof...
Bedroom


Bedside light

Switch easy to
turn on/off
 Touch lamp





Nightlight
 Telephone within
reach of bed



Be...
Stairways, Hallways & Pathways
Clutter-free
 Carpet: secured
 NO throw/ scatter rugs!
 Tightly fastened hand rails for ...
Stairways, Hallways & Pathways
Brightly colored
tape (red,
orange) to steps
 Stair dimensions:
7.2” riser heights,
11-12”...
Bathrooms









Small light on at all
times
Lever-shaped faucet
handles
Grab bars/ safety
rails: strong enough
to ...
Bathroom Innovations

46
Bathroom Innovations

47
Bathroom Innovations

48
Bathroom Innovations

49
Bathroom Innovations

50
Bathroom Innovations

51
Bathroom Innovations

52
Bathrooms







Portable, hand-held
shower head
Bath/ shower seat
Raised toilet seat
Nonskid mats or carpet
Minimal ...
Hand-Held Shower Head;
Bath Seat and Nonskid Mat

54
Raised Toilet Sheet With
Arms

55
Automobile Safety

56
Transportation & Safe Driving


Driving: important IADL




Lack of accessible transportation:







Essential to...
Transportation & Safe Driving




Giving up driving: many negative
ramifications
Factors related to safe driving for old...
Transportation & Safe Driving


Assessment of functional capacity:
Slower response/ reaction times
 Slower movement
 Po...
Loss of Driving Privileges






Decision to give up driver’s
license
 Feelings of isolation
 Lonely, anxious
“Indivi...
Action Strategies
for Driving Cessation (Negative)


Imposed








Report person to division of motor vehicles for
...
Action Strategies
for Driving Cessation (Positive)


Involved










Family members and individual come to mutual...
Safe Driving Tips (Elderly)









Drive on familiar roads & streets
Wear seat belt
Avoid heavy, fast-moving tra...
Avoid Heavy Fast-Moving
Traffic…

64
Avoid Left-Hand Turns

65
Avoid Driving at Night

66
Avoid Driving in Inclement
Weather…

67
Safe Driving Tips (Everyone)









Avoid distractions (especially cell phone)
Follow 4-second rule
Obey traffic ...
Question




Is the following statement true or false?
Rather than cease driving altogether,
some older adults may find ...
Situational Stressors & Safety

70
Effects of Changing
Life Situations






Change is usually stressful, regardless of
whether change is perceived as pos...
Influences of Changing Health and
Disability on Safety and Security


Vulnerability to Natural
Disasters






Older p...
73
Assistive Technology

74
Advantages/ Role of Assistive
Technology


Maintain
independence






Decreased need for
personal care
Promote functi...
Common Applications Assistive
Technology


Position and Mobility




Environmental Access




Walkers, canes, motoriz...
Nursing Diagnoses

77
Nursing Diagnoses (pp. 206-7)








Risk for Injury
Risk for Infection
Activity Intolerance
Sensory/ Perceptual A...
Upcoming SlideShare
Loading in …5
×

Safety & falls spring 2014 abridged

648 views

Published on

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

Safety & falls spring 2014 abridged

  1. 1. Safety & Falls NURS 4100 Care of the Older Adult Spring 2014 Joy A. Shepard, PhD(c), MSN, RN, CNE, BC 1
  2. 2. Objectives     Describe the effects of aging on safety Discuss the significance of the environment to physical and psychological health and wellbeing List the impact of age-related changes on the function and safety of the environment Describe adjustments that can be made to the environment to promote safety and function of older persons 2
  3. 3. Objectives      Identify hazards in the home and ways to minimize them Discuss factors that contribute to falls, consequences of falls, and ways to prevent falls in the older adult List ways to promote safe driving in older adults Explore the unique challenges of natural disasters to the older adult population Discuss assistive technology 3
  4. 4. Introduction   Older persons: same hazards as other adults Risks compounded by:     Age-related factors Increased vulnerability Nursing assessment: review of safety risks Interventions: address threats to safety 4
  5. 5. Aging Risks to Safety     Accidents 6th leading cause of death in older adults Older women: higher rate of injuries than any other adult female age group Death rate highest for 85+ age group (p. 206) Falls are most common cause of injury/ death in seniors 5
  6. 6. High Risk of Infections in Older Adult Population  Age-related changes       Altered antigen-antibody response High prevalence of chronic disease Atypical symptomatology: delayed dx of infection and higher rate of mortality Greater incidence nosocomial infections Pneumonia & influenza: 7th leading cause of death in older adults (Table 1-3, p. 9) Hand hygiene, sanitation, vaccinations   Influenza – annually Pneumonia – every 5 yrs 6
  7. 7. Question       Because illness in older adults is complicated by the normal changes of aging and multiple chronic conditions, many older adults do not display the usual signs and symptoms of illness. Atypical presentation of illness in older adults includes all of the following EXCEPT: (A) Anorexia (B) Cough (C) Confusion (D) Falls (E) Incontinence 7
  8. 8. Safety Risks Involving Medication Use in the Elderly      Altered pharmacokinetics Self-administration problems High volume of drugs used with older adults (polypharmacy) Risk for adverse effects and accidents Higher rate of hospital admission related to inappropriate drug administration 8
  9. 9. Question       Medications act differently in older adults than in younger adults for all of the following reasons EXCEPT: (A) Older persons tend to have increased total body fat and decreased lean mass (B) Older persons tend to have increased body water and decreased total body fat (C) The kidneys become less efficient with age (D) The liver decreases in size and function with age (E) The gastrointestinal system slows with age 9
  10. 10. Question   Is the following statement true or false? Altered pharmacokinetics, selfadministration of drugs, and the high volume of drugs consumed by older adults can lead to increased risks to safety. 10
  11. 11. Importance of Environment to Health and Wellness     Microenvironment: Immediate surroundings Macroenvironment: Elements in larger world Environment – continued development, stimulation, and satisfaction to enhance well-being Environmental needs and Maslow’s theory (lower-level needs must be met first) 11
  12. 12. Maslow’s Hierarchy of Needs 12
  13. 13. Safe Environment 13 13
  14. 14. Impact of Aging on Environmental Safety and Function Limitations posed by chronic disease: special environmental problems for older adults (Table 17-2, p. 208)  Older adults: safe, functional, comfortable, personal, and normalizing environment to compensate for limitations  14
  15. 15. Factors Affected by Lighting Function  Orientation  Mood  Behavior  15
  16. 16. Using Lighting to Promote Safety       Several diffuse lighting sources No fluorescent lighting Control bright lights and direct sunlight (glare) Nightlights: promote visibility & orientation Keep charged flashlight at bedside Natural light: maintain body rhythms 16
  17. 17. Several Diffuse Lighting Sources 17
  18. 18. Temperature and the Older Adult     Body temperature: tactile sensitivity, vigilance performance, and psychomotor tasks Older adults: lower than normal body temperatures Maintain adequate environmental temperature Recommended room temperature: 75°F 18
  19. 19. Question   Is the following statement true or false? Room temperatures less than 70°F can lead to hypothermia in an older adult. 19
  20. 20. Risks Associated With Carpeting       Static electricity and cling Difficult wheelchair mobility Cleaning Odors Pests Falls 20
  21. 21. Furniture  Furnishings: Appealing  Functional  Comfortable   Appropriate furniture 21
  22. 22. Falls 22
  23. 23. Falls & the Older Person     Falls: major health problem for older adults in all settings Leading cause of injury deaths for people 65 and older Most frequent reason for trauma admissions among the elderly Major cause of disability and a major cost 23
  24. 24. Falls: Serious Problem       Serious problem  need for ongoing prevention Main cause of injury in the home Most falls occur in home during normal routines Serious implications for older person Leading cause of accidental death in US (for older adults) Deaths from falls increase with age 24
  25. 25. How Big is the Problem?  Annually: 1/3 adults age 65 and older sustain serious falls          Leading cause of injury deaths Most common cause of nonfatal injuries Hospital admissions for trauma Deaths, emergency room visits, hospitalizations 20% of hospital and 40% of nursing home admissions related to falls $20 billion annually Projected > $34 billion (2020) Rates of fall-related deaths among older adults rose significantly over the past decade. http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html 25
  26. 26. Falls: Outcomes  20-30%: bruises, hip fx, or head traumas     Most common cause of traumatic brain injuries (TBI)    Injuries can make it hard to get around Limit independent living Increase the risk of early death TBI accounts for 50% of fatal falls among older adults. Majority of fx in elderly caused by falls Fear of falling – limit activity http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html 26
  27. 27. Fractures: Age-Related, Serious Consequence of Falls  Most common fall-related injuries   Risk sustaining a hip fx increases with age    Osteoporotic fx of hip, spine, and forearm (wrist) A person ≥ 85 yrs 10 times more likely to sustain hip fx Hip fx: greatest number of deaths After hip fx     20% of older people die within 1 yr 25% remain in institution for at least 1 yr Many never return home Only 33% regain prefracture functional level 27
  28. 28. Risk Factors for Falls (Box 17-2, p. 215)  Most falls occur near beds, bathrooms, & hallways. Some of the most common reasons for falls in the hospital are:         Fall history (at least one previous fall) Age Mental status: confusion, disorientation Sensory deficits (poor eyesight, hearing) Impaired ability to walk and move, weakness, poor coordination Effects of medications: such as sedatives, tranquilizers, and pain medication (benzodiazepines, psychotropics, opioids, anticholinergics) Special toileting needs: urgency of urinating, diarrhea Unsafe clothing (improper footwear, long robes or pants legs); clutter 28
  29. 29. Fall Risk Assessment Prevention begins with assessment  Commonly used fall risk instruments in acute/ long-term care  Fall Assessment Tool  Hendrick II  29
  30. 30. 30
  31. 31. Fall Risk Reduction Interventions (p. 217)  Prevention of falls in the clinical setting is one of the key goals of gerontological nursing practice***   Recognize older persons who are at risk for falling Identify and correct fall risk factors       Improve balance, gait, and mobility Improve functional independence Environmental modifications Medication review Evaluate outcomes Revise plan as needed 31
  32. 32. How Can Older Adults Prevent Falls? (p. 217)        Exercise regularly Functional footwear (rubber-soled, low-heeled shoes; no floppy slippers or slick socks) Avoid clothing that drags on the ground Remove hazards that can lead to falls Improve lighting in the home Review medications–both prescription & OTC– to reduce side effects and interactions Check vision at least once a year 32
  33. 33. 33
  34. 34. Home Safety 34
  35. 35. Falls: Environmental Hazards     Falls occur most frequently at home One-third of falls: hazards in the home Most common hazard for falls: tripping over objects on floor Other factors: poor lighting, loose rugs, no grab bars, poorly located/mounted grab bars, & unsturdy furniture 35
  36. 36. Injury Prevention Tips  Conduct walk-through of home   Identify possible fall hazards Nurse home visit Identify risk factors  Recommend appropriate actions  Home Safety Tips & Tools Home Inspection P.1 Home Inspection P.2 36
  37. 37. Outdoors      Cracks/ uneven edges Handrails High doorway thresholds Shrubbery Walk areas clear of clutter   Walk areas clear of snow & ice Adequate lighting 37
  38. 38. All Living Spaces       Color change: changes in surface types, levels Nonskid tape: rugs, carpet edges No throw rugs No oversized furniture & objects Phone extension at each level of home Emergency numbers 38
  39. 39. All Living Spaces        Electrical outlets Reduce clutter Lighting: adequate illumination, control glare Nightlights/ motion-sensitive lighting throughout home. Contrast Working smoke alarms – every floor Electronic emergency response system (e.g., Lifeline Medical Alert) Installing Smoke Alarms in Your Home 39
  40. 40. Kitchen Commonly used items within easy reach  Sturdy step stool  Appliance cords out of way  No floor polish or wax; wet floors  40
  41. 41. Living, Dining & Family Rooms Electrical & telephone cords out of way  Furniture: easy to move around (especially low coffee tables)  Chairs & couches: easy to get in/ out  No caster wheels on furniture  Television remote control & cordless phone  41
  42. 42. Bedroom  Bedside light Switch easy to turn on/off  Touch lamp   Nightlight  Telephone within reach of bed  Bed height: easy to get in/out Firm chair with arms  42
  43. 43. Stairways, Hallways & Pathways Clutter-free  Carpet: secured  NO throw/ scatter rugs!  Tightly fastened hand rails for stairs  Entire length  Both sides   Handrails: 34” high; diameter 1.5” 43
  44. 44. Stairways, Hallways & Pathways Brightly colored tape (red, orange) to steps  Stair dimensions: 7.2” riser heights, 11-12” tread width    Adequate lighting Light switches: each end 44
  45. 45. Bathrooms      Small light on at all times Lever-shaped faucet handles Grab bars/ safety rails: strong enough to hold weight Walls around tub Liquid soap dispenser   Floor surface free of clutter Nonslip surfaces    Nonskid mats Appliqués bathtubs Shower or bath seat 45
  46. 46. Bathroom Innovations 46
  47. 47. Bathroom Innovations 47
  48. 48. Bathroom Innovations 48
  49. 49. Bathroom Innovations 49
  50. 50. Bathroom Innovations 50
  51. 51. Bathroom Innovations 51
  52. 52. Bathroom Innovations 52
  53. 53. Bathrooms      Portable, hand-held shower head Bath/ shower seat Raised toilet seat Nonskid mats or carpet Minimal electrical appliances 53
  54. 54. Hand-Held Shower Head; Bath Seat and Nonskid Mat 54
  55. 55. Raised Toilet Sheet With Arms 55
  56. 56. Automobile Safety 56
  57. 57. Transportation & Safe Driving  Driving: important IADL   Lack of accessible transportation:      Essential to obtaining necessary resources Social withdrawal Poor nutrition Neglect of health care MVC and elderly Tragic case of George Russell Weller 57
  58. 58. Transportation & Safe Driving   Giving up driving: many negative ramifications Factors related to safe driving for older adults:     Age-related changes in driving skills Vision changes Cognitive impairment Medical illnesses/ functional impairments 58
  59. 59. Transportation & Safe Driving  Assessment of functional capacity: Slower response/ reaction times  Slower movement  Poor coordination  Poor judgment  Denial or lack of awareness  59
  60. 60. Loss of Driving Privileges    Decision to give up driver’s license  Feelings of isolation  Lonely, anxious “Individuals may not be licensed if they suffer from a mental or physical problem that might keep them from driving safely” (NCDOT) http://www.ncdot.org/dmv/driver_services/drivingpublic/applying.html#Ste p%204 60
  61. 61. Action Strategies for Driving Cessation (Negative)  Imposed     Report person to division of motor vehicles for possible license suspension Use of deception or threats such as false keys, disabling the car, saying car was stolen Attempts to order or control, such as provider writing a prescription Commands from children to stop driving 61
  62. 62. Action Strategies for Driving Cessation (Positive)  Involved      Family members and individual come to mutual agreement Dialogue ongoing from earliest signs of cognitive impairment Arrangements made for alternative transportation when needed & acceptable to individual Any abrupt change in an older person’s behavior (such as nearly running into a lamp post with a car) should be evaluated by his or her health care professional Giving up keys 62
  63. 63. Safe Driving Tips (Elderly)         Drive on familiar roads & streets Wear seat belt Avoid heavy, fast-moving traffic Drive short distances Keep eyes on road Avoid driving at night Avoid left-hand turns Avoid driving in poor weather (heavy rain, ice, snow) 63
  64. 64. Avoid Heavy Fast-Moving Traffic… 64
  65. 65. Avoid Left-Hand Turns 65
  66. 66. Avoid Driving at Night 66
  67. 67. Avoid Driving in Inclement Weather… 67
  68. 68. Safe Driving Tips (Everyone)        Avoid distractions (especially cell phone) Follow 4-second rule Obey traffic & motor vehicle laws, signs, signals Adjust speed to road/ weather conditions Expect the unexpected Always drive defensively Driving safely 68
  69. 69. Question   Is the following statement true or false? Rather than cease driving altogether, some older adults may find it useful to restrict their driving to daylight hours, noncongested areas, and good weather 69
  70. 70. Situational Stressors & Safety 70
  71. 71. Effects of Changing Life Situations    Change is usually stressful, regardless of whether change is perceived as positive or negative Changing life situations for older adults can affect safety and security by posing unfamiliar routes, routines, and persons in the environment Clients with dementia    Routine and familiarity very important Too much change – confusing and disorienting Stress of coping with sudden or significant change can make symptoms worse 71
  72. 72. Influences of Changing Health and Disability on Safety and Security  Vulnerability to Natural Disasters    Older people: great risk during/ after disasters Disaster planning to support older people Older people:   Less likely to seek help Not as much assistance 72
  73. 73. 73
  74. 74. Assistive Technology 74
  75. 75. Advantages/ Role of Assistive Technology  Maintain independence    Decreased need for personal care Promote function and adaptation Increase QOL  Ability to live safely at home Smart House Monitors Senior Safety 75
  76. 76. Common Applications Assistive Technology  Position and Mobility   Environmental Access   Walkers, canes, motorized chairs, mobility devices, straps Modifications to buildings, increased accessibility, Braille Environmental controls  Switches that control the surroundings such as touching a switch for lights, TV, phone, opening doors via mouthstick or key pad 76
  77. 77. Nursing Diagnoses 77
  78. 78. Nursing Diagnoses (pp. 206-7)        Risk for Injury Risk for Infection Activity Intolerance Sensory/ Perceptual Alterations Ineffective Tissue Perfusion Deficient Knowledge Ineffective Management of Therapeutic Regimen 78

×