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2015: Safety Issues in the Geriatric Environment of Care-Hysten


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Safety Issues in the Geriatric Environment of Care

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2015: Safety Issues in the Geriatric Environment of Care-Hysten

  1. 1. Safety Issues in the Geriatric Environment of Care Michaela Hysten, RN
  2. 2. Objectives  Recognize patients and environments at risk  Identify sources of safety issues to prevent and/or report  Discover ways of altering the environment to prevent unsafe events and situations  Outline the advantages of modifications in practice to accommodate geriatric changes
  3. 3. Definitions  Geriatrics – a branch of medicine that deals with the problems and diseases of aging people  Environment – the conditions that surround someone; the conditions and influences that affect the growth, health, progress, etc., of someone  Empathy – the action of understanding, being aware of, being sensitive to and vicariously experiencing the feelings, thoughts and experience of another  Dignity – the quality or state of being worthy, honored or esteemed Merriam-Webster Online, 2015
  4. 4. Effects of Aging  Physical effects  Visual problems  Diminshed Hearing  Decreased Sensation  Stiffness and decrease in dexterity  Cognitive decline  Psychological effects  Embarrassment  Fear  Depression  Pride  Social effects  Lonliness  Vulnerability
  5. 5. Environment of older patients  Home alone - 27% of surveyed elderly in San Diego  Lives with family or CG  Assisted Living or SNF  Homeless - 8,506 in San Diego County  26% of the unsheltered homeless in San Diego are over 54 years of age  4% of the unsheltered homeless in San Diego are over 65 years of age (San Diego County, 2014, p. 13-14); (SANDAG, 2012, p.C-7)
  6. 6. Home Safety Issues  Infestation/Sanitation  Insects  Rodents  Primary CG issues/neglect  Ambivalance  Physical, emotional, clinical neglect  Abuse  Physical, emotional, sexual  Neglect (including self-neglect), abandonment, isolation  Financial  Transitional care  Discharged with no primary caregiver  Polypharmacy with little understanding of medications  Unable to fully perform ADLs and IADLs (Health and Human Services, n.d.)
  7. 7. Role of the provider  Accommodations  Visual problems  Hearing problems  Decreased dexterity and sensation  Decrease flexibility  Recommendations and ideas  Practical  Preserve dignity  Express empathy
  8. 8. Case Studies  Patient #1  76 year old male arrives at his Primary Care visit disheveled, malodorous. He has a history of HTN, prostate cancer and chronic pain. The patient is being seen today for a worsening rash on his extremities. He uses hearing aids bilaterally, wears glasses and walks with a cane. While updating his face sheet, he does not provide an emergency contact, states that he is not married and estranged from his children.
  9. 9. Case Studies  Patient #2  65 year old male arrives at the community clinic via his own vehicle. He is being seen today for a follow-up appointment due to chronic health conditions which include CHF, HTN, DM and COPD. He presents with a productive cough, VS 187/90, 91, 20, 95%, 5/10 pain, and a blood sugar of 236. He was able to drive himself to the appointment and he has a cell phone. When updating his face sheet, he states his address as a PO Box.
  10. 10. Case Studies  Patient #3  91 year old female arrives in the ED via ambulance from her home. She has multiple bruises of varying ages. VS are 100/50, 99, 24, 95%, and complains of pain 8/10 in her left arm and shoulder. She is alert and oriented, but cannot give you a medical history and seems anxious and worried. Shortly after her arrival, her “grandson” arrives at bedside and answers all questions even though they are directed toward the patient.
  11. 11. Case Studies  Patient #4  89 year old female discharged from Telemetry after a 2 day stay for a change in level of consciousness (day one was in the step-down unit). She is discharged AMA because she wants to go home. She is alert and oriented, VS are 110/75, 85, 16, 99%, 0/10 pain. She has a history of CVA, DM, and syncopal episodes due to hypoglycemia. She walks with a cane and wears glasses. During her stay, she adjusts the TV so that it is directly in front of her. Upon discharge she states that although she normally drives herself around, she will have to take the bus home because she was brought to the hospital via ambulance.
  12. 12. References Health and Human Services (n.d.). Adult Protective Services. Retrieved from Merriam-Webster (2015). Retrieved from SANDAG (2012). Survey of Older Americans Living in San Diego. Retrieved from icans2003report.pdf San Diego County (2014). 2014 San Diego Regional Homeless Profile. Retrieved from