This document discusses safety issues in the geriatric environment of care. It recognizes that the aging process can impact patients physically, cognitively, and psychologically in ways that increase safety risks. Environments like the home, assisted living, nursing facilities and homeless shelters present unique risks. The role of healthcare providers is to accommodate age-related changes, recommend safety modifications, and preserve patient dignity. Case studies demonstrate how safety risks appear in individual patients and the importance of assessing living situations and support systems.

1. Safety Issues in the Geriatric Environment of Care
Michaela Hysten, RN

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. 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. 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. 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. 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. Role of the provider
 Accommodations
 Visual problems
 Hearing problems
 Decreased dexterity and sensation
 Decrease flexibility
 Recommendations and ideas
 Practical
 Preserve dignity
 Express empathy

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. 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. 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. 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. References
Health and Human Services (n.d.). Adult Protective Services. Retrieved from
http://www.sandiegocounty.gov/hhsa/programs/ais/adult_protective_services/
Merriam-Webster (2015). Retrieved from http://www.merriam-webster.com
SANDAG (2012). Survey of Older Americans Living in San Diego. Retrieved from
http://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/ais/documents/surveyofolderamer
icans2003report.pdf
San Diego County (2014). 2014 San Diego Regional Homeless Profile. Retrieved from
http://www.rtfhsd.org/wp/wp-content/uploads/2014/10/RHP-2014_FINAL_9-25-141.pdf