Chapter 15 –  Falls & Fall Risk Reduction.
Chapter 16 –  Promoting Safety.

Question(s): Technological advances hold promises for improving quality of life, decreasing need for personal care assistance, and enhancing independence and ability to live safely. Choose one of the technologies mentioned in your textbook and discuss / explain it. Please, support your answer with a research study: Is there any research study of technological innovation related with your topic that promises advantages in the future of healthcare? 

Guidelines: The answer should be based on the knowledge obtained from reading the book, no just your opinion. If there are 3 questions in the discussion, you must answer all of them. Your grade will be an average of all answers. 

Grading Criteria: Student chose 1 technology for the book (25%) and discussed it (30%). Students support his / her answer with a research study (45%).

Chapter 16
Promoting Safety
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Must be multifaceted and individualized to the areas of identified risks
Particularly important for older adults who are at risk for falls and is recommended in evidence-based protocols for fall risk reduction
Home Safety Assessment
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Exposed to temperature extremes in dwellings can impose a serious risk to older persons with declining physical health
Older individuals are vulnerable to environmental temperatures
Thermoregulation
Hyperthermia
Hypothermia
Environmental Temperatures
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Influenced by
Neurosensory changes
Medications
Economic, behavioral, and environmental factors
Diminished thermoregulatory responses and abnormalities in production and response to pyrogens contribute to differences in fever responses between older and younger patients
Thermoregulation
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Body temperature increases above normal ranges because of environmental or metabolic heat loads
Risk factors
Administration of diuretics
Low fluid intake
Those with cardiovascular disease, diabetes, or peripheral vascular disease
Certain medications
Hyperthermia
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Core temperature of less than 35°C (95°F)
Affects all body systems but most concern for cardiac and respiratory function
Older adults at risk for numerous reasons
Cardiac, respiratory, and musculoskeletal impairments
Excessive alcohol use
Poor nutrition
Inadequate housing
Certain medications
Surgery
Hypothermia
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Recognize clinical signs and severity of hypothermia and hyperthermia
Keep frail elders in environments with appropriate temperatures for comfort and prevention of problems
Monitor body temperature and pay particular attention to lower or higher than normal readings
Advocate for community resources
Implications for Gerontological Nursing and Healthy Aging
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Which patient assessment data does the nurse recognize could contribute to an older adult’s risk of hyperthermia?
Has a history of osteoarthritis
Takes furosemide 40 mg daily
Bathes daily with a hot shower
Keeps room temperature at 72°F
Question
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B—Patients receiving diuretic therapy have a higher risk of hyperthermia.
Answer
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Older adults are at great risk during and after disasters and have the highest casualty rate during disaster events
Older adults are vulnerable to natural disasters because of
Limited mobility
Social isolation
Cognitive impairment
Institutionalization
Natural Disasters
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Critical link in the ability to remain independent and functional
Lack of accessible transportation may contribute to social withdrawal, poor nutrition, depressive symptoms, and health decline
With age, the risk for impairments that affect driving skills increases because of disease-related and normal aging changes

Transportation Safety
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Assessment should include evaluation of whether an individual can drive, feels safe driving, and has a driver’s license
There is no gold standard for determining driving competency
Driving evaluations are offered by various community agencies
Implications for Gerontological Nursing and Healthy Aging
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Hold promise for improving quality of life, decreasing the need for personal care, and enhancing independence
Assistive technology is any device or system that allows a person to perform a task independently, easier, and safer
Gerotechnology describes assistive technologies for older people
Emerging Safety Technologies
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Use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration
Includes
Remote monitoring devices
Smart medical homes
Telehealth
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Advancements improve the quality of life, decrease need for personal care, and enhance the ability to live independently
Telemedicine allows for managing medical problems in the home or other settings, thereby reducing health care costs
Devices are available to monitor gait and to detect balance problems
Emerging Technologies
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Can lead to enhanced health and well-being
Components include
Addresses basic needs
Optimizes physical health and well-being
Maximizes independence
Provides social and civic engagement
Elder-Friendly Communities
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A nurse counseling an 85-year-old person regarding modifying driving habits would include
playing music will help keep you alert.
limit driving to familiar places close to home.
driving in heavy traffic is fine as long as it is not raining.
if you have a passenger, you may drive at any time of the day.
Question
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B—Encourage older adults to modify their driving habits, such as not driving on unfamiliar roads, during rush hour, at dusk or at night, in inclement weather, or in heavy traffic. Distractions should be minimized.
Answer
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Falls and Fall Risk Reduction
Chapter 15
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Leading cause of morbidity and mortality for people older than 65 years of age
Falls and subsequent injuries result in physical and psychosocial consequences
A nursing-sensitive quality indicator
Falls in nursing homes are termed sentinel events and must be reported to the Centers for Medicare & Medicaid Services
Falls and Fall Risk Reduction
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Hip fracture
More than 95% of hip fractures among older adults are caused by falls
Associated with considerable morbidity and mortality
Traumatic brain injury (TBI)
Falls are the leading cause of TBI for older adults
Fallophobia
Loss of confidence that leads to reduced physical activity, increased dependency, and social withdrawal
An important predictor of general functional decline and a risk factor for future falls

Consequences of Falls
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Etiology is multifactorial
May indicate neurologic, sensory, cardiac, cognitive, medication, or musculoskeletal problems or impending illness
Episodes of acute illness, infection, or exacerbations of chronic illness are times of high fall risk
Majority occur from a combination of intrinsic and extrinsic factors that combine at a certain point in time
Fall Risk Factors
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Intrinsic factors
Reduced vision and hearing
Unsteady gait
Cognitive impairment
Acute and chronic illnesses
Effects of medication
Extrinsic factors
Lack of support equipment in the bathtub and at the toilet
Height of the bed
Floor conditions
Poor lighting
Inappropriate footwear
Improper or inadequate assistive devices
Factors Contributing to Falls
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Institutional settings
Limited staffing
Lack of toileting programs
Use of restraints and side rails
Inadequate staff communication and training
Incomplete patient assessments
Environmental issues
Incomplete care planning
Inadequate organizational culture of safety
Factors Contributing to Falls (Cont.)
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Especially observed in those older than
85 years of age
Are indicative of an underlying pathological condition such as arthritis, diabetes, dementia, Parkinson’s disease, stroke, alcoholism, and vitamin D deficiency
Some underlying pathological conditions cause neurologic damage and result in gait problems
Gait Disturbances
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Deformities and ill-fitting footwear can cause gait problems
Contributing factors include neglect of corns, bunions, overgrown toenails, loss of fat cushioning, poor arch support, excess weight-bearing activities, obesity, or uneven distribution of weight on the feet
Nurse must assess the feet for clues of functional ability and identify problems
Foot Deformities
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Declines in depth perception, proprioception, and normotensive response to postural changes contribute to falls
Postural changes in the pulse rate and blood pressure occur with postural hypotension
Postprandial hypotension occurs after the consumption of a carbohydrate-filled meal and is more common in those with diabetes or Parkinson’s disease

Postural and Postprandial Hypotension
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Those with dementia and delirium are at an increased risk for falls and major injuries if falls occur
Screening tools can be used to identify cognitive impairments
Cognitive Impairment
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A significant relationship exists between vision and hearing and falls
Risk factors include poor visual acuity, reduced contrast sensitivity, decreased visual field, cataracts, and use of nonmiotic glaucoma medications
Formal vision assessment is an important intervention to identify remediable visual problems

Vision and Hearing
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A number of medications are implicated in increasing fall risk
Review all medications, including over-the-counter and herbal medications and limited to those that are essential
Provide patient teaching related to fall risk, appropriate dosing, and drug–drug and drug–alcohol interactions
Medications
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Fall risk assessment is an integral part of primary health care for the older person
Adults may be apprehensive about sharing information regarding a fall because of the fear of losing their independence
Screening tools can be used to determine the risk for falling

Implications for Gerontological Nursing and Healthy Aging
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Perform an initial fall assessment on admission, after any change in condition, and at regular intervals during a stay
Assessment of the older adult at risk
Nursing assessment of the patient after a fall
Assessment of the environment and other situational circumstances upon admission and during institutional stays
Assessment of the older adult’s knowledge of falls and their prevention
Fall Assessments
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Morse Fall Scale
Not for use in long-term care facilities
Performance-Oriented Mobility Assessment
Hendrich II Fall Risk Model
Validated with skilled nursing and rehabilitation centers
Minimum Data Set (MDS) 3.0
Includes information about the history of falls and hip fractures, as well as an assessment of balance during transitions and walking
Fall Risk Assessment Instruments
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Determining the reason for a fall occurred provides information about the cause of a fall and ensures that appropriate plans can be instituted to prevent future falls
Includes a fall-focused history, fall circumstances, medical problems, and medication review, as well as mobility, vision and hearing, neurologic, and cardiovascular assessments
Postfall Assessment
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One-size-fits-all approach does not work
Interventions depend on the person’s changing condition
Type, timing, and frequency of the interventions are tailored to the person
Education about fall prevention is an important intervention for patients, families, and the community

Interventions for Fall Prevention
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May be of benefit when part of a multifactorial program
Home safety assessment and modification interventions are effective in reducing the rates of falls in community-dwelling older adults
In institutional settings, the patient care environment should be assessed routinely for extrinsic factors that may contribute to falls and corrective action taken
Environment Modifications
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Many devices are available for specific conditions and limitations
Canes
Walkers
Wheelchairs
Can also improve functional ability and independence
Education is essential because improper use of these devices can lead to an increased fall risk
Assistive Devices
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Interventions the nurse may implement to help prevent falls include (Select all that apply.)
keeping the call light within reach.
rounding on the patient every 1 to 2 hours.
reducing fluid intake after the evening meal.
using a bed alarm if the patient is disoriented.
teaching the patient to change positions slowly.
Question
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A, B, D, E—Reducing fluid intake after the evening meal does not reduce fall risk. Fluid volume deficit may actually increase the risk because of syncope.
Answer
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Physical restraint
Manual method that uses either a physical or a mechanical device and is designed to reduce the ability of the patient to move his or her arms, legs, body, or head freely
Chemical restraint
Drug or medication is used as a restriction to manage the client’s behavior or movement, which is not a standard treatment or dose of a medication
Restraints and Side Rails
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Do not protect patients from falling, wandering, or removing tubes and other medical devices
Can cause serious injury and death
Are associated with higher death rates, injurious falls, nosocomial infections, incontinence, contractures, pressure ulcers, agitation, and depression
May cause fear and agitation in those with a history of trauma
Consequences of
Physical Restraints
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No evidence suggests that using side rails deceases the risks for or the rates of falls
Side-rail restraint is defined as the two full-length or four half-length raised side rails
If a patient is able to use the half- or quarter-length upper side rail to assist in getting in and out of bed, then he or she is not considered to be physically restrained
Side Rails
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Is the standard of practice and an indicator of quality care in all health care settings
Should not be used to manage behavioral symptoms of hospitalized older adults with delirium
What works for one patient may not work for another; assessment is key
Staff education regarding restraint-free care is important
Restraint-Free Care
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Gerontological nurses need to be knowledgeable about fall risk factors and fall risk reduction
Health promotion interventions can help maintain fitness and mobility in older adults
Knowledge of the home environment and risk factors for falls is a must
Implications for Gerontological Nursing and Healthy Aging
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If a patient is able to use the half- or quarter-length upper side rail to assist in getting in and out of bed, then this patient is considered to be placed in a form of physical restraints.
True
False
Question
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B—If the patient uses a half- or quarter-length upper side rail to assist in getting in and out of bed, it is not considered a restraint.
Answer
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