Transcript Risk Factors That Affect Mobility and Safety—(cont.)

Chapter 22
Mobility and Safety
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Introduction
• Mobility is the most important aspect of physiologic
function
• Maintenance for independence
• Risks affecting mobility
– Falls and fractures
• Safety is the integral aspect of mobility
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Age-Related Changes That Affect
Mobility and Safety
• Bones
– Framework for musculoskeletal system
– Age-related changes
o Increased bone resorption, diminished calcium
absorption, increased serum parathyroid hormone,
impaired regulation of osteoblast activity, impaired
bone formation secondary to reduced osteoblastic
production, fewer functional marrow cells, and
decreased estrogen in women and testosterone in
men
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Age-Related Changes That Affect
Mobility and Safety—(cont.)
• Muscles
– Directly affects all activities of daily living (ADLs)
– Age-related changes
o Decreased size and number of muscle fibers, loss
of motor neurons, replacement of muscle tissue by
connective tissue, deterioration of muscle cell
membranes, diminished protein synthesis
– Sarcopenia: loss of muscle mass, strength, and
endurance
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Age-Related Changes That Affect
Mobility and Safety—(cont.)
• Joints and connective tissues
– Harmed by continued use and begin to show wear
and tear during early adulthood
– Age-related changes
o Diminished viscosity of synovial fluid,
degeneration of collagen and elastin cells,
fragmentation of fibrous structures in connective
tissue, outgrowths of cartilaginous clusters,
formation of scar tissue and areas of calcification
in joint capsules and connective tissue, and
degenerative changes in articular cartilage
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Age-Related Changes That Affect
Mobility and Safety—(cont.)
• Nervous system
– Age-related changes
o Central and peripheral nervous system may be
primary mechanism in diminished muscle function
o Maintenance of balance
 Altered visual abilities, slower righting reflex,
impaired proprioception, diminished vibratory
and positioning sensations in lower extremities
o Body sway: measure of motion of the body while
standing
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Age-Related Changes That Affect
Mobility and Safety—(cont.)
• Osteopenia and osteoporosis
– Loss of bone: age-related change
– Bone density: amount of minerals in bone
o Scored according to standard deviations
 T-score: between 1 and 2.5 diagnosis is osteopenia
 Lower T-score is diagnosis of osteoporosis
o Osteoporosis: silent disease
o Fragility fracture: little to no trauma
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Question
Is the following statement true or false?
Exercise programs to increase strength and endurance
in the older adult population may help delay the
onset of the age-related functional consequences of
decreased strength and endurance.
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Answer
True
Age-related changes in skeletal muscles, which are
controlled by motor neurons, directly affect all activities
of daily living. The end result of these age-related
changes is a decline in motor function and a loss of
strength and endurance, even in healthy older adults.
Exercise programs to increase strength and endurance
may help delay the onset of the age-related
consequences of disability and loss of function.
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Question
Which statement about osteoporosis is true?
A. Primary osteoporosis occurs with pathologic problems.
B. Secondary osteoporosis occurs as a result of age-related
changes.
C. Osteoporosis can cause serious negative functional
consequences even in the absence of additional risk
factors.
D. Estrogen levels have a minimal impact on the
development of osteoporosis.
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Answer
C. Osteoporosis can cause serious negative functional
consequences even in the absence of additional risk
factors.
Osteoporosis is a gradual loss of bone mass that affects all
adults to some degree and is strongly associated with
low-trauma fractures in older adults. Osteoporosis is
classified as primary when it is associated with agerelated changes and as secondary when it is caused by
medications or pathologic disturbances.
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Risk Factors That Affect
Mobility and Safety
• Risk factors that affect overall musculoskeletal function
– Lacking physical activity and nutritional deficits
• Vitamin D: essential for the absorption of calcium and
bone health
• Calcium: essential for good musculoskeletal function
• Other dietary factors that increase risk
– Low intake of high-quality proteins
– Inadequate food sources of vitamin B12 and folic acid
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Risk Factors That Affect
Mobility and Safety—(cont.)
• Risk factors for osteoporosis and fragility fractures
– Inadequate calcium and vitamin D intake
– Lack of weight-bearing activity
– Hormonal changes with regard to estrogen in women
– Small bones
– Increased age
– Tobacco use
– Excessive alcohol consumption
– Certain medications
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Risk Factors That Affect
Mobility and Safety—(cont.)
• Risk factors for falls
– History of falls
– Use of walking aids
– Pathologic conditions and functional and cognitive
impairments
– Medication effects
– Environmental factors
– Physical restraints
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Question
Which statement related to risk factors for falls and the
older adult is true?
A. Falls are most often the result of an isolated risk factor.
B. The risk of falling increases in proportion to the number
of risk factors.
C. Risk factors for falls do not vary according to the
environment.
D. Functional abilities of the older adult are not considered
a risk factor for falls.
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Answer
B. The risk of falling increases in proportion to the number
of risk factors.
Falls are the result of a combination of risk factors rather
than one isolated risk factor, and the risk of falls
increases in proportion to the number of risk factors.
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Pathologic Condition Affecting
Musculoskeletal Function: Osteoarthritis
• Osteoarthritis: degenerative inflammatory disease
affecting joints and attached muscles, tendons, and
ligaments
• Characterized by pain, swelling, and limited movement
of joints
• Leading cause of disability
• Risk factors
– Trauma, genetics, obesity, and age-related changes
• Focus: self-care health education interventions
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Functional Consequences Affecting
Musculoskeletal Wellness
• Effects on musculoskeletal function
– Diminished muscle strength, endurance, and
coordination, increased difficulty performing ADLs
• Susceptibility to falls and fractures
– Osteoporotic fractures, increases with age, serious
consequences
• Fear of falling
– Excessive anxiety about falling
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Question
Which statement related to musculoskeletal function and
the older adult population is true?
A. There is a greater decline in muscle strength in the
upper extremities.
B. Diminished muscle strength is attributed primarily to
age-related loss of muscle mass.
C. Older adults experience muscle fatigue after longer
periods of exercise than do younger adults.
D. Lifelong patterns of exercise and activity have little
effect on muscle strength.
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Answer
B. Diminished muscle strength is attributed primarily
to age-related loss of muscle mass.
Beginning at about the age of 40 years, muscle strength
declines gradually, resulting in an overall decrease of
30% to 50% by the age of 80 years, with a greater
decline in muscle strength in the lower extremities than
in the upper extremities.
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Nursing Assessment of
Musculoskeletal Function
• Assessment of overall musculoskeletal performance
• Assessing musculoskeletal performance
• Identifying risks for osteoporosis
• Identifying risks for falls and injury
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Nursing Diagnoses
• Wellness nursing diagnosis: readiness for enhanced self
health management
• Related to osteoporosis: health-seeking behaviors,
ineffective health maintenance
• Related to fall risks: impaired physical mobility, risk for
falls
• Additional diagnoses that address fear of falling: fear
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Planning for Wellness Outcomes
• Balance, endurance, mobility, activity tolerance
• Risk control, risk detection
• Safety behavior: fall prevention, home physical
environment
• Coping, fear control, comfort level
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Nursing Interventions for
Musculoskeletal Wellness
• Promoting healthy musculoskeletal function
• Teaching about osteoporosis
• Preventing falls and fall-related injuries
• Addressing intrinsic risk factors
• Addressing extrinsic risk factors
• Using monitoring devices in institutional settings
• Providing assistance in independent settings
• Addressing fear of falling
• Promoting caregiver wellness
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Nursing Interventions for Musculoskeletal
Wellness—(cont.)
• Implementing fall prevention programs
– Eliminating risks
– Using monitoring devices
– Addressing contributing factors
• Preventing fall-related injuries and death
– Hip protectors
– Environmental interventions
• Addressing fear of falling
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Question
Which statement related to adequate calcium
supplementation and the older adult is true?
A. Calcium supplements are rarely necessary.
B. Calcium supplementation lowers the rate of fractures in
older adults.
C. Calcium supplements have few detrimental effects when
taken by older adults.
D. Absorption of calcium supplements is optimal at 1,500
mg per dose.
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Answer
B. Calcium supplementation lowers the rate of
fractures in older adults.
A recent report from the U.S. Surgeon General
recommended a pyramidal treatment approach to
osteoporosis that includes physical activity, fall
prevention, and supplementation with calcium and
vitamin D as the foundation for fracture prevention.
Absorption of calcium supplements is optimal at not more
than 600 mg per dose.
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Evaluating Effectiveness of
Nursing Interventions
• Evaluation based on person’s ability to achieve and
maintain highest possible level of independence and safe
mobility
• Incorporation of preventive measures in daily life to
ensure safety and prevent osteoporosis
• Expressed feelings of safety and improved quality of life
• Evaluation of risk factors
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