Transcript fall

Safety measures for elderly and
geriatrics
OUT LINE
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introduction
safety
risk factor - why the elderly ?
Most common hazards
assessment methods
prevention
Objectives
• After completing this seminar the students will be able
to :
• 1.Discuss factors that affects people's ability to protect
themselves from injury
• 2. Describe methods to assess a client's risk for injury
• 3. Identify common potential hazards through the life
span
• 4.Give examples of Nursing
diagnosis,interventions,outcomes for a client at risk for
accidental injury
• 5.Explain interventions to prevent falls
introduction
Safety why its important
• Safety: The condition of being safe; freedom
from danger, risk, or injury.
• Safety : a contrivance or device designed to
prevent injury
• - its important to take care about elderly
safety because of their poor health status and
body movement abilities .
risk factor - why the elderly?
• 1- poor vision
• 2- cognitive dysfunction (confusion, disorientation, impaired memory or
judgment )
• 3- impaired gait or balance and difficulty walking because of lower
extremity dysfunction (e.g arthritis )
• 4 – difficulty getting in and out of chair /bed
• 5-orthostatic hypotension : These
• individuals should be instructed to move slowly
• and to remain seated until the dizziness passes.
• 6- urinary frequency or receiving a diuretics
• 7- medication effect ( sedatives, hypotonic, narcotic analgesics , diuretics )
• 8- reflexes may also be slower than younger. The increased amount of
time it takes to react may make it harder to catch balance if you start to
fall.
Common hazards
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Falls
Burn
Polypharmacy
Pedestrian
Choking
Automobile accidents
Fall
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fall is defined as “an event which results in a
person unintentionally coming to rest on the
ground or another lower level; not as a result of
a major intrinsic event (such as a stroke) or
overwhelming hazard
• Falls are the most leading cause of both fatal and
nonfatal injuries in older adults.
• Over 95% of hip fractures are caused by falls.
• Any fall is the best predictor of future falls. Two thirds of those
who have experienced one fall will fall again within 6 months
• Many falls are linked to a person's physical condition or
a medical problem, such as a chronic disease. Other
causes could be safety hazards in the person's home or
community environment.
• Falls can result in
• injury, loss of independence, reduced quality of life, and
death in the elderly.
Fractures are the most serious health consequence .. •
• The most common fractures are of the vertebrae, hip,
forearm, leg, ankle, pelvis, upper arm, and hand
Risk factors
• hypotension, unsteady gait, altered mental
status, poor vision, cognitive change, fear ,
• • Impaired physical mobility
• • Sensory deficits
• • Lack of knowledge of health practices or safety
precautions
• • Hazardous environment
• • History of accidents or injuries
• • In the home or community setting
SAFETY ALERT
Older adults have trouble seeing the
edges of stairs .
Painting white stripes on the edges of
the steps will help increase contrast and
may prevent falls
• Nurse cane use an assessment tool called Get
Up And Go in hospital o r home sitting –
kimbell 2011
CLINICAL ALERT
Falls can break bones and selfconfidence, leading to fear of falling
causing decreased activity level and
decreased muscle strength .
Falling prevention
• 1-Exercise regularly. It is important that the
exercises focus on increasing leg strength and
improving balance, and that they get more
challenging over time. Tai Chi programs are
especially good.
• 2-Make their homes safer by reducing tripping
hazards by:
• • .Assess for potential personal cause of falls:
• hypotension, unsteady gait, altered mental status, poor
vision, cognitive change, fear.
• • In the home or community setting, assess for potential
environmental causes of falls
• Lighting: inadequate amount,
• inaccessible switches Floors: presence of electrical cords
• slippery surfaces Stairs: absent or unsteady railings, uneven
step height or surfaces
• Furniture: unsteady base, carpets are too high or too low,
chairs with wheels
• Bathroom: inappropriate toilet height, slippery floors or tub.
• Absence of Grab Bars
• fall out of bed : Place the matters directly onto the floor
Place padding on floor next to bed or between client and side
rails
Polypharmacy and Medication Errors
Older adults take considerably more
medications than younger people
The act of taking many medications 5 or more
concurrently is termed polypharmacy
“concurrent use of several drugs.”
Nonadherence is defined as the extent to which
patients are not willing to follow the
instructions they are given for prescribed
treatments
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An elderly person experiencing polypharmacy
is more susceptible to medication errors,
defined as taking the wrong medication or the
wrong dose at the wrong time or for the wrong
purpose
• There is an increased incidence of drug–
• drug interactions in a patient experiencing
• polypharmacy
• Clinical manifestations .
• may include varying degrees of
• nausea, constipation, gastrointestinal bleeding
• urinary incontinence, muscle aches, sexual
dysfunction,
• insomnia, confusion, dizziness, orthostatic
• hypotension, and falls
Reducing medication risks in older
adults
. Discuss with patients the need to:
-keep an accurate list of all medications, including generic and brand
names, dosages, dosing frequency, and reason for taking the drug
-keep a complete list of medical providers and their contact information
. Teach patients about:
- Supported self-administration of medications if possible
- importance of taking medications exactly as directed
- avoid sharing medications
Also, if appropriate, help patients establish memory aids. For instance,
advise patients to link drug administration to their daily routine or to
use color-coded charts, automatic dispensers with bells, or voiceactivated message services to remember to take their doses
Ensure that the patient/caregiver is an informed
Burns
• A study of elderly burn victims in the Journal of Burn
Care and Rehabilitation observed that 70 percent of
the burn victims surveyed were burned in their homes
("A Survey of Risk Factors for Burns in the Elderly and
Prevention Strategies," 2002).
• Burns are common injuries in case of explosions and
fires. Specifically, thermal burns are caused by contact
with sources of high heat, such as flames, hot liquids
and hot surfaces,
• contrary to what happens with chemical and electrical
• burns. Every year over 1,000 deaths due to burns
among elderly are reported in the United States
RISK FACTORS FOR BURN INJURIES
AMONG ELDERLY PEOPLE
• The main risk factors for fatal burns among
elderly people Are:
• Careless smoking, especially in the bedroom
• Absence of a smoke detector
• Winter time
• Electrical blanket of poor quality
• Excessively hot water used when showering
• or cooking oil or butter used when cooking
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Elderly are at higher risk for house
fire death for a number
of reasons:
Reduced sensory and cognitive abilities, such as smell,
touch, vision and hearing, and mental diseases such as
dementia, Alzheimer and depression leading to slower
reaction or complete inactivity
• Prescription drugs, when elderly alone and especially when combined due
to decreased alertness
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Mobility impaired, slowing or completely preventing escape and slow
response time can diminish an older adult's ability to sense a burn when it
happens
• Lack of financial means for environmental improvements
• aim to reduce risk of fire (portable heaters or heating blankets, older
homes, etc.)
Choking
• is one such real risk. Even though statistics show
that the use of dentures has lessened due to
attentive dental care, certain foods still pose a
problem.
• Here is a list of common choking hazards and
easy substitutions
• 1 -Meat
Large chucks of meat can be very hard to chew,
and as such swallow safely. It is highly
recommendable to avoid hard meats, like steak,
and big pieces of meat in general.
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Fruit
Large chucks of fruit pose a serious danger to eating elderly. Fruit that are especially
hard, like apples, pineapples and plums should peeled completely and cut into easy to
chew bites. Pureed versions of these fruits, like applesauce or blended plums might also
be a great option to consider.
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Bread
Bread poses to a threat because if it gets stuck in the airway, water can cause it to swell
and block the air passage. Cake and milk together poses a similar issue
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Liquids
Some liquids, like water, can pose choking hazards because of the lack of thickness.
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Better Choices: Foods With Low Choking Risks
Here are some food choices that are easier to swallow:
Fish, if it’s filleted
Ground meat
Soups
Chocolate (if it gets stuck, it melts)
Applesauce, pudding and Jello
Lightly toasted bread with butter or jelly
• Dos and Don’ts of Eating
• These tips will also help reduce incidences of choking:
• Don’t drink fluids while you’re eating. People do this to make
the food go down and it can lead to choking.
• Don’t talk while you eat. The epiglottis—the hinge like flap at
the base of your tongue that keeps food from entering your
windpipe—doesn’t know whether to open or close because it
doesn’t know whether food or air is coming.
• Don’t eat lying down.
• Do learn to eat more slowly.
• Do put less on your plate so you can’t eat too much too fast.
Have a second helping afterward instead.
• Do julienne the food.
• Do peel apples before serving or, better yet, serve
applesauce
conclusion
• Finally
, elderly need holistic care to cover
every weakness in there health or hazard in
there environment.
Video
referanses
• Fundamentals of Nursing_Kozier & Erb's 9th
Edition
• CDC
• Gerontocological nursing
• Community of Public health Nursing
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ARTICLE
Engaging Adolescents to Care for
Elderly Safety in the
Community
Asia Pacific International Conference on Environment-Behaviour
Studies, Grand Margherita Hotel, Kuching, Sarawak, Malaysia, 7-9
December 2010
In Hong Kong, a study of the trends and characteristics of accidents
involving older persons was undertaken in a railway system.
Participant: A team of gerontologist and psychologists and their
students was engaged.
Purpose: Conducting a community project with older railway
passengers to identify key factors related to accidents including
physical environmental conditions.
Sample and procedures: A total of 32 undergraduate students in
Lingnan University was recruited to participate in the project.
Students Role: They were briefed the objectives of the study, and
trained basic skills in conducting field observations and face to face
interviews.
Results:
• There has been a slight increase in accidents among older
persons in the past two years. The accidents involving older
passengers tended to occur between 9am to noon since
many of them needed to travel to a hospital. The major
types of accidents are ‘lost balance and fell inside the train
compartment’, ‘struck by the train doors’ and ‘stepped into
the platform gap’. There may be under-reporting of
accidents or near-miss accidents. The participants did not
have a good knowledge of the rail routes, more than 20%
had chosen a longer and/or indirect route that involved
unnecessary change(s) of trains. Elderly passengers are in
general satisfied with the rail services. The three aspects
that received relatively low ratings were: train frequency,
train seat availability, and elderly train seat arrangements.
• Fnidings:
• According to the safety attitude model, the
railway corporation can impart more safety
knowledge to elderly passengers
• In the end, safety behaviour of elderly
passengers can be enhanced.
• DATA CLUSTER Mr.P.S suffered a stroke
resulting in left-sided Weakness.As a result his
gait is unsteady . The nurse noticed that his
home has several throw rugs and furniture
impending mobility .The bathroom doesn't
have grab bars by the toilet
• Nursing. Diagnosis Risk for injury r/to impaired mobility
and potential home hazards /At risk of injury as a result of
environmental conditions interacting with the individual's
adaptive resources
• Interventions : Environmental Management : Safety
/Monitoring and manipulation of the physical environment
to promote safety .
• Sample Activities :
• . Identify safety needs of client
• Identify safety hazards
• .Modify the environment to minimize hazards & risks
• .Monitor the environment changes in safety status
• Educate about enviromental hazards
• *environmental
• Outcomes:
• Safe Home Environment