Chapter 19 Falls and fall risk reduction

Question 1

Mobility and Aging

Answer 1

Mobility is intimately linked to health status and quality of life

Mobility and comparative degrees of agility are based on muscle strength, flexibility, postural stability, vibratory sensation, cognition, and perceptions of stability

• Gait and mobility impairments are not an inevitable consequence of aging, but often a result of chronic disease or trauma
• Impairment of mobility is an early predictor of physical disability and associated with poor outcomes such as falling, loss of independence, depression, decreased quality of life, institutionalization, and death
• Maintenance of mobility and function is an essential component of best practice gerontological nursing and is effective in preventing falls, unnecessary decline, and loss of independence

Question 2

Falls

Answer 2

One of the most important geriatric syndromes and the leading cause of morbidity and mortality for older people

Leading cause of both fatal and nonfatal injuries

Most falls may be preventable

Falls are a significant public health problem

A key nursing quality indicator

Education on falls and fall risk reduction is an important consideration in the Quality and Safety Education for Nurses safety competency

Question 3

Consequences of Falls

Answer 3

Hip fractures
95% of hip fractures are caused by falls
Hip fractures are associated with considerable morbidity and mortality

Traumatic brain injury (TBI)
Persons over the age of 75 years have the highest rates of TBI-related hospitalization and death
Falls are the leading cause of TBI for older adults
Signs and symptoms of TBI (Box 19-2)

Fallophobia
Fear of falling is an important predictor of general functional decline and risk factor for future falls

Question 4

Fall Risk Factors

Answer 4

Falls are a symptom of a problem and are rarely benign in older people

Seven types of fall classifications (Box 19-3)

A history of falls is an important risk factor and individuals who have fallen have three times the risk of falling again

Question 5

Fall Risk Factors

Answer 5

Gait disturbances
Affect 10%-60% of people older than 65 years
Are not a normal consequence of aging alone, but most likely indicative of underlying pathological condition

Foot deformities
Falls were reduced in those with disabling foot pain who received enhanced podiatry care
Most adults over age 65 have some form of altered foot integrity

Question 6

Promoting Healthy Aging: Implications for Gerontological Nursing

Answer 6

Nursing care should be directed toward optimal comfort and function, removing possible mechanical irritants, and decreasing likelihood of infection

The nurse has the important function of assessing the feet for clues of functional ability and their owner’s well-being

Question 7

Orthostatic and postprandial hypotension

Answer 7

The detection of orthostatic hypotension (OH) (decrease: 20mm/10mm +) is of clinical importance to falls prevention since OH is treatable

OH coupled with syncope has been found to be predictive of falls

Measuring orthostatic BP (Box 19-7)

Care of resident with OH (Box 19-8)

Postprandial hypotension occurs after the ingestion of a carbohydrate meal and may be related to release of vasodilatory peptide

Question 8

Fall Risk Factors

Answer 8

Cognitive impairment
Older adults with cognitive impairment, such as dementia or delirium, are at increased risk for falls

Vision and hearing
Poor visual acuity, reduced contrast sensitivity, decreased visual field, cataracts, and use of nonmiotic glaucoma medications have all been associated with falls

Medications
Medications implicated in fall risk include those that cause drowsiness, mental confusion, problems with balance or loss of urinary control, and sudden drops in blood pressure when standing

Question 9

Screening and assessment

Answer 9

Fall risk assessment should be an integral part of primary health care for the older adult

The intensity of the assessment will vary with the target population

• Low-risk community-dwelling individuals
• Those who report a single fall
• High-risk populations

Question 10

Screening and assessment hospital/long-term care (LTC)

Answer 10

Individuals admitted to acute care or LTC should have an initial assessment on admission, after any change in condition, and at regular intervals during their stay

Assessment is an ongoing process that includes multiple and continual types of assessment, reassessment, and evaluation following a fall or intervention to reduce risk

Question 11

Fall Risk Assessment Instruments

Answer 11

• Fall risk assessment instruments are commonly included in fall prevention interventions
• The National Center for Patient Safety recommends the Morse Fall Scale, except for LTC
• The Hartford Foundation for Geriatric Nursing recommends the Hendrich II Fall Risk Model, which has been validated with skilled nursing and rehabilitation populations

Question 12

Postfall Assessment

Answer 12

Determination of why a fall occurred is vital and provides information on underlying fall etiologies so that appropriate plans of care can be instituted

The purpose of the postfall assessment is to identify the clinical status of the person, verify and treat injuries, identify underlying causes, and assist with risk reduction interventions

Components of a postfall assessment include fall-focused history, fall circumstances, medical problems, medication review, mobility assessment, vision and hearing assessment, neurological examination, and cardiovascular examination

Question 13

Interventions

Answer 13

Fall risk reduction programs (Box 19-11)
ACE
NICHE
GRN
HELP
Vision screening
Medication reduction
CV assessment
Hip protectors/assistive devices
Education

Question 14

Environmental Modifications

Answer 14

CDC fall prevention checklist
Assistive devices
Safe patient handling
Wheelchairs
Osteoporosis treatment/Vitamin D supplementation
Hip protectors
Alarms/motion sensors/staff observation

Question 15

Restraints and Side Rails

Answer 15

Consequences of restraints

• Physical restraints may exacerbate many of the problems they are used for and can cause serious injury and death, as well as emotional and physical problems
• The most common mechanism of restraint-related death is asphyxiation
• Use of restraints is a great source of physical and psychological distress to older adults and may intensify agitation and contribute to depression

Side rails

• Side rails are now defined as restraints or restrictive devices when used to impede a person’s ability to voluntarily get out of bed and the person cannot lower them by him or herself
• No evidence that side rails decrease the risk or rate of fall occurrence

Question 16

Restraint-free care

Answer 16

Is now a standard of practice and an indicator of quality care in all health care settings, although the transition to the standard of care is still in progress

Question 17

Risk factors for falls include:
A. OH.
B. cognitive impairment.
C. vision and hearing problems.
D. foot deformities.
E. all of the above

Answer 17

E. all of the above

Question 18

The use of restraints can lead to:
A. death.
B. depression.
C. exacerbation of agitation.
D. asphyxiation.
E. all of the above.

Answer 18

E. all of the above.