Week 10: Physical Activity, Exercise Falls, Fall Risk Reduction And Safety/Security

Question 1

Assessment of Physical Activity in the Gerontological Population

Answer 1

• Assessment of function and mobility.
• Exercise counseling should be provided as part of the assessment.
• Frail individuals will need more comprehensive assessment to adapt exercise recommendations to their abilities to ensure benefit without compromising safety.

Question 2

Physical Activity Screening

Answer 2

• The Exercise and Screening for You tool can be used to determine a safe exercise program for older adults on the basis of underlying physical conditions (resource listed in Box 18-2).
• The Hendrich II Fall Risk Model includes the Get-Up-and-Go test, which can be used to assess mobility, gait, and gait speed.

Question 3

Physical Activity for Interventions

Answer 3

• The nurse should be knowledgeable about recommended physical activity guidelines, educate individuals about the importance of exercise and physical activity, and provide suggestions on ways to incorporate exercise into daily routines.
• Older people are less likely to receive exercise counseling from their primary care provider than younger individuals.
• Nurses can design and lead exercise and physical activity programs.

Question 4

Function Focused Care

Answer 4

• Previously known as restorative care.

- Comprehensive, systems-level approach that prioritizes the preservation and restoration of functional capacity.

Question 5

Mobility and Aging

Answer 5

• Mobility is intimately linked to health status and quality of life.
• Gait and mobility impairments are not an inevitable consequence of aging, but often a result of chronic disease or trauma.

Question 6

Impairment of mobility is an early predictor of what?

Answer 6

physical disability and associated with poor outcomes such as falling, loss of independence, depression, decreased quality of life, institutionalization, and death.

Question 7

Consequences of Falls: Hip Fractures

Answer 7

• 95% of hip fractures are caused by falls.

- Hip fractures are associated with considerable morbidity and mortality.

Question 8

Consequences of Falls: Traumatic Brain Injury

Answer 8

• 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.

Question 9

Consequences of Falls: Fallophobia

Answer 9

-Fear of falling is an important predictor of general functional Celine and risk factor for future falls

Question 10

Fall Risk Factors

Answer 10

• A history of falls
• Drugs
• Environmental hazards
• Weakness
• Gait/balance impairment
• ADL impairment
• Sensory deficit
• Age-related frailty
• Vertigo
• Cognitive impairment
• Medical illness

Question 11

Fall Risk Factors: Gait Disturbances

Answer 11

Are not a normal consequence of aging alone, but most likely indicative of underlying pathological condition.

Question 12

Fall Risk Factors: Orthostatic Hypotension

Answer 12

-OH coupled with dizziness has been found to be predictive of falls.

Question 13

Postprandial Hypotension

Answer 13

-Occurs after ingestion of a carbohydrate meal and may be related to release of vasodilatory peptide.

Question 14

Fall Risk Factors: Cognitive Impairment

Answer 14

Those with cognitive impairment such as dementia or delirium are at an increased risk for falls

Question 15

Fall Risk Factors: Vision and Hearing

Answer 15

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

Question 16

Fall Risk Factors: Medications

Answer 16

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 17

Screening and Assessment Hospital/Long-Term Care

Answer 17

• 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 18

Fall Risk Assessment Instruments

Answer 18

• 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 19

Post fall assessment

Answer 19

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

Question 20

What is the purpose of a postfall assessment?

Answer 20

to identify the clinical status of the person, verify and treat injuries, identify underlying causes, and assist with risk reduction interventions.

Question 21

Components of a postfall assessment include

Answer 21

fall-focused history, fall circumstances, medical problems, medication review, mobility assessment, vision and hearing assessment, neurological examination, and cardiovascular examination.

Question 22

Fall Interventions

Answer 22

• Fall risk reduction programs (Boxes 19-13 and 19-15).
• Environmental modifications.
• Assistive devices (Box 19-17).
• Safe patient handling (Box 19-18).
• Wheelchairs.
• Osteoporosis treatment/vitamin D supplements.
• Hip protectors.
• Alarm motion sensors.

Question 23

Consequences of Restraints

Answer 23

• 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.

Question 24

Restraint-Free CAre

Answer 24

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 25

Environmental Safety

Answer 25

A safe environment is one in which one is capable, with reasonable caution, of carrying out activities of daily living and instrumental activities of daily living (IADLs), as well as the activities that enrich one’s life, without fear of attack, accident, or imposed interference.

Question 26

Home Safety Measures

Answer 26

• Home safety assessments must be multifaceted and individualized to the areas of identified risks.
• Particularly important for older adults at risk for falls.

Question 27

Crimes Against Older Adults: Risks and Vulnerability

Answer 27

• Living alone, sensory, mobility, memory impairments, and loneliness make elders more susceptible to crime.
• Property crime is the most common crime against persons 65 years and older.

Question 28

Crimes Against Older Adults: Fraudulent Schemes Against Elders

Answer 28

• Fraud against elders ranges from solicitations from seemingly worthwhile charities to requests for a cash deposit to win a prize.
• Medical fraud is another serious type of fraud that effects older citizens on a national scale.

Question 29

Fire Safety for Elders

Answer 29

• Fire-related mortality rates are three times higher in people older than 80 years than in the rest of the population.
• Most fires occur at home during the night, and deaths are attributed to smoke injury more often than burns.
• Reducing fire risk in the home (Box 20-4).
• Preventing fires and burns (Box 20-5).

Question 30

Vulnerability to Environmental Temperatures

Answer 30

• Environmental temperature extremes impose a serious risk to older persons with declining physical health.
• Preventative measures require attentiveness to impending climate changes, as well as protective alternatives

Question 31

What can affect thermoregulation in older adults?

Answer 31

• Neurosensory changes in thermoregulation delay or diminish the individual’s awareness of temperature changes and may impair behavioral and thermoregulatory response to dangerously high or low temperatures.
• Drugs can affect thermoregulation.
• Economic, behavioral, and environmental factors may combine to create a dangerous thermal environment affecting the older person.

Question 32

Temperature monitoring in older adults: what may indicate a fever in frail older people

Answer 32

98.6 F

Question 33

Hyperthermia

Answer 33

• When body temperature increases above normal ranges because of environmental or metabolic heat loads.
• Hyperthermia is a temperature-related illness and is classified as a medical emergency.

Question 34

Hypothermia

Answer 34

• Produced by exposure to a cold environment and defined as a core temperature of less than 35°C (95°F).
• Hypothermia is a medical emergency requiring comprehensive assessment of neurological activity, oxygenation, renal function, and fluid and electrolyte balance.

Question 35

Vulnerability and Natural Disasters

Answer 35

Older people are at a great risk during and after disasters and have the highest casualty rate during disaster events when compared to all other groups.

Question 36

Older adults most at risk for vulnerability and natural disasters include those

Answer 36

• that depend on others for daily functioning.
• with limited mobility.
• socially isolated, cognitively impaired, or institutionalized.

Question 37

Transportation Safety

Answer 37

• Available transportation is a critical link in the ability of older adults to remain independent and functional.
• A “crisis in mobility” exists for many older people because of lack of an automobile, inability to drive, limited access to public transportation, health factors, geographical location, and economic considerations.

Question 38

Driving and Aging

Answer 38

• Driving is one of the IADLs for most elders because it is essential to obtaining necessary resources.
• Driving is a highly complex activity that requires visual, motor, and cognitive skills.
• As individuals age, the risk for impairment that affects driving skills increases due to changes related to aging, as well as disease-related changes.

Question 39

Driving Safety

Answer 39

• When compared with younger age groups, older people have more accidents per mile driven and have a ninefold increased risk of traffic fatality.
• The leading cause of injury-related deaths among drivers 65-74 years of age is a motor vehicle accident and, if over 75 years, the second leading cause of death, after falls.
• Silver alert system.

Question 40

Driving and Dementia

Answer 40

• Driving has been identified as one of the top 10 tough ethical issues associated with dementia.
• Evidence of some studies of motor vehicle crashes suggests that drivers with dementia have at least a twofold risk of crashes compared to those without cognitive impairment.
• Legal regulations regarding driver’s license renewal in older drivers and the responsibility of medical practitioners to identify unsafe drivers vary from state to state and country to country.

Question 41

Driver Cessation

Answer 41

• Giving up driving is a major loss for an older person both in terms of independence and pleasure, as well as feelings of competence and self-worth.
• Planning for driver cessation should occur for all older adults before their mobility situations become urgent.

Question 42

SAFE DRIVE

Answer 42

Addresses key components in screening older adults drivers.

Question 43

Emerging Technologies to Enhance Safety of Older Adults

Answer 43

Advancements in all types of technology hold promise for improving quality of life, decreasing the need for personal care, and enhancing independence and the ability to live safely at home and age in place.
Examples include:
telehealth
smart homes
robots

Question 44

Elder-Friendly Communities

Answer 44

Developing elder-friendly communities and increasing opportunities to age in place can lead to enhanced health and well-being.

Question 45

Components of elder-friendly community

Answer 45

• Addresses basic needs
• Optimizes physical health and well-being
• Maximizes independence for frail and disabled
• Provides social and civic engagement

Question 46

Aging in Community Models

Answer 46

• Naturally occurring retirement communities are neighborhoods or buildings in which a large segment of the residents are older.
• Provide a range of health and social services for residents, as well as individual assessments of risk, coordination of nonprofessional services, and referrals and follow-up.
• Examples: the village model, cohousing communities, and shared housing.