Week 10: Physical Activity, Exercise Falls, Fall Risk Reduction And Safety/Security Flashcards
Assessment of Physical Activity in the Gerontological Population
- 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.
Physical Activity Screening
- 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.
Physical Activity for Interventions
- 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.
Function Focused Care
- Previously known as restorative care.
- Comprehensive, systems-level approach that prioritizes the preservation and restoration of functional capacity.
Mobility and Aging
- 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.
Impairment of mobility is an early predictor of what?
physical disability and associated with poor outcomes such as falling, loss of independence, depression, decreased quality of life, institutionalization, and death.
Consequences of Falls: Hip Fractures
- 95% of hip fractures are caused by falls.
- Hip fractures are associated with considerable morbidity and mortality.
Consequences of Falls: Traumatic Brain Injury
- 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.
Consequences of Falls: Fallophobia
-Fear of falling is an important predictor of general functional Celine and risk factor for future falls
Fall Risk Factors
- A history of falls
- Drugs
- Environmental hazards
- Weakness
- Gait/balance impairment
- ADL impairment
- Sensory deficit
- Age-related frailty
- Vertigo
- Cognitive impairment
- Medical illness
Fall Risk Factors: Gait Disturbances
Are not a normal consequence of aging alone, but most likely indicative of underlying pathological condition.
Fall Risk Factors: Orthostatic Hypotension
-OH coupled with dizziness has been found to be predictive of falls.
Postprandial Hypotension
-Occurs after ingestion of a carbohydrate meal and may be related to release of vasodilatory peptide.
Fall Risk Factors: Cognitive Impairment
Those with cognitive impairment such as dementia or delirium are at an increased risk for falls
Fall Risk Factors: 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
Fall Risk Factors: 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.
Screening and Assessment Hospital/Long-Term Care
- 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.
Fall Risk Assessment Instruments
- 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.
Post fall assessment
Determination of why a fall occurred is vital and provides information on underlying fall etiologies so that appropriate plans of care can be instituted
What is the purpose of a postfall assessment?
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.
Fall Interventions
- 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.
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.
Restraint-Free CAre
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.
Environmental Safety
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.
Home Safety Measures
- Home safety assessments must be multifaceted and individualized to the areas of identified risks.
- Particularly important for older adults at risk for falls.
Crimes Against Older Adults: Risks and Vulnerability
- 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.
Crimes Against Older Adults: Fraudulent Schemes Against Elders
- 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.
Fire Safety for Elders
- 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).
Vulnerability to Environmental Temperatures
- 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
What can affect thermoregulation in older adults?
- 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.
Temperature monitoring in older adults: what may indicate a fever in frail older people
98.6 F
Hyperthermia
- 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.
Hypothermia
- 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.
Vulnerability and Natural Disasters
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.
Older adults most at risk for vulnerability and natural disasters include those
- that depend on others for daily functioning.
- with limited mobility.
- socially isolated, cognitively impaired, or institutionalized.
Transportation Safety
- 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.
Driving and Aging
- 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.
Driving Safety
- 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.
Driving and Dementia
- 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.
Driver Cessation
- 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.
SAFE DRIVE
Addresses key components in screening older adults drivers.
Emerging Technologies to Enhance Safety of Older Adults
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
Elder-Friendly Communities
Developing elder-friendly communities and increasing opportunities to age in place can lead to enhanced health and well-being.
Components of elder-friendly community
- Addresses basic needs
- Optimizes physical health and well-being
- Maximizes independence for frail and disabled
- Provides social and civic engagement
Aging in Community Models
- 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.
