As We Learned Earlier This Semester There Is No Longer Acces
As We Learned Earlier This Semester There Is No Longer Access To The H
As we learned earlier this semester there is no longer access to the Hartford case studies without paying a fee. Here is the information for your first case study. Please construct your responses and upload them into the Case Study 1 drop box. Complete the case study questions including what the appropriate interventions hat should be done to address her symptoms. The assignment will be due by 11:59 pm on Sunday at the end of week 3.
Opal Smith (Part 1) - retrieved from page 235 of the Ham and Sloane course text. Opal Smith, an 80-year-old woman, comes to your office as a new patient. She has hypertension, type 2 diabetes (diet-controlled), osteoarthritis, and mild hearing loss. Mrs. Smith’s main reported symptoms are bilateral mild knee pain and some sense of unsteadiness on walking.
She denies dizziness, postural symptoms, or falls in the past year. She takes lisinopril 10 mg daily, a multivitamin, calcium with vitamin D, acetaminophen as needed for pain, and diphenhydramine as needed for occasional insomnia. She has lived alone since her husband died 3 years ago. She still drives and has several friends with whom she visits. One of her friends suffered a fall several months ago and fractured a hip, from which she is still recovering.
Mrs. Smith is somewhat worried about her own unsteadiness and risk for falls. On exam, her blood pressure is 136/78 mmHg, pulse 72, weight 150 lbs (68 kg), and height 5 ft 5 in. She is mildly hard of hearing but communicates well. She has some mild crepitus on motion of her knees; her gait is slowed with short steps and is somewhat wide based.
The rest of her examination is unremarkable, as are all routine laboratory tests. At the end of her examination, Mrs. Smith asks you for fall prevention recommendations.
Paper For Above instruction
Falls among older adults pose a significant health concern, often leading to serious injuries, diminished independence, and increased healthcare costs. Recognizing the multifactorial nature of fall risks is essential for effective prevention strategies. This paper identifies the major risk factors for Mrs. Smith’s falls and discusses tailored interventions to mitigate these risks, emphasizing a holistic, evidence-based approach aligned with current clinical guidelines.
Major Risk Factors for Falls in Mrs. Smith
Mrs. Smith’s age is inherently associated with increased fall risk, owing to physiological changes such as decreased muscle strength, balance impairments, and sensory deficits. Her gait pattern—slowed with short, wide steps—indicates balance and mobility issues, which are significant contributors to fall likelihood, especially when combined with her osteoarthritis, which causes joint pain and stiffness, further impairing mobility (Rubenstein, 2006).
Her mild knee crepitus suggests osteoarthritis, which can cause pain and reduce joint function, impairing gait and balance. The mild hearing loss she exhibits can diminish spatial awareness, complicating her balance, especially in environments with poor lighting or obstacles (Anstey et al., 2006).
Her medication regimen includes diphenhydramine, an antihistamine with sedative properties, which can cause dizziness, sedation, and impair cognition, further increasing fall risk (Checkoway et al., 2013). Moreover, her antihypertensive medication, lisinopril, although well-controlled, can contribute to orthostatic hypotension, especially in the context of aging and polypharmacy (Kaufman et al., 2018).
Psychosocial factors also play a role; she lives alone and reports concerns about her unsteadiness. The recent hip fracture of her friend underscores her perceived vulnerability and may contribute to a fear of falling, which can paradoxically lead to gait changes and increased fall risk (Zijlstra et al., 2012).
Interventions to Minimize Fall Risk
To reduce her fall risk effectively, a multifaceted approach should be employed, combining medical management, environmental modifications, and personalized physical therapy. Evidence suggests that interventions targeting multiple risk factors are most successful (Gillespie et al., 2012).
Medication Review and Adjustment
An essential initial step involves reviewing her medications to identify potentially inappropriate drugs, especially sedatives like diphenhydramine. Transitioning her to non-sedating alternatives for insomnia, such as melatonin or cognitive-behavioral therapy, can minimize sedative-related falls (Campbell et al., 2010). Additionally, monitoring and adjusting antihypertensive therapy to prevent orthostatic hypotension is important; this might include avoiding rapid positional changes and reassessing the need for medications like lisinopril in her context (Kaufman et al., 2018).
Physical Activity and Weight-Bearing Exercises
Encouraging regular, tailored physical activity focused on strength, balance, and gait training can significantly reduce fall risk. Programs like Otago or Tai Chi have demonstrated efficacy in improving balance and decreasing falls among older adults (Li et al., 2005). For Mrs. Smith, supervised physical therapy sessions emphasizing lower limb strength, flexibility, and gait training would be beneficial.
Visual and Hearing Impairment Optimization
Although her hearing loss is mild, ensuring she has optimal hearing aid use if applicable can improve spatial awareness. Regular assessments by audiologists and ensuring well-functioning hearing devices are crucial to enhance her environmental awareness (Wallhagen et al., 2008).
Environmental Modifications
Home safety assessments can identify and mitigate fall hazards. Recommendations include removing loose rugs, installing grab bars in the bathroom, ensuring adequate lighting, and using non-slip mats and footwear. These modifications can create a safer environment that compensates for her mobility limitations (Gillespie et al., 2012).
Patient Education and Behavior Modification
Educating Mrs. Smith about safe mobility techniques, proper footwear, and the importance of assistive devices if needed fosters engagement in fall prevention strategies. Addressing her fear of falling through confidence-building practices and support groups can also improve her mobility without unnecessary restrictions (Zijlstra et al., 2012).
Follow-up and Monitoring
Periodic reassessment of her balance, gait, medication regimen, and home environment is necessary. Implementing a fall risk management plan in collaboration with physical therapists, primary care providers, and possibly occupational therapists ensures ongoing safety and adaptation.
Conclusion
Mrs. Smith’s fall risk arises from a complex interplay of physiological, pharmacological, environmental, and psychosocial factors. A holistic, multifactorial intervention plan that emphasizes medication review, physical activity, environmental safety, and patient education is essential for effective prevention. Timely, personalized interventions can help maintain her independence and reduce the likelihood of falls and associated injuries.
References
- Anstey, K., et al. (2006). Auditory and visual sensory impairments and risk of falling among older adults. Journal of Gerontology: Medical Sciences, 61A(3), 262–267.
- Campbell, N. L., et al. (2010). Use of antihistamines and risk of falls: A systematic review. Annals of Pharmacotherapy, 44(5), 757–763.
- Gillespie, L. D., et al. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, (9), CD007146.
- Kaufman, J. S., et al. (2018). Orthostatic hypotension in older adults: Management and implications. Journal of the American Geriatrics Society, 66(4), 770–778.
- Li, F., et al. (2005). Tai Chi and fall prevention in older adults: A randomized controlled trial. Journal of the American Geriatrics Society, 53(9), 1495–1500.
- Falls in older people: Epidemiology, risk factors, and strategies for prevention. Age and Ageing, 35(suppl_2), ii37–ii41.
- Wallhagen, M. I., et al. (2008). Hearing impairment and falls among older adults. Aging & Mental Health, 12(4), 486–491.
- Zijlstra, G. A., et al. (2012). Prevention of falls in community-dwelling older adults. Age and Ageing, 41(4), 481–488.