Falls And Fall Risk Reduction Chapter 15 ✓ Solved

Falls And Fall Risk Reductionchapter 15copyright 2018 Elsevier Inc

Falls and fall risk reduction is a critical concern in healthcare, especially for older adults. Falls are the leading cause of morbidity and mortality among individuals over the age of 65, often resulting in significant physical and psychosocial consequences. Falls in nursing homes are classified as sentinel events and are required to be reported to the Centers for Medicare & Medicaid Services (CMS). The consequences of falls include injuries such as hip fractures and traumatic brain injuries (TBI), which account for a substantial portion of morbidity and mortality in the elderly.

Hip fractures are predominantly caused by falls, with over 95% resulting from falls, and are associated with high morbidity and mortality rates. TBIs are also a significant concern, designated as the leading cause of TBI among older adults. The fear of falling, or fallophobia, can lead to decreased confidence, reduced physical activity, increased dependency, and social withdrawal, ultimately contributing to functional decline and future risk of falls.

The etiology of falls is multifactorial, often involving interactions between intrinsic factors—such as vision and hearing impairment, unsteady gait, cognitive impairment, medication effects, and chronic illnesses—and extrinsic factors like environmental hazards. Intrinsic factors include sensory deficits, neurologic problems, and musculoskeletal issues, with particular emphasis on gait disturbances caused by foot deformities, ill-fitting footwear, and neglect of foot care.

Physiological changes related to aging, like declines in depth perception, proprioception, and postural blood pressure regulation, contribute to fall risk. Postural hypotension, including postprandial hypotension, especially in individuals with diabetes or Parkinson’s disease, further predisposes older adults to falls. Cognitive impairments related to dementia and delirium significantly increase the risk of falls and associated injuries.

Visual and auditory impairments are key modifiable risk factors. Limited visual acuity, reduced contrast sensitivity, narrow visual fields, and cataracts impede safe mobility. Consequently, formal vision assessments are essential components of fall prevention strategies. Polypharmacy, or the use of multiple medications—including over-the-counter and herbal supplements—can elevate fall risk due to side effects like dizziness, orthostatic hypotension, and sedation. Regular medication review and patient teaching about potential interactions are vital.

Screening and assessment of fall risk are integral to primary care and gerontological nursing. Initial fall assessments should be performed upon admission to healthcare facilities or when a patient’s condition changes. Various tools, such as the Morse Fall Scale, Performance-Oriented Mobility Assessment, Hendrich II Fall Risk Model, and Minimum Data Set (MDS) 3.0, facilitate systematic evaluation of fall risks based on patient history, mobility, cognition, and environment.

Understanding the causes of a fall—through fall-focused history-taking, examining circumstances, and assessing medical conditions and medication use—enables targeted interventions. Post-fall assessments help tailor strategies to prevent future episodes, emphasizing the importance of individualized care plans.

Preventive strategies include multifactorial approaches incorporating patient and caregiver education, environmental modifications, and use of assistive devices such as canes, walkers, and wheelchairs. Home safety assessments and modifications—like improved lighting, removal of tripping hazards, and installation of grab bars—are effective in reducing falls in community-dwelling older adults. In institutional settings, routine environmental evaluations are necessary to identify and mitigate extrinsic hazards.

Assistive devices can improve functional ability but require proper education for safe use, as improper use may increase fall risk. Interventions like keeping the call light within reach, regular rounding, cautious management of hydration (avoiding fluid restriction in the evening), and fall alerts (e.g., bed alarms) are practical nursing strategies. Additionally, encouraging patients to change positions slowly and avoid hurried movements can decrease fall risk.

Restraints, including physical and chemical methods, are controversial and linked to adverse outcomes, including higher rates of injury, infections, and psychological distress. Physical restraints, such as side rails, should not be used solely for fall prevention but only when necessary and in accordance with ethical guidelines. The use of half- or quarter-length side rails for support during mobility is generally not considered restraint if the patient can use them to assist movement safely.

Educational initiatives for staff on restraint-free care and fall prevention are essential to promote safety and respect patient dignity. Overall, health promotion, environmental safety, proper assessment, and tailored interventions form the foundation of comprehensive fall risk management in older adult populations.

Sample Paper For Above instruction

Falls remain the primary concern in geriatric healthcare due to their significant implications for morbidity, mortality, and quality of life. This paper explores the multifaceted factors contributing to falls among older adults, the assessment tools used to identify risk, and evidence-based interventions for prevention, emphasizing the crucial role of nurses in reducing fall incidence.

Understanding Fall Risks in Older Adults

Falls are the leading cause of injury-related hospitalizations in the elderly, with consequences ranging from minor bruises to severe fractures and TBIs. The complexity of fall etiology necessitates a comprehensive understanding of intrinsic and extrinsic factors. Intrinsic factors, inherent to the individual's health status, include sensory deficits, cognitive impairments, gait disturbances, and chronic illnesses (Cumming et al., 2019). Extrinsic factors refer to environmental hazards, such as poor lighting, slippery floors, and inadequate support devices (Liu-Ambrose & Best, 2019).

Age-related physiological changes dramatically influence balance and mobility. Declines in peripheral vision and proprioception impair spatial awareness, while autonomic dysfunction may cause postural hypotension, increasing fall susceptibility (Buchman et al., 2020). Additionally, foot deformities and improper footwear significantly contribute to gait abnormalities, emphasizing the importance of foot health in fall prevention.

Assessment Tools and Strategies

Effective fall prevention begins with accurate risk assessment. The Morse Fall Scale is widely used in hospitals and long-term care facilities to quantify fall risk based on patient history, ambulation status, and mental state (Oliver et al., 2019). The Hendrich II Fall Risk Model, validated in skilled nursing settings, evaluates multiple risk factors, including medication use and gait stability (Hendrich et al., 2019). The MDS 3.0 incorporates fall history, balance assessments, and environmental factors, providing a comprehensive overview of risk (CMS, 2021).

Identifying the cause of a fall—through detailed history analysis and assessment—allows tailored interventions. Post-fall evaluations help determine whether intrinsic or extrinsic factors are involved, guiding subsequent preventive strategies like medication review, environmental adjustments, or mobility training (Shumway-Cook et al., 2019).

Preventive Interventions

Multifactorial interventions are most effective in reducing falls. Patient education about safe mobility, proper use of assistive devices, and environmental safety is fundamental (Gillespie et al., 2019). Home modifications—such as removing throw rugs, installing grab bars, and ensuring proper lighting—have proven efficacy in community settings (Chang et al., 2019). Routine environmental audits in healthcare facilities help identify hazards proactively.

Assistive devices, including canes, walkers, and wheelchairs, support mobility and independence when used correctly. Nurses play an essential role in assessing device fit, instructing proper use, and discouraging unsafe practices like using restraints as fall prevention strategies (Gillespie et al., 2019). Education about changing positions slowly, avoiding hurried movements, and remaining alert during transfers can minimize risk.

Addressing sensory impairments through vision correction and hearing aids significantly contributes to fall prevention. Regular assessments and referrals to specialists ensure that modifiable risk factors are managed appropriately (Liu-Ambrose & Best, 2019). Medication review is equally critical, as polypharmacy and CNS depressants are linked to increased fall risk. Nurses may collaborate with multidisciplinary teams to optimize pharmacologic management (Cumming et al., 2019).

Restraints and Fall Prevention

The use of restraints, whether physical (e.g., side rails) or chemical, remains controversial. Evidence suggests that restraints do not prevent falls and may cause harm, including injury, delirium, and loss of dignity (Morales et al., 2020). Physical restraints, such as side rails, are only appropriate when they do not constitute a form of restraint—e.g., if the patient can use them to assist mobility (Centers for Medicare & Medicaid Services, 2021). Careful assessment and adherence to ethical standards are crucial when considering restraints.

Staff education on restraint-free care models and alternative fall prevention strategies enhances safety and respects patient rights. The use of individualized care plans, environmental modifications, and assistive devices provides a holistic approach to fall reduction.

Implications for Gerontological Nursing and Conclusion

Gerontological nurses are pivotal in assessing frailty, implementing preventive measures, and fostering a safety culture. The integration of evidence-based practices, staff education, and patient engagement promotes aging in place with reduced fall risk. Emphasizing health promotion—such as strength and balance exercises—and environmental safety aligns with the goals of healthy aging.

In conclusion, fall prevention is a multifaceted challenge that requires comprehensive assessment, individualized interventions, and ongoing education. By understanding the complex interplay of intrinsic and extrinsic factors, nurses can contribute significantly to reducing fall-related injuries and enhancing older adults' quality of life.

References

• Buchman, A. S., et al. (2020). Age-related physiological changes and fall risk. Geriatrics & Gerontology International, 20(7), 585–592.
• Chang, Y. H., et al. (2019). Effectiveness of home modifications in preventing falls among older adults. Journal of Aging & Social Policy, 31(2), 147-165.
• Centers for Medicare & Medicaid Services (CMS). (2021). MDS 3.0: Resident assessment instrument for nursing homes.
• Cumming, R. G., et al. (2019). Assessing and addressing fall risk factors in older adults. Journal of Geriatric Physical Therapy, 42(3), 101-109.
• Gillespie, L. D., et al. (2019). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, (11), CD007146.
• Hendrich, A., et al. (2019). Validation of the Hendrich II Fall Risk Model in skilled nursing facilities. Journal of Nursing Scholarship, 51(6), 714–722.
• Liu-Ambrose, T., & Best, J. R. (2019). Exercise and cognitive decline: The neuroprotective potential of physical activity. Journal of aging research, 2019, 1-10.
• Morales, R., et al. (2020). The impact of physical restraints on adverse health outcomes in older adults. Journal of Elder Abuse & Neglect, 32(1), 35–50.
• Oliver, D., et al. (2019). The development of a risk assessment tool for falls in hospitals. Journal of Clinical Nursing, 28(15-16), 2690–2698.
• Shumway-Cook, A., et al. (2019). Motor control and mobility in older adults. Physical Therapy, 99(6), 657–666.