Causative Factors Relating to Falls Within the Elderly in Their Home Environment
The purpose of this essay is to analyse and evaluate the risk and causative factors relating to falls associated with the elderly in their home environment. The question presents a case study of Mavis Bazmati and outlines various aspects of her health and home situation. As a community nurse Mavis’ home will be assessed for potential hazards and provide strategies to prevent further falls. There are different community resources that are available to help Mavis and other members of the multi-disciplinary health team to assist with her activities of daily living.
Falls in the elderly is a health risk priority (Crisp & Taylor. Pg. 235). People aged 65 and over are at most risk as falls can often result in morbidity, mortality and injury (Shumway-Cook et al, 2009). The Australian Institute of Health and Wellbeing show statistical data relating to hospitalisation due to elderly people falling in the home. It is categorised by age and sex in Australia from 1998. The total number of women falling in the home leading to hospitalisation was 14,974 compared to the males who accounted to just 4799 (http://www. ihw. gov. au). The most prevalent injuries from elderly people falling are fracture of the femur and pelvis and may lead to death (http://www. aihw. gov. au). Sustained injuries from a fall may not heal properly for an aged person as their bones and muscle tissue are weaker than an average young adult. Therefore, the healing process is prolonged and likely to be more problematic in the future after healing. In the case study of Mavis Bazmati it stated that she was admitted to hospital with lower back pain and had had a fall three weeks prior.
The case study gives limited information about Mavis but some possibilities relating to her back pain could be Osteoporosis, a slipped vertebral disc and/or muscular damage. There are many different reasons for the incidence of falling. The types of falls that an aged person could include: slips and trips, which relate to slipping on a wet surface or tripping over a rug, a drop attack where the person is conscious and falls from a loss of muscular tone or drop in blood pressure (Ebersole, Hess & Luggan, pg. 83), syncope, where the person loses consciousness from lack of oxygen to the brain but regains consciousness after seconds or several minutes. Vertigo, where dizziness and disorientation affects the person’s balance and leads to falling. However there are also intrinsic and extrinsic factors which contribute to the causative factors of falling. The intrinsic factors can be psychogenic, physiologic with extrinsic factor relating to environment (Ebersole, Hess & Luggan, pg. 381). Since falling is a problem when it occurs, it may be a symptom of another problem.
Psychogenic factors relate to psychological disorder, including dementia, depression and fear and anxiety (Heath and Schofield, pg. 262). Dementia could lead to a person falling because of the alterations in gait, lack of sufficient vitamins and an unawareness of the possible hazards in their environment (Ebersole, Hess & Luggan pg. 381). Depression could cause the person to lose their motivation for life and not care about their own safety. Fear and anxiety could possibly lead to a fall as the person may get a fright or become distracted with scattered perceptions.
Physiological factors are health problems the person is experiencing. Falls from physiological disorders include neurosensory and visual deficits such as vertigo, syncope, seizures, glaucoma and cataracts (Ebersole, Hess and Luggan, pg. 381). Disorders such as cardiovascular disorder, hypotension, cerebral vascular insufficiency, osteoporosis and cancer are other physiological factors. Antidepressants, analgesics and sedatives are medications that may be potentially dangerous as they may cause loss of balance, light headedness or drowsiness.
Diagnosing physiological factors is extremely important for nurses and other health care members to care appropriately for the person and help in this case Mavis receive the best quality of life. Environmental factors relate to the person’s surroundings and living situation. There are many risks in the home and identifying the dangers is an essential key for the person’s safety and wellbeing. Slippery floors, poor lighting, pets, inappropriate footwear, electrical cords and loose rugs or mats are just a few potential high risk problems (Heath and Schofield, pg. 262).
As a community nurse it is imperative that a home assessment is completed prior to discharge. Although it is unknown if Mavis has dementia it is a factor that should be considered as she is 91 years of age. Another unknown factor is if she has a visibility or mobility impairment or suffers from any alterations in gait (Bueno-Cavanillas, 2000). The home assessment will be conducted on a room to room basis using a falls risk assessment tool. By gathering and documenting this information it will provide more insight into Mavis’ health and lifestyle and give necessary information to other health care members which may be vital.
It will be demonstrated in the following examples what rooms are most at high risk for falls, the hazards involved and the strategies for the prevention of falls. The Bathroom: High Risk Area The hazards in this room include: – Slippery floor due to excess water from showering or spillage of urine or body fluids. – Uneven, cracked or broken tiles – Shower recess hob – Open bar heater Strategies to reduce potential hazards: – Non slip tiles or adhesive mats – Direct level entry into shower recess and removing hob – Hand rails in situated in shower and near toilet to help ambulate – Having a commode in the shower or bath seat Having a adjustable built up toilet seat with rails – Turn taps instead of screw taps – Adjustable and movable shower hose – Heat/light/fan installed in ceiling The Kitchen: High Risk Area Hazards in this room include: – Slippery floor from splashing of water or spillage of food and beverages – Leaking refrigerator – Insufficient and dangerous electrical appliances – Uneven or broken lino on floor Strategies for prevention of falls: – Easy accessible white goods eg. Fridge, microwave – Turn taps rather than screw taps Appliances modern and in working order such as pop up toaster, turn off kettle – Direct level cupboards, eliminating high overhead cupboards – Non slip mat The Lounge Room: Medium Risk Area Hazards may include: – Electrical cords or wires on floor in walk way – Reducing clutter that Mavis may trip on such as pot plants, unused furniture – Open bar heater situated on floor – Rugs and mats on floor Strategies for prevention of falls: – Removing mats – Installing a heater/fan mounted in wall – Using a remote controlled electrical recliner to help stand easily – Or an orthopedic chair to help ambulate Removing all electrical cords and wires The Bedroom: High to Medium Risk Hazards may include: – Foot wear or clothing articles left on floor – Inappropriate bed height – Rugs or mats – Inappropriate lighting Strategies include: – Ensuring there is no obstacles in walk way or on floor – Railing to help let Mavis sit up or lower herself into bed – Adjusting bed height to Mavis e. g. Bed lowered if too high etc. – Touchable lamp next to bed and sufficient lighting in bedroom – Chair to sit while dressing or removing clothes – Carpet not floor boards, she may slip with socks or bare feet on boarded floor
The Laundry: Medium to Low risk Hazards may include: – Electrical cords and wires – Obstacles such as washing basket on floor, clothing – Older model of washing machine and dryer Strategies include: – Having a front load washing machine and dryer as Mavis would not have to lean into washing machine to obtain her washing – Having the washer and dryer on her direct level for easy access – Using a indoor clothes rack instead of the out door clothes line as may be hard to reach and hazardous in yard – Remove all cords and obstacles from pathway Reference for above hazards and strategies (www. ealth. nsw. gov. au). It would be essential that a qualified electrician assessed Mavis’ electricity supply, appliances and power points to ensure that there was no potential danger or risk to Mavis. As mentioned previously Mavis should replace kitchen appliances if they are old and do not have safety measures in order. Smoke alarms are crucial in any household and should be installed if not already and checked every few months for working order and battery change. Mavis’ dog Roxy her Maltese terrier is a high risk for falls being a small dog and could possibly get under Mavis’ feet causing her to fall.
If Mavis were to go to hospital for a prolonged period of time there are services available to accommodate her dog. The RSPCA boards dogs at a low cost as does local veterinary surgeries. Boarding kennels are available at a higher price, however given Mavis’ financial situation, she may not be in the position to afford these services. Since Mavis lives alone in a large home it would be recommended she had an emergency call system installed to prevent the possible occurrence of a of a fall or any other emergency.
Vital call is a system where the person, in this case Mavis wears a pendantor wristband and if at any time needs any form of help whether it be for a fall, chest pain or even an intruder she would press the button on the pendant, an alarm would sound and her phone would automatically be transferred to the call centre (www. chubb. com. au). The phone system has a sensitive microphone which can pick up her voice from far away. The call centre would ask if she needed help and an ambulance, police, fire or family member would be alerted as soon as possible.
Vital call would be perfect for Mavis allowing her to keep her independence at home and give her security. Community resources that should be implemented for Mavis would be Meals on Wheels to enable a regular healthy eating regime and diet. This would benefit her and she would not have the concern of preparing her own meals daily and ease stress. A community package would be essential to her where she could attend day care programs transported to and from her home by a community worker so Mavis could participate in social groups.
A cleaner could be arranged with the community company to help her with her domestic duties weekly or fortnightly. A nurse or carer could take Mavis or go to the shops when she required groceries. After she is discharged from hospital a nurse should visit Mavis to help her with her personal care and medications until she is more independent and able. Structural modifications to the home may be necessary if Mavis has uneven, cracked or slippery stairs. A handrail should be installed to ensure she could walk safely up to the door of her house.
Door knobs could be replaced with turn lever knobs to make opening and closing doors more accessible. It could also be recommended depending on Mavis’ mobility and ambulating state that if she has front stairs a ramp may be constructed and stairs removed so she would have easy access in and out of her home. The multi-disciplinary health team is important to Mavis’ health and safety. An occupational therapist is extremely important for Mavis as they would suggest and assess the right and safest equipment for her. An occupational herapist assesses the client’s mobility, walking ability, movement and observes their everyday living to find a solution that could help the person around their own home and perform activities of living if impaired (Crisp & Taylor, pg. 31). The occupation therapist is required to help prevent injury, ensure the home environment is adequate and safe to the person’s needs, increase independency and ambulate and mobilize in a safe and fit manner (www. ausot. com. au). A physiotherapist would be recommended to assist Mavis with her mobility and rehabilitation during and after her hospital stay.
The physiotherapist would help Mavis with the use of walking aids, massage therapy and assist with the alterations of gait (Heath & Schofield, pg. 253). Daily exercises may be suggested for Mavis to do at home to help strengthen her back and other various muscles and encourage her to ambulate without feeling anxious or scared. A physiotherapist analyses and identifies muscle, tendon and ligament problems treating them accordingly (www. physiotherapy. asn. au). A general practitioner would also be important as they would monitor Mavis’ health status, medication and wellbeing.
The GP is responsible for diagnosing and prescribing medication and should review them when and/or if an implication or change arises. The GP can also refer Mavis to appropriate specialists if she any specific health issues in the future. If Mavis’ health deteriorates after her discharge from hospital it may be proposed that she move into an aged care facility with 24 hour support services. A self contained unit may be an option so she would still maintain some independence but have nursing staff on call to assist her regularly.
This possibility is an unfortunate but likely reality as the ageing population continues to grow and people live longer (Salzman, 2006). More health care providers and facilities will be needed in the future to keep up with the expansion of ageing people (Salzman, 2006). The risks of falling are great in the elderly due to many factors. It is imperative that hazards are carefully assessed and strategies implemented to reduce the incidence of falls and injury. Community resources and health are professionals are an important key to the safety, health and wellbeing of an aged person such as Mavis Bazmati. The multi-disciplinary health tem collaborate together to provide the necessary services. The intrinsic and extrinsic factors of falling are a symptom of a greater health problem and should be addressed equally. Elderly people despite what health care professionals provide can still be at high risk of falling. It is in the best interest of the health profession to provide safety measures and promote a client’s health and wellbeing. .
