Geriatric Screening For Falls: A Case Study

Falls among any individual can cause significant trauma, often leading to an increase in mortality. According to the Centers for Disease Control and Prevention (2012), one in every three adults over the age of 65 falls each year. Long-term care facilities account for many of these falls, with an average of 1.5 falls occurring per nursing home bed annually (Vu, Weintraub, & Rubenstein, 2004). In 2001, the American Geriatric Society, British Geriatric Society, and the American Academy of Orthopaedic Surgeons Panel on Falls Prevention published specific guidelines to prevent falls in long-term

The widespread falls among the geriatric population reduce their quality of life and take away their functional independence. Lee et al (2013) state that falls leads to the rise in mortality rates and morbidity complications such as fractures and disabilities,1 out of 3 elderly persons in a community setting falls in a year. About 87% of all fractures in the elderly are due to falls. Several of the risk factors that are associated with falls are visual impairments, cognitive impairments, and health-related problems: arthritis, orthostatic, back pains, lack of balance-weakening muscles, previous falls, polypharmacy or psychoactive drugs (Lee et al, 2013).

Falls are a common and complex geriatric syndrome that cause considerable mortality, morbidity, reduced functioning, and premature nursing home admissions. Falls have multiple precipitating causes and predisposing risk factors, which make their diagnosis, treatment, and prevention a difficult clinical challenge. Identifying effective interventions to prevent falls and fall-related injuries among older adults is a major area of research and policy development in geriatrics. Several published clinical guidelines review the evidence for fall prevention strategies and provide recommendations for assessment and intervention (Rubenstein & Josephson, 2006).

“In the United Sates, unintentional falls are the most common cause of nonfatal injuries for people older than 65 years (Hughes, 2008).” This illustrates a problem that requires addressing. “Rates of falls vary across hospitals and units however, the highest rates are found in neuroscience (6.12-8.83/1000 patient days) and medical (3.48-6.12 falls/1000 patient days) units” (Mion, 2014). Older adults are usually those most affected and their falls are

Therefore, one could understand the importance of fall prevention among the elderly population in both the institutional and home settings. The following will discuss best practices to assist in the prevention of falls and geriatric syndromes.

Falls are considered a leading cause of mortality and injury among older adults and majority of the falls occurs while hospitalized. One would think being in the hospital would be one of the safest places for older adults as far as fall prevention is concern due to the fact that hospitals provide staffing around the clock for patients but more and more falls have been occurring in the hospital especially in the older adult population. Fall is an unintended descent to the ground. It raises public and family care liability; it also decreases patient’s functioning because it causes pain and suffering, and increases medical costs (Saverino et al, 2015). The Center for Disease Control

According to the Joint Commission Resources-JCR (2005), there is no universally accepted definition of a fall. Thus several definitions have been floated over time in an attempt to define the same. One such definition of a fall is "an untoward event that results in the patient or resident coming to rest unintentionally on the ground or another lower surface" (Joint Commission Resources, 2005). Falls are regarded common causes of injury at every age. However, it is important to note that for seniors, falls can have serious consequences. This is more so the case given that a fall can bring about pain, trauma, or even death. With that in mind, the primary purpose of this program remains the reduction of falls and hence the aversion of related injuries amongst the concerned patients. Of key importance remains the identification of patients who appear to be at high risk of falling. This way, appropriate strategies can be developed to reduce the injuries related to inpatient falls.

Falls are the leading cause of unintentional injuries in the elderly patients living in the long-term care setting. The aim of this project was to identify risk factors associated with increase falls among the elderly in order to prevent and monitor safety related events relating to falls. There are numerous risk factors associated with falls among the elderly, as the direct care nurse, working in the long-term care setting, we need to identify any possible factors that can contribute to falls, in order to prevent injury. Through evidence-based research and education we can help decrease the incidents of falls in our elderly community.

A fall is a lethal event that results from an amalgamation of both intrinsic and extrinsic factors which predispose an elderly person to the incident (Naqvi et al 2009). The frequency of hospital admission due to falls for older people in Australia, Canada, UK and Northern Ireland range from 1.6 to 3.0 per 10 000 population (WHO 2012). The prevalence of senior citizen’s falls in acute care settings varies widely and the danger of falling rises with escalating age or frailty. Falls of hospitalized older adults are one of the major patient safety issues in terms of morbidity, mortality, and decreased socialization

Several national and global campaigns already exist that provide tips and resources for fall prevention. However, statistics continue to demonstrate that falls continue to remain a serious problem in the elderly community. No one can argue that education is the best defense against falls. Nor can they argue that national efforts are not needed. Despite these national campaigns, falls

In February, I had the opportunity to volunteer as a student nurse at one of Fresno State’s SAFE Balance screening sessions. This event was not only specifically important to our community, but to the entire realm of medical field in general because people are living longer. Not only is the elderly population increasing, they also are having to live with many other health issues, which is where medical professionals’ come into play to promote disease prevention, wellness, and overall living a lifestyle in the healthiest and most independent way possible. Precisely, one of the major health concerns among the elderly, is their risk for falls, since falls are growing an increasing problem in fractures, which often lead to other health problems.

In the absence of evidence to support a population-based approach to prevention and the imperative to deliver cost-effective and efficient services, health care providers need risk assessment tools that reliably identify at-risk populations and guide intervention by highlighting remediable risk factors for falls and fall-related injuries. Such tools typically consist of a rating or scoring system designed to reflect the cumulative effect of known risk factors for the purpose of identifying those at greatest risk for sustaining a fall or fall-related injury [*]. Historically, fall risk tools have focused on institutional settings with little attention to tools tested in community settings. Of the reviews that do include community dwelling seniors, tools are typically limited to the assessment of balance with little consideration of other risk factors [*].

The clinical theme identified for my review of Dr. Toto's work is on geriatrics and gerontology. Its primary focus is on several issues such as prevention of falls through modification of areas of residence, development of exercise programs for improvement of physical activity and many other sensitive areas in the field to improve the well-being of the elderly. The theme also advocates for early identification and early screening in order minimize disabilities common in community-dwelling adults (Toto, Raina, Holm, Schlenk, & Rogers, 2011)

Fall is the major cause of injury in the elderly, which places more load on the health care system (Krasovsky, Lamontagne, Feldman, & Levin, 2014). Samuel D. Towne Jr. and his colleagues conducted a study to calculate the cost of hospitalizing older people as a result of falling in Texas Hospital. 77,086 fallers were hospitalized, costing around 3.1 billion dollars in 2011, which is an increase of around 2 billion dollars since 2007 (Towne, Ory, & Smith, 2014). Moreover, fall directly causes 21,649 deaths and indirectly causes 5,402 deaths in the United States in 2010 (Stevens & Rudd, 2014). Also, 420,000 individuals around the world die yearly because of falling (Mignardot et al., 2014). Most falls in older adults take place during walking (Lee, Verghese, Holtzer, Mahoney, & Oh-Park, 2014). Therefore, falls are related to gait variability

Being a smaller clinic we have the ability to build rapport with our patients and effectively address all of their needs. We have a smaller group of geriatric patients who are the most common demographic associated with the risk of falling. We have the ability to offer fall risk assessments to all of our patients over 65 who may be susceptible to a fall. Since we have the ability to know our patients personally, we have the advantage to stress the urgency of fall risk factors and provide referrals and educational materials on a case-to-case basis.