The Use Of Benzodiazepines Or Opioids Increase The Risk Of Falls

Opioid use in the US has increased over the years, and this has led to an increase in substance abuse. Substance abuse is not only associated with use of illicit drugs but also prescription drugs. In 2015, of the 20.5 million reported cases of substance abuse, 2 million had an abuse disorder related to prescription pain relievers and 591,000 associated with heroin.1 The increase in substance abuse disorder has led to an increase in opioid related death. In 2015 drug overdose was the leading cause of accidental death in the US with 52, 404 lethal drug overdoses.2

The following paper is a written critique of the following research article “Improving the evaluation of risk of fall through clinical supervision: an evidence” (Cruza, Carvalhoa, Lopesb, 2016). The purpose of this critique is to analyze, evaluate, and review each section of the above stated quantitative research article. This quantitative, descriptive and correlational study focuses on improving patient safety and quality of nursing care by improving the evaluation of a patients' fall risk using the Morse Fall Scale (MFS) assessment tool in practice under the implementation of a clinical supervision model. (CS)

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).

Considerable cautions have been obtained throughout the United States to decrease the misuse of prescription opioids and helps to minimize opioid overdoses and related complications. Even though the pain medications have a significant part in the treatment of acute and chronic pain situations, it sometimes happen that the high dose prescription or the prescribed medications, without having enough monitoring, can create bad outcomes. It is always a dilemma for the providers to find who is really in need of pain medications and to identify those who are questionably misusing opioids.

Opioids are being over prescribed in the United States resulting in increased deaths by drug overdose. Pain medication strategies are being looked into as substitutes for pain management. Over decades, the amount of medicine being prescribed has more than tripled. State policies regarding the medication were implemented and who'd a small decrease in the likelihood of opioid prescriptions. Nationally, death rates are on the rise. Studies monitoring prescription drugs do not account for illegal opioids and manufactured fentanyl. While not mentioned in this article, there is a possible correlation between young people prescribed opioids and illegal drug use seeing that overdoses are common in patients already abusing their prescription medication, yet overdose death being most common after

Although addiction and overdose of opioids was not declared an epidemic by the Center for Disease Control and Prevention (CDC) until 2011, the beginning of the epidemic can be traced back as early as the 1980’s when attention in medical care began to turn toward pain management. By the early 2000’s the Joint Commission on Accreditation of Healthcare Organizations named pain “the fifth vital sign,” implying that pain is as important clinically as pulse rate, temperature, respiration rate, and blood pressure (Wilson, 2016). At the same time, there has been an emphasis change from patient wellness to patient satisfaction metrics. Non-steroidal anti-inflammatory drugs such as Advil, Aleve, or aspirin have raised safety their own safety concerns, contributing to increased use of opioids. The lack of patient access to and insurance coverage for chronic pain management specialists or alternative healing therapies also contributes to the opioid epidemic (Hawk,

Opioid abuse, misuse and overdose is a problem in The United States. You can’t turn on the TV or read a newspaper without some mention of the epidemic. This issue has caused the practice of prescribing or taking narcotic pain medication to be looked at under a microscope. Patients are fearful to use some necessary pain medication, because they may become addicted. Other patients who genuinely do have pain and need medication are having a tougher time obtaining the help they need. The problem of abuse and addiction is tough to solve since for some people the medications are the only way they can function and live a semi-normal life. A patient with pain may be hesitant to visit the doctor and

Jamison RN, Serraillier J, Michna E. Assessment and treatment of abuse risk in Opioid prescribing for chronic pain. Pain Res Cl. 2011;2011:1-12. doi:10.1155/2011/941808.

The misuse of opioids has been around for over 20 years in the United States. In a 2017 article “Opioid Crisis”, it states that in the late 1990s, pharmaceutical companies misled healthcare providers by informing them that patients would not become addicted to opioid painkillers. As a result, healthcare providers too liberally prescribed opioid pain relievers. Opioid abuse rates started to climb and it was clear that these medications were highly addictive. According to Volkow, Frieden, Hyde, and Cha (2014), between 1990 and 2010 death rates from prescription opioid overdose quadrupled in the United States. This surpassed the death rates from cocaine and heroin overdoses combined. Furthermore, they state that the epidemic is a result

Individuals who use Opioids are Addicts. The history of this very debatable topic is very educational and

Prescription drugs are given to patients daily all over the world. Opioid painkillers are known to provide pain relief, but there seems to be an excessive amount of death and injuries because, more than ever, they are highly marketed and incorrectly prescribed. More than 2 million of Americans are dependent or abuse prescription pain pills (Opioid Crisis…). Worldwide nearly 26.4 million people abuse opioids (Public Affairs). It’s not just an issue in the United States but is becoming a worldwide crisis. The issue is known as the opioid epidemic. This is the question that is being asked: What are the factors of prescription opioids in the United States?

The following research question was addressed: What is the effect of falls in the older adults while hospitalized? CINAHL Complete and Google scholar databases were used to search for relevant quantitative research articles. CINAHL Complete was searched using words like “falls in older adults while inpatient”, “impact of falls in older adults while hospitalized”, falls in older adults”, “and falls in the hospital amongst older adults“, ” fall impact in older adults while hospitalized”. Google scholar databases was searched using keywords such as “impact of falls in hospitalized older adults”, “Fall in the older adults during hospitalization”, “effects of fall on older adults while hospitalized”. Quantitative research article published in English, where any author is a nurse, and adult subjects were analyzed; dates of publications for all articles were limited to the years between 2011–2016. The University of Texas at Arlington’s library site titled finding quantitative and qualitative research was used to evaluate the qualities of the research article to ensure quantitative articles were utilized. Research articles that were utilized were those that involve interventions focused on effects of falls in the older adults population while hospitalized. Multifactorial fall prevention programs, environmental, educational

The Opioid Risk Tool (ORT) specifically identifies whether or not an individual has a family history of substance use, personal history of substance use or a psychological disorder. A second assessment is The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R), this tool is typically self administered and consists of 24 questions. The SOAPP-R was designed to identify aberrant medication-related behaviors (Lakha, Louffat, Nicholson, Deshpande & Mailis-Gagnon, 2014). Finally, The Current Opioid Misuse Measure (COMM), a 17 question inventory, was also designed to measure the likelihood that the patient will misuse their prescribed medication. The SOAPP-R and the COMM were both designed to take an individual's pain scale into consideration during the assessment (Jamison, Serrailler & Michna,

Risk factors for falls are categorized by intrinsic or extrinsic (Tzeng, & Yin, 2009). According to Tzeng and Yin (2008), intrinsic factors, referring to the patient themselves, are related to their health status and possibly associated with age-related changes: previous falls, reduced vision, unsteady gait, musculoskeletal system deficits, mental status deficits, acute illness, and chronic illness. Extrinsic factors are involved in the patient’s environment, including medications, lack of support equipment, furniture, bathroom designs, small patient rooms, poor lighting, and improper use of and inadequate assistive devices. Tzeng & Yin (2008; 2009) focused on the extrinsic risk factors for the basis of their studies.

There must be special attention toward the patient's addiction history before these agents are prescribed. An understanding of the toxicity and side effects of benzodiazepines, abuse patterns and alternative anxiolytic and hypnotic agents may help clinicians to be safe from issues of medico legal case.