1. Assessment on the risk of falls and participation of patient in planning the strategies:
Old age is the latter part life, the part of life after one's prime. The risk falls is high in this stage. Research studies show that one- third of all elderly population experiences one or multiple falls in a year, particularly after 80 years. Increased age, sensory and cognitive impairment, side effects of medicines are some of the risk factors of falls in elderly.
It is important to maximise the participation of elderly patient in the assessment on risk of falls and in planning the falls prevention strategies, as the incidents of falls largely affect their self esteem and they will not accept just a strategy for preventing falls as it may indicate and project their weekness and it may again worsen the psychological hurt.
So it is important that the elderly patients has to open up their experiences of falls and they can suggest some preventive measures and the nurse or health care provider can supplement more options into that. Then the elderly patients may follow the strategies for falls prevention. Ensure the participation of elderly by encouraging their independence. Establish a therapeutic relationship and rapport with the eldery client , who is in risk of falls. Understand their nature ; some may need a psychological support, but some may be courageous enough, but may have physical weekness, such people may not be interested in sympathy or just following strategies of preventing falls.
They may go in an independent way or decision. Some time they may restrict the movement and confine to the bed. Nurse has to encourage the healthy movements and walking, meantime a safe environment for walking. Encourage the elderly participation in risk assessment and in planning phase. Healthcare provider can categorise the risk into mild , moderate and high risk by assessing the condition of elderly and the environment.
If falls minimization strategies, are not achieving the desired results , then the healthcare provider has to assess the causes of ineffectiveness of strategies. The causes might be :
* unwillingness of patient in following the. instructions
* Environment related risk
* Elderly patient's physical condition or medication side effects.
If the patient is having nonadherence to instructions, the Nurse can have an open discussion with the patient and consider his opinions and encourage him to adapt the safety measures. Psychological support can greatly help the elderly.
Environmental related risk such as slippery falls, stairs without no proper rails etc. can posses a great risk for falls.
Family members has to take the initiative for changing the environment to a safe place for elderly.
Report to the physician, if any medication side effects, such dizziness, Orthostatic hypotension, are causing the falls . Physician can change the medications or lower the dose. Educate the patient about the medical condition, and the risk for falls and encourage him to follow the falls prevention strategies. Instruct on adequate rest and safe movement.
Encourage the use of walking aids such as front - wheeled walker.
3. Stroke and other conditions that increase the risk of falls:
Stroke: The loss of brain function arising when the blood supply to the brain is suddenly interrupted.
It may be Ischemic stroke or haemorrhagic stroke. Loss of function of a part of brain can cause postural instability and difficulty in balance and coordination of movement. This inturn increases the chance of falls.
Dementia: Another major cause of falls in elderly is Dementia. Dementia is a progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal ageing . Neuronal damage causes cognitive impairment and also problems with mobility, balance and muscle weekness.
This inturn increases the risk of falls in elderly with Dementia.
4. Ageing process and the risk of falls
The process of becoming older is called ageing. In old age, as age increases, progressive decline may occur in the different physiological function and anatomical structure. Certain changes in the old age may increase the risk falls.
1. Sensory impairment : In elderly as age progress, the ablity of the special senses may get reduced such hearing, vision etc.
Impairment in vision, double vision, use of bifocal lenses, short sightedness or long sisightedness may increase the risk of falls by stumbling on the objects .
2. Problem with balance: Hearing impairment may often associated with balance and coordination problem in elderly. Balancing function of the body is mainly controlled by the help of vestibular system of the inner ear. Problems with the inner ear may cause balancing problems in elderly and increase the risk of falls.
3. Arthritis and other musculoskeletal disorders: Arthritis: inflammation , pain and swelling of joints can impair the movement of elderly.
Osteoarthritis is common in elderly population. This medical condition also increases the risk of falls.