2024 Lecture 7 Falls Nursing Management PDF

JESMAR S. ESPIRITU PhD Associate. Professor  LEARNING OUTCOMES: 1. Identify potential fall risk factors 2. Determine high risk medication that may contribute to falls 3. Implement key fall interventions 4. When to refer to pharmacist for review 5. Use national fall prevention progra...

JESMAR S. ESPIRITU PhD Associate. Professor  LEARNING OUTCOMES: 1. Identify potential fall risk factors 2. Determine high risk medication that may contribute to falls 3. Implement key fall interventions 4. When to refer to pharmacist for review 5. Use national fall prevention programs to assist with patient/family education 2 FALLS  Identifying Fall Risk: Strategies to Prevent Falls  Intrinsic Risk Factors Demographic Age Gender Race  Intrinsic Risk Factors Age related Impaired Medical Changes Sensory Conditions * Muscle * Vision/hearing * Dizziness weakness Impairment / Vertigo * Gait & * Peripheral * Cardiovascular balance Neuropathy disease disturbance * Decreased * Proprioception * Neurological body weight condition  Intrinsic Risk Factors Medications Personal Environmental Factors Hazards High Risk Ill fitting Throw rugs Medication footwear Polypharmacy Inappropriate Poor Lighting walking aids Medications Nocturnal Electrical Cords Voiding  Intrinsic Risk Factors Examples: ✓ Remove loose floor mats ✓ Paint edges of steps ✓ Reduce glare ✓ Grab bars and stair rails ✓ Remove clutter– Improve lighting ✓ Best results when safety evaluation done by occupational therapist  FALLS AND FRACTURES Minor trauma like a fall can cause a fracture in a frail or osteoporotic patient : fragility fracture Risks Low bone strength : Increase risk of trauma  FALLS AND MORBIDITY Decline in function: ✓Increased likelihood of going to a nursing home ✓Greater use of medical services– ❑hip fracture patients: 25-75% do not recover back to functional status before the fall  RISK FACTORS FOR FALLS Personal Factors Environmental Older age Factors Female gender Slippery or uneven floors Low body mass Rugs Musculoskeletal diseases Poor lighting Balance problems Poor vision Electrical cords Problems with cognition Chairs without handrails Problems with sensation Slippery surfaces Low blood pressure when Use of certain standing medications  FALLS PREVENTION EXERCISE ✓ Exercise for strength, balance, flexibility, endurance ✓ Single best modification to reduce falls ✓ Group and home-based exercise both helpful ✓ Talk with your doctor before starting an exercise program to find best fit  FALLS PREVENTION Environmental Factors ✓Slippery or uneven floors ✓Rugs ✓Poor lighting ✓Electrical cords ✓Chairs without handrails ✓Slippery surfaces ✓Use of certain medications FALLS IN THE HOME  Huge impact on quality of life Among people who fall, less than half talk to their healthcare provider about it. https://youtu.be/UzlgYS9S82I 32  ADJUST YOUR FOOTWEAR Footwear that fits poorly, has worn soles, high heels, not laced are associated with higher risk of falling Anti-slip shoes reduced rate of falls in icy condition If you have chronic foot pain/conditions, ask your podiatrist for foot and ankle exercises Anti-slip socks do not seem to prevent falls in hospitalized older patients  MINIMIZING MEDICATIONS Some medications put people at increased risk of falls ✓ Medications that can affect your mental state ✓ Too many medications ▪ Anticholinergics: oxybutynin, amitriptyline, diphenhydramine. ▪ Antihistamines: hydroxyzine ▪ Medications affecting blood pressure ▪ Muscle relaxants: cyclobenzaprine, methocarbamol ▪ Psychotropics Anti-diabetic Opioid analgesics Cardiovascular agents Antiepileptics Antidepressants  MINIMIZING MEDICATIONS ❑ Gradual removal of certain drugs for improving sleep, reducing anxiety, treating depression were shown to reduce rate of falls  30% lower risk for stroke 21% increased risk for falls Cardiovascular Medication Use: RISK VS BENEFIT  CERTAIN INTERVENTIONS ❑ Gradual removal of certain drugs for improving sleep, reducing anxiety, treating depression were shown to reduce rate of falls  CERTAIN INTERVENTIONS ❑ Gradual removal of certain drugs for improving sleep, reducing anxiety, treating depression were shown to reduce rate of falls Review all your medications with your doctor or pharmacist. MEDICATIONS INCLUDE: Prescriptions Supplements Over-the-counter medications Vitamins  Medications that relax you, help you sleep, or improve your mood can increase your risk of falling. Use only 1 pharmacy and never take someone else’s medications. Alcohol affects medication – be careful.  Medication and Fall Risk ▪ Fluoxetine 40 mg daily ▪ Clonazepam 1 mg qhs as needed for sleep ▪ Atorvastatin 10 mg at bedtime ▪ Aspirin 81 mg daily ▪ VITALS: Supine – 129/53, 59; ✓ Sitting – 103/40, 60; ✓ Standing –101/51, 62.  SAFE Medication Review Framework ▪ A Team-based Approach ▪ Use this framework to conduct a medication review to help prevent older adult falls. Screen for medications that may increase fall risk. Assess the patient to best manage health conditions. Formulate the patient’s medication action plan. Educate the patient and caregiver about medication changes and fall prevention strategies. 2016 Formulate the patient’s medication action plan. Stop medications when possible  Formulate the patient’s medication action plan. Switch to safer alternatives Formulate the patient’s medication action plan. Educate the patient and/or caregiver about medication changes and fall prevention strategies. Discuss the following: Reasons for medication changes Steps for implementing action plan Other approaches to reduce fall risk Importance of referrals to specialists such as PT/OT/vision check Measuring Orthostatic Blood Pressure 1 Have the patient lie down for 5 minutes. 2 Measure blood pressure and pulse rate. 3 Have the patient stand. 4 Repeat blood pressure and pulse rate measurements after standing 1 and 3 minutes. A drop in BP of ≥20 mm Hg, or in diastolic BP of ≥10 mm Hg, Or experiencing lightheadedness or dizziness is considered abnormal. Who Has High Risk Factors for Falls? ▪ Time frame of 1 month post hospital discharge ▪ Suffered a fall within past 12 months ▪ Diagnosed as a frail individual ▪ Acute illness ▪ Exacerbations of chronic illness KEY STEPS FOR FALL PREVENTION ▪ Identify and address fall risk factors ▪ Refer as needed to specialists or community programs ▪ Follow up with patient in 30 days KEY FALL INTERVENTIONS Add Vitamin D supplementation Modify medication Manage hypotension Address foot and vision problems Enhance strength and balance Educate patient and family Optimize safety  CERTAIN INTERVENTIONS ❑ Cardiac pacemaker insertion if you have carotid sinus hypersensitivity ❑ Treatment of postural hypotension ❑ Cataract surgery for the first time– Not as helpful for the second eye  VITAMIN D SUPPLEMENT ❑ Cardiac pacemaker insertion if you have carotid sinus hypersensitivity ❑ Treatment of postural hypotension ❑ Cataract surgery for the first time– Not as helpful for the second eye  VITAMIN D SUPPLEMENT ❑ you have low Vitamin D levels,Vitamin D supplementation may reduce your rate of falls– ❑ Goal dose of Vitamin D3 800-1000 IU daily– ❑ However, does not seem to reduce rate of falls or risk of falling if you have normal Vitamin D levels  BE CAREFUL AFTER CERTAIN EYE TREATMENTS ❑ One study showed vision assessment resulting in new eyeglasses or ophthalmologic treatment resulted in increase in fall risk – ❑ This may reflect an adjustment period to  IF A PERSON FALLS ADVICE ❑ Stay calm and check to see if they’re hurt ❑ Call for help if they are hurt ❑ If they think they can get up, do it safely (next slide) ❑ Seek medical attention immediately if they have hit their head ❑ Inform physician about the fall  TALK WITH YOUR DOCTOR ❑ Talk about recent falls, fear of falling, or difficulty with balance/walking at least once a year ❑ Review medications ❑ Get eyes checked yearly ❑ Have cardiovascular status assessed ❑ A plan that is individualized to individual patient is better than a general standard plan  START SMALL ❑ Stand up slowly ❑ Assess home for hazards ❑ Avoid excess tobacco and alcohol ❑ If an elderly felt unsteady, can try cane or walker ❑ Wear non-skid, low-heeled or lace up shoes ❑ Review your medications with pharmacist or doctor ❑ Exercise with guidance…  CHECK SURROUNDINGS PAY ATTENTION TO WHAT IS IN CLUTTERS IN THE PATHWAY ❑ Use bright lights and nightlights inside your home. Use motion-sensing lights outside. CHECK SURROUNDINGS Advice to watch their step!  CHECK SURROUNDINGS Install grab bars for tub, shower, and toilet. Use the right equipment  Heel cup is deep with a Laces or Velcro® snug collar to provide closure allows a support and prevent heel snug fit and room slipping for swelling Toe box is deep and Heel is wide and wide flat to provide enough to allow toes better side to move stability Shoe length is no more than 7 mm Heel should be no (1/4") longer than more than 10 mm your longest toe (3/8") higher than the toe For better stability, the Sole provides thickness of the midsole good grip but does should not be thicker not stick to carpet than 25 mm (1")  SPEAK UP ABOUT DIZZINESS INFORM HEALTH CARE PROVIDERS AND TAKE ACTION. Have blood pressure checked. SPEAK UP ABOUT DIZZINESS Before getting up: Clench fists and circle ankles ten times Rise slowly Sit or lie down again if feeling dizzy or light-headed  PREVENT FALLS. Many falls are preventable Take action to prevent a fall Identify risk factors and make a plan Tell healthcare provider if they have fallen. 74 QUESTIONS?  Sources www.cdc.gov/steadi ncoa.org/healthy-aging/falls-prevention/falls-prevention- awareness-day/general-resources/infographics-handouts/ https://www.medscape.com/viewarticle/841020 https://www.medscape.com/viewarticle/831517 https://www.youtube.com/watch?v=o54v_tuEvpw https://youtu.be/UzlgYS9S82I Mrs. Doubtfire