Mobility Challenges & Environmental Safety PDF

Objective 11: Mobility Challenges & Environmental Safety Required Readings: Chapter 12 & 13 Mobility: is essential to survival. contributes to quality of life. Aging Changes & Mobility involves such maneuvers as general locomotion (total body in motion). includes fine motor e.g. grasping, holdi...

Objective 11: Mobility Challenges & Environmental Safety Required Readings: Chapter 12 & 13 Mobility: is essential to survival. contributes to quality of life. Aging Changes & Mobility involves such maneuvers as general locomotion (total body in motion). includes fine motor e.g. grasping, holding. Age related changes Strength & flexibility of muscles decline Endurance declines Movements & ROM are more limited Joints change, regeneration of tissue slows, cartilage & muscle wasting occurs Mobility: Age Related Changes Changes are LESS pronounced in those who remain active & are at a reasonable weight *Management of chronic illnesses & maintaining healthy lifestyle can maintain mobility & agility* Aging & Gait Changes Velocity decreases, steps are slower Decrease in step height (lifting foot when taking step) Length of stride decreases Width of stride increases (wider side to side swaying) Narrowing standing base More deliberate, cautious movement Slower responses Diminished arm swing Risk Factors Mobility Changes: Risk Factors & Consequences • Sedentary lifestyle • Excess weight • Smoking Consequences of Immobility • Dehydration • Pneumonia • Contractures • DVT (Deep vein thrombosis) • Constipation • Pressure ulcers • Incontinence • Isolation & depression Muscle strength...Weight bearing Flexibility…Smooth movement Mobility: Assessment Considerations Postural stability…Center of gravity Cognition…Comprehension Perceptions of stability…Limitations Gait (balance)...e.g. shuffling gait Medications...Vertigo; postural hypotension, polypharmacy. Immobility/Gait Related Conditions Mental Health: Depression, Substance abuse Neuromuscular: Parkinson’s, Dementia Musculoskeletal: Arthritis; Fractures, Osteoporosis Neurosensory: Tinnitus; Vertigo Cardiovascular: Circulation problems, CVA Osteopenia/Osteoporosis • Porous bones, gradual loss of bone density with aging, leading to a weakening. • Often asymptomatic, associated with 80% of fractures, in those 60 years & over. • Height loss of > 3 cm or kyphosis • Risk Factors: (Box 18-1). • Interventions: Exercise, nutrition, vitamin D & calcium supplements (800-2000 IU in >50 years), Fall prevention. Arthritis 1 Recall from Obj. 5 2 Number 1 reason for limited activity from middle age onward 3 ROM can be limited 4 5 Gait can be uncoordinated (Stiff/fixed/guar ded) Pain/Swelling/I nflammation can reduce flexibility & mobility Parkinson’s Disease • Degeneration of the neurons of the substantia nigra. • Death of the dopamine generating cells of the substantia nigra in the mid brain. • Abnormal movement called parkinsonism leads to mobility issues. • S/S • Resting tremor (hands/feet) • Rigidity • Bradykinesia (Slow movement) • Postural instability / abnormalities • Shuffling gait (festination: very short steps) Falls Leading cause of death by injury in older adults Most common cause of nonfatal injuries & hospitalizations for trauma 20% – 30% of older adults fall every year A ‘Fall’ is often a symptom of underlying issue 95% of hip fractures caused by falls Fall Risk Assessment Determine the risk for falls: (Table 12.1) •Previous falls •Medications •Vision •Postural hypotension •Balance & gait •Neurological assessment: proprioception, cognitive fx •Underlying Cardiac disease •Home environment *Eastern Health Fall Prevention: https://hi.easternhealth.ca/healthy-living/injury-prevention/general-injury-prevention/falls/ Hendrich II Fall Risk Model Morse Fall Scale The Berg Balance Scale Fall Risk Assessments Minimum Data Set (MDS) Resident Assessment Protocol (RAP) Activities-specific Balance Confidence (ABC) scale Comprehensive Fall Evaluation (CFE) Health Assessment of all systems. Identify risk factors. Fall Prevention Environmental modifications (lighting, loose rugs Assistive devices (note: avoid rubber-soled shoes). Education (older adults + caregivers). Programs to promote age-appropriate activities / exercise. Restraints • Aimed at eliminating or reducing the risk of physical and psychological harm associated with falls in older people • Types • Chemical: Drugs (psychotrophics) • Non-chemical: Posey restraint products, geri-chairs, dinner trays, wander guards, side-rails, caregivers, strangers, family members • Environmental: Secure unit Restraints Alternatives should always be implemented before invasive restraints are used Doctor’s/court’s order for restraints ALWAYS check facility policy Alternatives to Restraints: •Close observation •Develop individualized plan •Arrange for family to stay with person •Keep in supervised area, or near nursing station •Use night lights •Lower bed •(Box 12-4) Challenges of Thermoregulation Older adults are very vulnerable to extreme temperatures (high/low) Pose extreme risk to declining physical health Prevention & early detection is key Sensorineural changes in thermoregulation = decreased awareness of temperature change, High risk for Hyperthermia & Hypothermia Reduced subcutaneous tissue (loss of insulation) = a person is sensitive to cold. Age Related Changes: Thermoregulation Decrease efficiency of sweat (eccrine) glands become fibrotic & surrounding connective tissue becomes avascular = hard to cool down. Decrease in ability to shiver or sweat to regulate temperature. Risk Factors: Challenges of Thermoregulation • Medications affect thermoregulation (i.e. BP medications that vasoconstrict/vasodilate blood vessels) • Alcohol & sedatives inhibit response to extreme temperatures • Multiple chronic / acute illnesses predispose to hypo/hyperthermia Environmental Factors: • Older adults may not have access to fluids. • May not be able to take off or put on extra clothing, or bed clothes, or adjust room temperature. • May not be able to afford appropriate heating or air conditioning. Prevention of Hyper/Hypothermia Hyperthermia: Education Hypothermia: Nursing strategies • Keep out of direct sun • Stay inside if home cooler, use fans • Drink lots of water • Take a cool shower / bath • Limit physical activity • Ask about adverse effects of medications • Avoid sugary drinks • Take extra salt if having muscle cramps • Maintain a warm temperature, not less that 18-degree Celsius. • Ensure enough clothing & bed clothes are worn. • Cover the person when bathing, dry hair. • Provide as much exercise / activity as possible (to generate heat). • Provide hot high protein meals to sustain heat production (See Box 12.8) Seniors & Driving • Driving = An Instrumental Activity of Daily Living (IADL) • Driving is a highly complex activity, it requires that a person has motor, visual, and cognitive skills • Health changes & conditions associated with aging affect ability to drive safely. Referred to as a ‘mobility crisis’ when an older person can’t drive any more or use public transportation Seniors & Driving When Seniors can’t drive it contributes to: • Social isolation / depression / anxiety • Poor nutrition • Decreased accessibility to healthcare services, neglect of health care • Decreased quality of life • Greater risk for placement in LTC Seniors & Driving Older Adult Driving Patterns Nursing Strategies • Drive fewer miles, do not tend to drive at night or in poor weather conditions or congested high traffic areas • They have more accidents compared to younger age groups, & 3x more likely to die • Age 65-74 years of age – the leading cause of injury related deaths is MVAs • *Important for healthcare providers to have candid discussion with older adults about driving & safety • Encourage assessment to address impairments to enhance safety (i.e. visual exam, updated glasses, modifications to vehicles – hand controls, etc.) • Driving evaluations to assess driving competency, varies across country Purpose of Assessment Tools • Part of a Gerontological Assessment is a Function Assessment, which is focused on: • The evaluation of a person’s ability to carry out self-care & live independently, also show to result of decline with aging • Also identifies physical needs reflecting function (i.e. FANCAPES) used for frail older adults Examples of Assessment Tools Activities of Daily Living (ADL): eating, toileting, ambulation, bathing, dressing & grooming. Instrumental Activities of Daily Living (IADL): Telephone, travelling, driving, shopping & preparing meals. Tasks requiring a higher level of functioning. See box 13.1 pg 198 Katz Index: Point system that can demonstrate the performance ability of an individual with respect to 6 functional ADL’s (bathing, dressing, toileting, transferring, continence & feeding). See Table 13.2 pg 199. • Scale can range from independence to dependence. Examples of Assessment Tools • FANCAPES: Useful in assessing the frail elderly. Assesses the basic needs and the individual’s ability to meet those needs • Fluids • Aeration • Nutrition • Communication • Activity • Pain • Elimination • Socialization Implications for Gerontological Nursing Goal of assessment is to assist older adult in improving quality of life. Gerontological nurse challenged to provide highest level of excellence in assessment of older adults without burdening person. The assessment tools provide a common language between professionals. Assessment of the Older Adult: Key Points Listen patiently. Be able to identify normal age-related changes / disease pathology /lifestyle implications. Understand the barriers that impact function. Be familiar with assessment tools, seek guidance when necessary. Ask open ended questions, avoid leading questions. Questions family & caregivers as appropriate. Use observational skills. Use Team Approach.