Meeting Safety Needs of Older Adults

Objectives

1. Discuss the types and extent of safety problems experienced by the aging population.

2. Describe internal and external factors that increase safety risks for older adults.

3. Discuss interventions that promote safety for older adults.

4. Discuss factors that place older adults at risk for imbalanced thermoregulation.

5. Describe those older adults who are most at risk for developing problems related to imbalanced thermoregulation.

6. Identify signs and symptoms of thermoregulatory problems.

7. Identify interventions that assist older adults in maintaining normal body temperature.

Key Terms

heatstroke (HĒT-strōk) (p. 174)

hyperthermia (l-pĕr-THĔR-mē-ă) (p. 174)

hypothermia (l-pō-THĔR-mē-ă) (p. 173)

thermoregulation (thĕr-mō-RĔG-ū-lā-shŭn) (p. 173)

http://evolve.elsevier.com/Wold/geriatric

Safety is a major concern when working with or providing care to older adults. Although older adults compose approximately 11% of the population, they account for approximately 23% of accidental deaths. A report from the National Safety Council reveals that approximately 24,000 people older than 65 years die from accidental injuries each year, and at least 800,000 sustain injuries serious enough to disable them for at least 1 day.

Falls, burns, poisoning, and automobile accidents are the most common safety problems among older adults. Exposure to temperature extremes also places older adults at risk for injury or death. Older adults are more susceptible to accidents and injuries than are younger adults because of internal and external factors. Internal factors include the normal physiologic changes with aging, increased incidence of chronic disease, increased use of medications, and cognitive or emotional changes. External factors include a variety of environmental factors that present hazards to older adults.

Internal risk factors

Vision and hearing are protective senses. When the acuteness of the senses diminishes with aging, the risk for injury increases. Vision and hearing changes are common with aging. Diminished range of peripheral vision and changes in depth perception are common and can interfere with the ability of older adults to judge the distance and height of stairs and curbs or to determine the position and speed of motor vehicles. Night vision diminishes. In dim light or glare, older adults may be unable to see that a curb, step, or other hazard is present. They may be unable to see or read stationary road signs that provide directions or warnings. Falls or motor vehicle accidents often result from altered vision.

Changes in visual acuity make it more difficult to read labels with small print. This can make it difficult for older adults to read the directions on prescriptions. Many older adults have taken incorrect medications or wrong doses or have even consumed poisonous substances because they could not see adequately to read the labels.

Decreased auditory acuity reduces an older person’s ability to detect and respond appropriately to warning calls, whistles, or alarms. For example, older adults may not hear a warning call of impending danger, may not hear a motor vehicle or siren in time to avoid an accident, or may not respond to a fire alarm in time to leave a building safely.

The senses of smell and taste also help protect us from consuming substances that might be harmful to the body. Decreased sensitivity of these senses increases the risk for accidental food or chemical poisoning in the elderly population.

Older adults often experience one or more physiologic changes that increase their risk for falls and other accidental injuries. Any of these changes alone or in combination can reduce the older person’s ability to respond quickly enough to prevent an accidental injury. When these problems are combined with chronic diseases or health problems, the risk increases dramatically. Common physiologic changes that affect safety include the following:

• Altered balance

• Decreased mobility

• Decreased flexibility

• Decreased muscle strength

• Slowed reaction time

• Gait changes

• Difficulty lifting the feet

• Altered sense of balance

• Postural changes

Conditions affecting the cardiovascular, nervous, and musculoskeletal systems are most likely to contribute to safety problems. Any cardiovascular condition that results in decreased cardiac output and decreased oxygen supply to the brain can cause older adults to experience vertigo (dizziness) or syncope (fainting). Common disorders with this result include anemia, heart block, and orthostatic hypotension. Studies have shown that approximately 52% of long-term nursing home residents older than 60 years experience four or more episodes of orthostatic hypotension a day.

Older persons with neurologic disorders such as Parkinson’s disease or stroke experience weakness and alterations in gait and balance that increase the risk for falls. Neurologic and circulatory changes can also decrease the ability to sense painful stimuli or temperature changes, increasing the risk for tissue injuries, burns, and frostbite. A study has shown that nursing home residents with diabetes are more than twice as likely to suffer from falls as those who do not have diabetes.

Musculoskeletal conditions such as arthritis further reduce joint mobility and flexibility, decreasing the ability of the older person to move and respond to hazards and intensifying the likelihood of accidents or injury. Box 9-1 lists injury risks for older adults.

Box 9-1

Injury Risks for Older Adults

• Impaired physical mobility

• Sensory deficits

• Lack of knowledge of health practices or safety precautions

• Hazardous environment

• History of accidents or injuries

Medications often contribute to falls, and, because older adults commonly take one or more medications, their risk for untoward effects is increased. Any medication that alters sensation or perception, slows reaction time, or causes orthostatic hypotension is potentially dangerous for older adults. Common types of hazardous medications include sedatives, hypnotics, tranquilizers, diuretics, antihypertensives, and antihistamines. Alcohol, although not a prescription medication, acts as a drug in the body. Alcoholic beverages, particularly in combination with prescription drugs, increase the risk for falls and other injuries. More information regarding safe use of medications is included in Chapter 7.

Cognitive changes or emotional disturbance and depression may be overlooked as risk factors for falls or injury. These disturbances reduce the older person’s ability to recognize and process information. Distracted or preoccupied older adults are less likely to pay full attention to what is happening or what they are doing. This lack of attention and caution increases the risk for accidents and injury.

Falls

Falls are the most common safety problems in older adults. Consider the following statistical facts revealed in the literature:

1. One-third to one-half of people older than age 65 are prone to falling.

2. Any fall is the best predictor of future falls. Two-thirds of those who have experienced one fall will fall again within 6 months.

3. The older a person becomes, the more likely he or she is to suffer serious consequences, such as a hip fracture, from a fall.

4. Falls are a leading death caused by injury in people older than age 65 and number one for men over 80 and women over 75.

5. Approximately one-fourth of older adults who experience falls will die within a year and another 50% will never return to their previous level of independence or mobility.

6. The incidence of falls is higher among those residing in long-term care facilities than among those who live independently in the community.

7. The number of hip fractures due to falls is projected to exceed 500,000 per year in 2040.

8. The cost to Medicare and Medicaid will climb dramatically as the elderly population increases. Direct costs related to falls are expected to exceed $32 billion by 2020.

These statistics were dramatic enough that the federal government enacted the Elder Fall Prevention Act of 2003 to develop a national initiative intended to reduce falls. This act was designed to fund research, promote public education, and provide services proven to reduce or prevent elder falls. In 2009 and 2010, additional legislation designed to reduce the number of falls among older adults was passed. Legislation requiring training on fall prevention for long-term care workers also has been implemented.

Many independent elderly are reluctant to report a fall because of the implication that they are frail and dependent. In addition to causing bodily harm, falls take a psychological toll on the elderly, causing them to lose confidence and decrease mobility. This is unfortunate because early recognition and interventions can reduce the risk for further falls. Studies have shown that supervised exercise focusing on balance, gait, and strength may be of help, as will environmental modifications. Older adults living independently in the community often do not recognize hazards in their home environment because they are too accustomed to their surroundings to view them as potential hazards. The elderly and their family members need to be aware of things they can do to reduce the risk for falls. Some helpful approaches are summarized in Box 9-2.

Box 9-2

Reducing the Risk for Falls

• Prepare safe surroundings. Make sure you have adequate lighting, particularly in stairwells. Keep frequently needed items such as the telephone, tissues, etc., on a table near your chair or bedside. Avoid placing items on the floor, particularly near your favorite chair or bedside. Make sure there are no throw rugs, uneven floors, electric wires, oxygen tubing, or other items that could cause tripping. Mop up spills in the kitchen or bathroom immediately. Do not climb on anything other than an approved step stool to reach high places.

• Allow adequate time to complete an activity or task. Haste increases the risk for falls or other injuries. If you feel dizzy or lightheaded, sit for a while before standing.

• Wear proper-fitting footwear. Shoes with nonslip soles and low heels are recommended because high-heeled shoes contribute to balance problems. Shoes should have closures that are easy to manipulate. If shoes have laces, check that they do not come loose and cause tripping. Loose-fitting slippers or shoes can drop off the foot and lead to a fall.

• Use assistive devices if needed. A cane or walker provides security by enlarging the base of support. These devices should be kept close at hand to avoid leaning or reaching. The tips should have solid rubber grips to prevent slipping and may need to be modified on icy surfaces to promote gripping.

• Ask for help when necessary. This Bible passage provides good advice: “Pride goeth before destruction, and a haughty spirit before a fall.” Failure to seek help can lead to serious injury. Older adults should be encouraged to recognize that good judgment is a sign of healthy aging and not a sign of weakness.

Fall prevention is everyone’s responsibility. Outreach sessions about fall prevention designed to meet the needs of elderly adults, their families, and anyone who has contact with elderly adults could be offered at senior centers, libraries, businesses, and community colleges. Health care settings need to maintain current and complete policies and procedures for fall prevention, new employee training regarding fall prevention, a method for prompt reporting and investigation of all falls, and scheduled multidisciplinary meetings to identify problems and plan interventions.

Coordinated Care

Collaboration

Fall Prevention

Nursing assistants often have good insights into the reasons for a fall. The nurse could ask the CNA for a few suggestions for actions that might help prevent a future fall. These ideas could then be included in the plan of care. Ownership of the idea is likely to improve compliance with the plan. Make sure that the nursing staff and all other departments take fall prevention seriously. Report the presence of any unsafe conditions, no matter how minor they seem. Notify housekeeping, maintenance, or security promptly and then verify that the problem has been corrected. Another strategy is “Catch me doing something right.” Too often we are quick to blame someone when a fall occurs. It is a far better practice to praise the staff when you see call lights being answered promptly, spills being mopped up, and proper footwear or assistive devices being used. Some literature even suggests identification of a “Falls Champion”—a staff member who has additional training regarding fall prevention who can then provide training to others, act as a mentor to new staff, and keep a high awareness of the need for fall prevention.

Cultural Considerations

Home Fall Risk Among Chinese Older Adults

A study designed to identify risk factors for falls in the homes of elderly adults residing in China revealed data that are very similar to those found in the United States. In China, falls are identified as the second leading cause of accidental death. As with Americans, many elderly Chinese do not recognize safety hazards because they have lived with them for a long time. Risk areas and hazards in China and the United States are almost identical. Tai chi chuan, an exercise designed to maintain balance, is a common daily practice among the elderly in China. The benefits of this exercise for fall reduction are being researched in the United States.