Safety



Safety


Sue E. Meiner, EdD, APRN, BC, GNP




Feeling safe and secure in one’s living area is important for all people. With aging comes a need to maintain peace of mind while engaging in daily activities. The confidence to carry out daily tasks is affected by perceived security and safety. Safety is a broad concept that refers to security and the prevention of accidents or injuries. When working with older adults, the gerontologic nurse must provide a standard of care that promotes safety and prevents foreseeable accidents or injuries while also respecting individuals’ autonomy to make decisions. This standard of care should pervade all aspects of the nurse’s health care relationships with older adults.


Healthy People 2000/2010 identified motor vehicle accidents, firearms, falls, and fires as the responsible factors for most of the 400 deaths from injuries per day in the United States. Violent crimes including homicide are another concern for all Americans, including older adults.


Part of the nurse’s role in ensuring safety is educating older adults so that they can make informed choices. Education allows one to weigh benefits versus risks and to choose the best option in the situation. In situations in which clients are unable to make informed choices, family members or significant others are sought as advocates for the clients. If clients are unable to make informed choices and no family members are available, the nurse must use nursing judgment and follow an acceptable standard of care to promote safety and security.


This chapter presents common problems that can jeopardize client safety and lead to accidents, injuries, and even death. These include falls, restraint use, accidental injuries, crime and victimization, elder abuse, vulnerability to temperature changes, disasters, and dangers in the home environment. Attention will be given to safety tips and interventions for injury prevention.



Falls


Overview and Magnitude of the Problem


Falls are a common clinical problem affecting nearly one third of community-dwelling older adults and more than half of institutionalized older persons in the United States. Falling is a major health problem for those older than 65 (Hausdorff, Rios, &Edelber, 2001). In 2005, 15,800 people 65 or older died from injuries related to unintentional falls; about 1.8 million people 65 or older were treated in emergency departments for nonfatal injuries from falls, and more than 433,000 of these patients were hospitalized (Centers for Disease Control and Prevention [CDC], 2005b). Falling occurs among people of all ages, but falling results in higher rates of morbidity and mortality among those older than 75 because of the higher incidence of frailty and a limited physiologic reserve among the aging population (CDC, 2005b). After age 75, white men have the highest fall-related fatality rates, followed by white women, black men, and black women; non-Hispanics have a higher fatal fall rate than Hispanics (CDC, 2005b). In terms of serious injury, falls are the leading cause of hip fractures, accounting for more than 270,000 occurrences annually. In 2000, traumatic brain injury accounted for 46% of fatal falls among older adults (Stevens, 2006). Older individuals who fall are also more likely than other age groups to be hospitalized or institutionalized as a result of the fall or a concomitant serious injury. Fall-related injuries account for 5.3% of all hospitalizations for those 65 years or older (Bell, Talbot-Stern, & Hennessy, 2000; Jager et al, 2000). Women sustain about 80% of all hip fractures (Stevens & Sogolow, 2005). In a research study by Tideiksaar (2005), falls accounted for nursing facility placement in 40% of the population seeking institutionalization.


Falling has numerous antecedents and consequences that can be identified and managed. Most clinical research demonstrates a reduction in fall frequency as a result of intervention strategies to modify risk factors. Clinical programs targeting high-risk older adults have incorporated intervention strategies aimed at medication modification, environmental improvements, and behavioral modification. Clinical research findings demonstrate variability in the effectiveness of these interventions. Not all falls are preventable; therefore goals for individuals who fall frequently are fall reduction, prevention of serious injury, and modification of significant risk factors.


It is also important to note that because falls are multifactorial, not all individuals fall as a result of the same antecedents. For instance, an older woman may lose her balance and fall when hurrying to answer the telephone and then experience a second fall the next morning when getting up from bed too quickly. In this example there are two distinct causes of falling, both of which can be modified through education and behavioral modification. Thus, because falls tend to be multifactorial in this age group, care must be taken to perform a comprehensive assessment of individuals who have fallen; this includes a detailed history and physical examination.


Client education is the cornerstone of fall prevention and management. The gerontologic nurse must explore client beliefs and misconceptions about falling. Older individuals may consider falling to be a normal part of the aging process. For some, it is an expectation of growing old. Individuals who hold these stereotypes must be educated about the normal aging process, which is distinct from diseases and the adverse effects of medications. It is important to tell older adults that the etiology of falling can most often be determined by a health care professional who has expertise in fall assessment and that falls can be reduced and even prevented through some simple interventions (Box 12–1). The treatable causes of falling must also be emphasized in continuing education and staff development programs in all health care settings. Once the clients’ and staff’s knowledge of falling improves, the reporting of falls in an effort to seek treatment may improve.




Falling Defined


It is crucial for the gerontologic nurse to recognize that older individuals define falling in variable ways and are influenced by perceptions of aging and disease and the context of the situation. For instance, older individuals may not perceive a slip that results in a fall to the floor to be an actual “fall”; rather it may be termed a slip, trip, or accident but not a fall. Box 12–2 illustrates some common reasons given by older adults to explain the fall. The falling event needs to be reviewed in detail to determine whether the person fell to the lowest level (i.e., the ground). Moreover, how individuals define falling is likely to influence the reporting of falls. A fall can be anything that causes a person to unintentionally move from one level plane to another. An example of this is a sudden and unexpected drop from standing upright into a seat or onto the floor. Injuries such as bruising, sprains, strains, or fractures can result from minimal height drops.



History taking should be detailed enough for the examiner to envision the details leading to the fall. Refer to the later section Evaluation of Clients Who Fall for specific questions to ask during history taking (Tideiksaar, 2005).



Meaning of Falling to Older Adults


Falling, in a broad sense, is a concept that holds negative connotations because it is associated with a decline, drop, or descent to a lower level. As it relates specifically to client falling, the same negative connotation appears to hold true, as evidenced by the plethora of research that presents the significant negative consequences of falling. However, to clients, falling may mean something entirely different. It may not be associated with an actual dropping to a lower level, such as the ground; falling might mean a perceived loss in status. In a research investigation of community-dwelling older adults’ statements about falls, the extent to which the fall was attributed to a person’s own limitations instead of the environment depended on self-rated health, among other variables (Arfken et al, 1994; Sterling, O’Connor, & Bonadies, 2001). Thus the meaning of falling involves several related variables and most likely is determined according to an individual perception of how serious the fall is in terms of daily living.


The health care professional may equate a fall with a decline in client health or function or a worsening of a client’s condition. Falling may be viewed as a marker of future decline. In fact, the concept of prodromal falling refers to a series of falls that occurs before the onset of illness or disease, as a prelude (or prodrome). Events such as infections are classic examples of medical conditions associated with falling.



Normal Age-Related Changes Contributing to Falling


Numerous age-related changes can predispose older adults to falling, especially when these changes affect functional ability and give rise to sensory impairment or gait and balance instability. This section highlights the salient age-related changes associated with falling, along with nursing interventions directed at modifying the impact of these changes to prevent falling. Normal age-related changes in organ function can contribute to an intrinsic risk for falling (Tideiksaar, 2005).



Vision


Accompanying the aging of the eye are structural changes in eye shape and crystalline lens flexibility. It is the latter change—inflexibility of the lens—that causes presbyopia, a reduction in the eye’s accommodation for changes in depth, such as when ascending or descending the stairs. If older individuals are experiencing presbyopia, instruction must be given for them to carefully watch door edges, curbs, and landing steps, which signal a change in height. Additionally, because of the tendency for the crystalline lens to become cloudy and form a cataract with advancing years, eye glare can occur and cause temporary visual disturbances. This effect is particularly evident outdoors on sunny days or indoors as bright light reflects off shiny floors. Instruction must be given to older individuals with this problem to wear wide-brimmed hats or sunglasses to shield the eyes from the glare effect and to shade indoor windows with drapes or blinds to minimize the effects of sun glare.



Hearing


An age-related change affecting the inner ear is atrophy of the ossicle in the inner ear, which causes changes in sound conduction, including a loss of high-tone frequencies, called presbycusis. Other age-related changes include an amplification of background noise and a decrease in directional hearing. The vestibular system is an integral part of maintaining balance and to a large degree is dependent on intact hearing. Therefore older individuals with hearing impairments are more susceptible to falling when feedback to the brain is altered.


Assessment of hearing difficulties begins during the initial interview. In some individuals with significant hearing loss it becomes necessary to use alternative forms of visual cues to signal where their feet and bodies are in space so they can maintain stability. For instance, when hearing loss cannot be corrected, one aim of the management of hearing problems is to introduce vibratory or visual cues to compensate for hearing loss. The use of bells on shoelaces causes a vibratory sense that can be felt by older adults when a foot is placed on the ground. Nursing interventions include instructing older clients to observe foot placement on the floor by literally “watching their step” and to be especially cognizant of environmental conditions such as floor surfaces.



Cardiovascular


One of the most common problems facing older adults is the loss of tissue elasticity, which affects the arteries. This lack of elasticity leads to a decrease in tissue recoil, resulting in changes in blood pressure with position changes. Older adults who lie supine and then get up quickly are likely to experience the effects of lack of tissue elasticity when the blood pressure drops and a feeling of lightheadedness develops. It is important to educate older individuals to change position slowly and to dangle the legs a few minutes when arising from a supine position. Older adults should be encouraged to wait between position changes and to hold onto the side of the bed or other furniture should an episode of lightheadedness occur. The use of a single bed rail specially manufactured for transferring can aid older adults in getting in and out of bed.



Musculoskeletal


The bones of aging individuals, particularly the weight-bearing joints, undergo “wear and tear,” which causes a loss of supportive cartilage. As a result, joints can become unstable and “give way,” leading to a fall. In many instances osteoarthritis occurs in the weight-bearing joints, causing pain with weight bearing and further eroding joint stability. Interventions are directed at identifying such problems and correcting them through the use of antiinflammatory agents, prescribed activity and exercise, braces, and/or joint replacement. If joint pain develops and remains untreated, it can cause older adults to become sedentary or immobile. This phenomenon of disuse and muscle atrophy contributes to muscle weakness. This cycle of pain, reduced mobility, disuse, and atrophy can become a vicious one unless interrupted by regular mobility and pain control through topical or systemic medication use. Nursing interventions are directed at encouraging, supervising, or assisting with regular ambulation; appropriate use of ambulation aids; joint range of motion; and modalities such as ice, hot packs, and physical therapy.


Another normal age-related musculoskeletal change is the reduction in steppage height, which can place older adults at risk for tripping, especially when door edges are not visible or carpeting is frayed. The gerontologic nurse’s role is to identify these changes and offer suggestions for improvement, depending on the cause. In some cases an assistive device can be employed to aid mobility and avoid further joint damage.



Neurologic


One of the most universal age-related changes affecting the neurologic system is a slowing in reaction time. It takes older individuals a longer time to respond both verbally and physically to changes in position. Older adults who lose their balance are able to right themselves to an upright position provided the musculoskeletal strength of hips, ankles, and shoulders is adequate. However, those with functional impairments and diseases, muscle weakness, or adverse effects from medications might lose their postural stability and fall. For these individuals, uneven surfaces in the environment such as steps, sidewalks, and curbs can lead to a loss of footing and subsequent falls. Nursing interventions for those with impaired righting reflexes include monitoring mobility for signs of unsteadiness and offering supervision and assistance when needed. In an effort to promote autonomy, it is important to allow older clients to continue to perform their usual activities independently and safely.


When independent activity is no longer possible, older adults require a physiatric, or physical therapy, evaluation for the use of a walking aid, such as a straight cane, stationary walker, or posterior walker. Nursing interventions also include the use of chair or bed alarms or call buttons worn around the neck to signal that assistance is needed. Shoes should be inspected for sturdy heels that are low and preferably wedge-type. Observation of an older adult client’s ability to walk is crucial. For instance, is the walking path straight, or does the client deviate from it? Does the client trip when walking because of inappropriate shoes? For some older adults with gait disorders, rubber soles, like those on sneakers, worn on high-pile carpeting can actually be a hindrance and result in shuffling or stumbling while walking. Leather soles are preferable, as are those that are low heeled and have laces, providing extra ankle and foot support.



Fall Risk


Overall, most published research on falls and falling pertains to determining fall risk. There are clearly identified antecedents (e.g., diseases such as stroke, delirium, dementia, or urinary incontinence) that can lead to falls (Box 12–3), but many individuals with these disease-related risk factors do not fall. Thus fall risk is not determined solely on the basis of the number and kind of diseases but also on how these risk factors influence an older adult’s functional ability, specifically in the areas of mobility, transferring, and negotiating within the environment.



Fall risk is best determined by observation of mobility. Fall risk can be categorized according to intrinsic (illness or disease-related) or extrinsic (environmental) risk. A risk for falling according to these categories is different from the intrinsic or extrinsic causes of falling. Risk is determined by the clinician and is a term that reflects a judgment, based on a thorough evaluation of a client, known hazards for falling, and foreseeable events. Older clients at “risk” for falling may not experience a fall at all. There are numerous extrinsic risks for falling, such as lack of color contrast on curbs, poor lighting, frayed carpeting, and unsteady furniture. Intrinsic risks for falling include conditions such as orthostatic hypotension, blindness, or advanced dementia. The presence of these risk factors, however, does not mean that an older client will actually fall—just that he or she is likely to fall given certain circumstances. In fact, some individuals who are at risk for falling, as evidenced by the presence of these risk factors, do not fall. Some of the circumstances that can lead to falling in older adults include unsteady gait or balance instability, delirium or side effects of medications causing unsteadiness, and an inability to right themselves when footing is lost or balance is unstable.


As mentioned, risk for falling is different from actual intrinsic or extrinsic causes of falling. In the latter case, a fall has actually occurred and is the result of either intrinsic disease, extrinsic causes in the environment, or a combination of the two. These falls are likely to occur among those deemed at “risk for falling.” The workup seeks to identify the underlying cause so that it can be treated, thus ultimately preventing or reducing recurrent falling. One aim of fall management is the reduction of risk factors to promote safety while still respecting client autonomy. Because falling is individually determined and not always preventable or predictable, it is important to avoid classifying clients according to the clinician’s perception of their risk for falling (i.e., high risk versus low risk). As previously discussed, falling does not necessarily occur among individuals who are deemed at greatest risk. The effect of functional ability has significance as it relates to older individuals who fall. Research has shown that the individual with frailty and physical functional limitations is at greatest risk for falling (Tideiksaar, 2005).



Intrinsic Risk


Intrinsic risk for falling refers to the combined effect of normal age-related changes and concurrent disease. The most salient observations for intrinsic risk relate to gait, balance, stability, and cognition. This requires the gerontologic nurse to observe and analyze older individuals’ gait and balance and determine whether impairment exists. Measurement tools have been developed to rate both gait and balance. These tools identify key components of gait such as step length and height, step symmetry, and path. Important areas of balance assessment include sitting and standing balance, turning, and the ability to sit without loss of balance. The Tinetti Gait and Tinetti Balance instruments are measurement tools that quantitatively score gait and balance. These tools have been tested through clinical research and hold acceptable validity and reliability ratings (Tinetti, 1986). Before managing gait or balance impairments with assistive aids or physical therapy, older individuals require medical workups for treatable causes of gait and balance abnormalities (Table 12–1).




Extrinsic Risk


Numerous environmental hazards, both indoors and outdoors, can predispose individuals to falling. Research has found that older persons continue to perform the same types of risk-taking behaviors in their later years of life as before. Modification of risky behaviors in the face of functional impairment can prevent accidental falls in and around the home. Instruction in home safety tips should be incorporated into health encounters with older individuals who experience falling.


The modification of environmental risk factors is also critical for fall prevention. Environmental hazards are those that contribute to accidental falls. Research has found that about 30% of falls can be prevented through environmental modification (Warde, 1997). The key areas that require evaluation for safety are steps, floor surfaces, edges and curbs, lighting, and grab rails; nursing interventions are directed at environmental assessment of the indoor living space in these key areas. Whenever possible, steps that are uneven should be repaired or at least have a sturdy handrail to hold onto for support. Floor surfaces should have low-pile carpeting in good repair. Tears should be sewn to prevent shoe heels from becoming caught. Throw rugs should be eliminated because they are a tripping hazard. Curbs and cement landing surfaces should be painted with a contrasting color to outline edges. Lighting should be adequate in high-traffic and dimly lit areas. On a more global scale, a community effort to notify the local Housing Commission of areas needing improvement is an important step in the design of future homes that are safe for older adults.



Steps

The most commonly cited place where falls occur in the home is the last step of a staircase. The last step is a problem area primarily because of visual changes or functional impairment. Handrails should be present on both sides of a staircase or series of steps. The handrail typically ends at the second to last step; if a person descending the stairs is using the handrail as a guide for the landing surface, it will place the individual at the second to last step. Interventions to correct this include educating clients about this situation, teaching individuals to count the steps (i.e., keeping a mental tally of the number of steps ascending or descending), and reinstalling handrails that meet individuals’ needs. Another problematic area on the staircase is an unevenness of steps (Fig. 12–1). Observation and correction of this phenomenon may be the first step toward fall prevention in the home.








Risk for Serious Injury


A small percentage of older individuals who fall are at the greatest risk for serious physical injury (Box 12–4). It is vital for the gerontologic nurse to identify these individuals because they possess intrinsic risk factors that can be identified and often modified to prevent serious injury. Additionally, recognition and treatment of these individuals are part of the gerontologic nurse’s role in preventing foreseeable accidents. Serious injuries such as hip fractures, head trauma, and internal bleeding affect only a relatively small percentage of older individuals who fall. Although falls are the leading cause of hip fractures, only about 5% to 6% of older individuals who fall sustain them (CDC, 2004). There is a high mortality rate associated with hip fractures, and the cost of their treatment places great economic strain on society for rehabilitation and other ancillary services (Liporace et al, 2005).



In addition, the use of physical restraints can increase the risk for serious injury. Individuals who are physically restrained can injure themselves attempting to remove the restraints. Incidents of strangulation and asphyxiation have been reported secondary to restraint use. The elevation of both side rails can cause demented or delirious older adults to fall in their attempts to climb over the side rails. These individuals are at risk for serious injury because of the height of the fall; thus the impact is greater than if the side rails had not been elevated. Physical restraint use does not prevent falls and therefore should never be employed for “safety precautions.”



Reducing the risk of serious injury

Behavioral modification is a broad term applied to interventions that alter behavior to effect positive outcomes. The gerontologic nurse is in a pivotal position to educate older individuals, especially those at risk for serious injury from falling, about fall prevention measures. Older individuals’ knowledge base and receptivity to changing behavior are important aspects for the gerontologic nurse to assess before initiating a teaching program. Specific teaching points will vary individually, but general guidelines for fall prevention and home safety can be illustrated through a pictorial display of high-risk environmental hazards or by issuing a handout with teaching points. As they relate to those conditions most likely to result in serious injury, specific interventions can be reinforced (Table 12–2).



Behavioral modification and instruction, such as teaching an older client who has orthostatic hypotension to rise slowly or an individual with dizziness who moves too quickly to slow down, may not be as easy as it seems. Behavior modification first requires older clients to recognize behaviors that are contributing to problems. Often, the causes and effects of these behaviors need to be pointed out to clients in a clear and concise manner. However, this is not a foolproof method because while clients are modifying behaviors falls might not occur. The client’s behavior may thus be negatively reinforced, and he or she may feel justified in continuing to perform the same behaviors. Behavioral modification requires older clients to make conscious attempts, whenever a behavior is performed, to change or alter it. Much of what the nurse teaches must be remembered for later action; the use of notes and tape recorders as daily reminders can help.


Disease or condition modification to reduce the risk of serious injury from falls includes appropriate treatment of the actual disease. In the case of osteoporosis, agents to prevent bone demineralization and build bone mass are prescribed and used with calcium and vitamin D supplements. The nurse plays a key role in teaching clients with osteoporosis about the importance of calcium-rich foods and ways to incorporate these foods into the diet on a daily basis. Teaching about the risk factors associated with the development of osteoporosis is also important.


In cases of delirium, condition modification includes a determination of the underlying etiology; unless the cause is identified and treated, the condition will not resolve and clients will remain at increased risk of serious injury from a fall. It is imperative for the nurse to recognize that the etiology is often multifactorial, thus requiring a variety of interventions based on the identified causes. While the delirium is resolving, injury can be prevented through additional nursing interventions, including padding of side rails, increased surveillance, assistance with activities of daily living (ADLs), and measures to promote a calm and reassuring environment.



Fall Antecedents and Fall Classification


Falling occurs when persons are upright and walking, termed bipedal or ambulatory, or when they are sitting or lying down, termed nonbipedal. Falls may also be considered serious or nonserious, depending on the consequences for clients. Individuals who fall but not to the lowest level (the ground) and those who catch themselves are considered to be experiencing “near falls”; those who actually fall to the ground are experiencing true falls. Falling can be classified according to the cause of the fall (intrinsic, extrinsic, or multifactorial), frequency of falling, and the timing of falling in relation to other diseases. Most falls in the older adult are multifactorial in etiology, that is, a combination of both intrinsic and extrinsic factors. Because so many different circumstances lead to falls in older adults, it is important to determine the type of fall according to a classification system (Box 12–5).



Isolated falling refers to a one-time event that was most likely purely accidental. The term accidental fall has been avoided in the literature during the last decade because most falls are not accidental but rather indicate specific disease processes or conditions.


Cluster falls can be observed among individuals with specific diseases who decompensate. The classic example is an older individual with congestive heart failure who falls with the onset of oxygen desaturation or cerebral hypoperfusion associated with overexertion. Usually several falls occur over a short period and are markers of a decline in health.


Premonitory falls are those produced by specific medical illnesses. These types of falls have key symptoms that can be elicited on history taking; physical examination findings and diagnostic tests may also confirm this type of falling. Classic examples of premonitory falls are those in individuals with the new onset of stroke, seizure activity, hypoglycemia, or positional vertigo.


Prodromal falling refers to the onset of frequent falling heralding an acute medical problem; thus falling is a prodrome to later disease onset. An infectious disease typically causes this type of fall. Falls have also been associated with a clinical syndrome called drop attack. A drop attack has been defined as sudden leg weakness without loss of consciousness. Drop attacks are diagnosed when all other medical illness and environmental conditions have been excluded and clients continue to fall.


Intentional falls refer to falls by individuals who fall on purpose, possibly with a desire to do harm. Older clients with significant depression or suicidal ideation may throw themselves down to cause bodily harm. Other types of intentional falls include when one resident pushes another resident to the ground. This is frequently observed among demented residents in long-term care institutions.


Thus classifications of falls will often aid in determining the underlying causes of the falls. Box 12–6 illustrates the risk factors associated with the various types of falls. It is important to note that individuals can experience any one of these types of falls singularly or in combination. If an older resident experiences a premonitory fall on one occasion, the next fall may be from a different cause altogether. Because falls are often unpredictable and therefore not always preventable, it behooves the clinician to start the evaluation with the goal of identifying and managing those falls that are treatable.




Fall Consequences


Physical Injury


The incidence of fall-related injuries spans from trivial trauma, such as skin tears and sprains, to serious injury, such as hip fractures, internal bleeding, or subdural hematomas. Each year thousands of older Americans fall at home. Many of them are seriously injured, and some are disabled. In 2001 more than 11,500 people older than 65 died because of falls (CDC, 2004). Overall the rate of serious injury is low; from 5% to 6% of falls result in hip fractures (Nevitt & Cummings, 1994). Research investigations have found that cognitive impairment, gait and balance impairment, low body mass index, and at least two chronic conditions were factors independently associated with serious injury during a fall (Tinetti, McAvay, & Claus, 1996). Among older adults most injuries caused by falling are considered minor. Perhaps because of the low incidence of serious injury, older individuals often do not perceive falling to be a problem that warrants a report or a medical evaluation.


Serious injury from falling is more likely to occur among those with osteoporosis. Bones weakened by osteoporosis, particularly weight-bearing bones like the femur, are more susceptible to breakage. Injury prevention measures to reduce the impact of falling, such as lowering the distance an older client might fall to the ground and even using padding over the bony prominences of the hips, are required. Undergarments such as girdles with extra padding over the high-risk bony prominences have been designed for women. Individuals with osteoporosis should also be prescribed medications to increase bone mineral density and strength over time. Exercise can aid in increasing bone mass.



Psychologic Trauma


Older individuals who fall may or may not experience psychologic trauma after the fall. Many factors influence the development of postfall trauma, including personality, depression, anxiety, and stress-related syndromes. Overall, little research has been done to elucidate the incidence, prevalence, and occurrence of postfall psychologic trauma. One significant consequence of falling may be fear of falling again or fear of being able to get up independently after a fall. Both these conditions have been researched more extensively than other psychologic trauma associated with the postfall period. However, the fear is not limited to those who fall; it has also been reported among nonfallers (Howland et al, 1998).


Fear of falling appears to occur variably in the older adult population. One study found that the majority of a sample of community-dwelling older adults expressed no fear of falling (Arfken et al, 1994). In still other community-based research of older adults, fear of falling existed in both those who had fallen and in those who had not and was evenly distributed between the groups (Gray-Miceli, 1997). Some research has shown that if older persons express a fear of falling, they may avoid activities (Vellas, Wayne, Romero, et al, 1997; Tideiksaar, 2005) and become physically dependent (Burker et al, 1995). One researcher found that chronic dizziness is strongly associated with a fear of falling (Franzoni et al, 1994).


The gerontologic nurse’s role is to determine whether fear of falling or other psychologic trauma has occurred after the fall. The best time to elicit this information is during history taking with older individuals who fall. The nurse focuses attention on how confident the older adults are in performing activities that might predispose them to falling. One exception to consider, however, is an older individual who falls when nonambulatory, as in the case of a fall from bed. In this case, confidence may be unaffected during mobility. Possible indicators of a fear of falling are presented in Box 12–7.


Nov 26, 2016 | Posted by in NURSING | Comments Off on Safety
Premium Wordpress Themes by UFO Themes