The Incidence Of Falling In Elderly Patients

The Incidence of Falling in Elderly Patients Student’s Name Institutional Affiliation The Incidence of Falling in Elderly Patients A Description of the Research Problem Falling is defined as inadvertently coming to rest on the floor, ground, or any other lower level place (Stenhagen et al., 2013). The rate of falling is high among the elderly and has resulted into unintentional injuries. Falling is mainly common among women than men, especially women who are in their menopause stage. However, there had been a problem in defining a fall. Several studies fail to specify operational definition of a fall which results into misinterpretation of the concept as people will define it differently. For instance, older people seem to define it as loss of balance while health professionals term it as event leading to ill health and injuries. Hence, there is need to provide an operational definition of the term to prevent different interpretations of the term. The frequency of falls globally among people who are around 65 years is approximately 28-35% (Chang et al., 2004). However, this number had been increasing by 2-4% annually. Contrarily, the falling rates among those who are over 70 years of age stand at 32-42% with annual increase of 5-7% (Chang et al., 2004).The statistics show that the number of falls increase with age and frailty level. Elderly persons who are living in nursing homes tend to fall more frequently than those who are living in community. Almost 30-50% of those living in long-term care institutions fall annually, and 40% percent of them experience recurrent falls (Phelan et al., 2016). Moreover, the rate of falling among the old age differs in various nations. For example, more people fall in Chile and Barbados than Japan and China.   Research Questions * Why are incidences of falling more prevalent among the elderly? * Can aerobic training be used to reduce falls among the elderly? * What other alternative actions can be taken to reduce falls among the elderly? Research Variables * Chronic health conditions * Walking balance * Impaired Vision * Confusion * Injuries * Decreasing abilities to function Conceptual Definitions of the Research Variables * Chronic health conditions: chronic health conditions are those diseases that are persistent in people. They could also be taken to mean those diseases that have long lasting effects on people and they come with time. The elderly people are susceptible to suffering from chronic health conditions that affect their abilities to function normally. Some of the chronic health conditions include: hypotension, dementia, and heart diseases. Hypotension is known to cause dizziness among people and making the susceptible to falling. * Walking balance: walking balance refers to the steadiness of walking. Many elderly people are known to have a balance disorder that causes them to walk unsteadily. As a result, they are more susceptible to experience falls due to their inability to maintain a steady balance. Several conditions are known to cause walking balance disorder such as Parkinson’s disease, labyrinthitis, spinal stenosis etcetera. Those with the conditions above always feel to be moving, floating, or spinning. For one to have a normal balance, the body systems that include blood vessels, ear nerves, inner ear’s balance organ, vision, joints, bones, and muscles must work normally. * Impaired Vision: impaired vision is used to refer to a decrease in the ability to see to certain degree. Those with visual impairments cannot be helped by any means including glasses. Certain visually impaired people also lack the access to objects that would enhance their abilities to see such as glasses. Among the elderly, they undergo certain transformations that make them to have a “blurry vision” and their fields of view end up narrowing to such extent that they cannot be able to see where they are going clearly and be susceptible to falling. * Confusion: among the elderly people, confusion is taken to mean being unable to function mentally and live independently. Among the elderly, it is normally a symptom of dementia. What normally cause confusion are anesthesia, dehydration, and affection in the urinary tract. Confusion can lead to falls especially when one does not know what they are doing. * Injuries: when elderly people fall, they run the risk of being injured depending on how serious the fall was. In certain circumstances, the fall can be so serious to the extent that those elderly people are not able to function normally for a very long time. Some of them might end up being bed-ridden of the rest of their lives. * Decreasing abilities to function: With age, the elderly people become less and less able to function normally. They cannot talk normally, hear, normally, and walk normally. Besides, their mental conditions become unstable and they experience dementia for a long period of time. Consequently, they cannot hold it together; their body organs cannot coordinate and make them steady enough to avoid falling. As a result, they find themselves falling without intending to do so.  Significance of the Problem for Nursing The fall among the elderly is of great importance to the nursing profession. Many a time, it is the nursing homes that play host to the elderly. When they are too weak to take care of themselves and there is no one in their lives that can give them the care that they need, the elderly are normally sent to the nursing homes. When at these homes, there would be cases of elderly people complaining that their legs just wobbled while they were walking and they fell. And yet it is the duty of the nurses to care for the elderly. To the nursing profession and public health at large, falls among the elderly is a major concern. The issue is a big one for the nurses because falls are among the leading causes of unintentional injuries among those aged 65 and over. To the elderly people, falls are their greatest concern that makes them go to the long-term care setting institutions. The nursing profession needs to ensure that it is well prepared to handle the issues. They need to ensure that they are able to identify, they are well educated, and have appropriate tools that can help them to deal with cases of falls among the elderly. Nurses can never prevent everyone from falling, but it is their duty to enlighten the elderly on the risks of falling and advise them on how best they can protect themselves from incurring serious injuries due to falls. The clinicians are responsible for identifying those elderly with a high risk of falling and know the kind of injuries they might experience when they fall. When an elderly person has experienced a fall, or run the risk of falling, clinicians should make the effort to assess them and intervene on their behalf. Dealing with falls among elderly people can be difficult for clinicians. This is because a good number of the elderly people never recall falls that occurs to them in the last three months. Clinicians cannot therefore get sufficient information from just relying on falls that the patients have reported themselves. Consequently, there is a possibility of a significant number of high risk individuals. Additionally, nurses need to be careful when dealing with potential fall victims. Historically, some elderly people are too proud to admit that they were the victims of a fall as they believe that it would make them appear too weak and frail and it would damage their reputation in their eyes. Fall assessment should be performed by people that are experienced because it is a specialist service. The assessment of fall patients should be a “multidisciplinary process”. In the primary healthcare, nurses are charged with spotting patients that need fall assessment and talking deeply with them about the issues in their primary care. It is important that the nurses make them aware of what to do when they fall. Even though a fall might look light, many elderly fall victims have in the past been found dead in their beds hours or even days after a fall. Any elderly person that experiences a fall should know that they need to notify the nurses immediately for monitoring and assessment. The nurses must in turn ensure that they document the fall for future reference because it is important to understand the fall history of patients so that one can know that to do on every fall victim. Theoretical Frameworks in Relation to Selected Problem Falls among the elderly and its prevention in line with “Dorothea Orem’s” self-care deficit Normally, falls are prevalent among the elderly because of “self-care deficit”. According to Hayakawa et al. (2014)”self-care deficit” necessitates nursing requirement for adults when they can never maintain the quality of self-care that is needed for them to live and sustain a healthy life. When people age they are less likely to be engaged in active participation in important events. Those who are active still participate culturally, socially, and economically in important activities. As a result, they improve the quality of their lives and increase life expectancy. But they more they age the less likely they are to engage in active events. Dorothea relates deficits in self-care to its demands, agency and agency of nursing in an attempt to explain why elderly individuals can never take care of themselves. Dorothea holds that nursing should cover three steps: assessment, nursing diagnosis; planning, implementation, and diagnosis. Assessment: this is aimed at determining the patient’s needs. This is the basic approach especially when the nurse practitioner encounters the patient at the first sight. The practitioners seek to find out why the patient needs care by collecting all the relevant data on the history of the health of the patient. Nursing Diagnosis: After the data has been collected it’s analyzed in order to determine the right care system that the client needs. This requires that the nurse defines a relevant nursing system for the client and the system of delivery of care for the patient. Planning, Implementation, Evaluation: The nurse comes up with the appropriate plan of care for the patient taking into consideration the risk factors for the patient, the environment of the patient and the alignment of the patient’s goals with the goals of care. The plan is implemented and is subjected to evaluation after a given period of time. Any recommendations are given for adjustment of the plan or if necessary termination of the plan especially in cases where the plan does not meet its set objectives and the patient experiences falls. Older people cannot provide for themselves a sustained and quality self-care. Therefore, they need help to get all their healthcare needs. Many elderly people take to the streets today to try and stay fit and health. That would not have been possible decades ago. Today, elderly people understand that they are at greater risks of being victims if their vital organs do not function. Times have changed and elderly people are no longer expected to sit and take it easy like it was the case many years ago. Historically, models of retirement have encouraged elderly people to just sit and take it easy and be passive in their lives. The systems in place discouraged them from being physically active. In response to the need to ensure that the elderly people remained active, World Health Organization (WHO) devised a program in the early 1990’s. The program was on health and aging. The aim was to respond to a population that was aging in a very passive manner. The aim of the program was to ensure that the elderly people became aware of why it was important for them to ensure they aged in a healthy manner. The WHO promoted their agenda through research, training, and advocacy. The theory is relevant to my research because it is because of the tendency to fall that the elderly are brought to nursing homes so that they can be provided with self-care. When the elderly persons stay in the nursing homes, they will be able to get sufficient care and the incidences of falling will be reduced. Grace Care Model The model started operations in 2005. It was designed with the concerns about the elderly people not being able to take care of themselves. GRACE stands for Geriatric, Resource for, Assessment and, Care of, Elderly. How individuals age would dictate the risk factors of falling and their severity. Some aging patterns are dependent a lot on family history but ensuring active aging can held change what is considered to be inherited in the blood (Etman et al., 2012). Various factors that can determine the susceptibility to falling in the elderly but all these factors are related to health and the life choices that people make. Those that engage in appropriate physical activities, eat health, never smoke, avoid alcohol and use their medications in a wise way are less more likely to age healthily and become less likely to have high risks of falling when they age. Being physically active is important to the life of every individual if they want to remain functional into the foreseeable future. Being physically active can help in preventing chronic diseases that have been known to cause falls among the elderly. Some illnesses such as metal health can be less prevalent in those that engage in physical activities. Mental illnesses are one of the main causes of falls. When people engage in physical activities with groups, they are able to create social contacts and share their experiences with the people they practice with (Stenhagen et al., 2013). Elderly people are known never to be able to live independently. However, with physical activities, they are able to live independently for a long time and they would be able to do whatever they need by themselves. It is not just healthy to engage in physical activities, it is also economical because less costs are incurred in medical bills. Those who have been involved in physical activities before retirement and continue in the same way after retirement remain normally have a better balance and never suffer any serious falls compared to those that have never embraced exercising. However, the fact that one has not been exercising all their lives does not mean they cannot start at a certain point and achieve the level of balance and stability that they need. They can start off by engaging in simple exercises regularly and this can help them build their muscles and remain steady and balanced. Those who are active are more balanced and stronger and they can respond quickly while maintaining control over their bodies. Healthy eating is also important in ensuring that one remains healthy, strong, and balanced. Eating can be limiting because certain individuals can have reasons for not eating healthy. Not all people have equal access to food. On the other hand, socioeconomic conditions of an elderly person can dictate a lot what they are able to eat. Moreover, some individuals may lack nutritional knowledge and therefore they can never know what constitutes an healthy meal. Some people may need to use medications that can limit what they can eat. In all these conditions, one can still ensure that they remain active and exercise on a regular basis and they can still be healthy and steady. As people able, the need to reduce on their smoking and drinking because it would make no sense to exercise and drink and smoke at the same time. Drinking and smoking have a big negative impact on health. GRACE care model encourages home assessment by qualified practitioners to ensure that the elderly people get individualized care so that their chronic health conditions do not cause them to be at more risk of falling. The model with therefore be relevant for my research in this regard. Table of Evidence Introduction to the Review of Literature To get the necessary information to support this research, I have to look for the relevant and necessary research work on Ebscohost, Google, Scholar, Sciencedirect, and google search engine. The search key words for the sources were: “falls among the elderly”, “why the elderly fall”, “post-menopausal women and elderly falls”, “causes, consequences, and solutions to falls among the elderly”, “prevalence of falls among the elderly and the need for active exercises”. This review of literature is organized into: Table of references (TOE), Gaps in the literature used, and synthesis. Table of References (TOE) Citation Research Question Site/Sample Design & Methods Variables & Measures Findings Critique Suggestions made for further study Uusi-Rasi, K., Patil, R., Karinkanta, S., Kannus, P., Tokola, K., Lamberg-Allardt, C., &Sievänen, H. (2015). Exercise and vitamin D in fall prevention among older women: a randomized clinical trial. JAMA internal medicine, 175(5), 703-711 “What is the effectiveness of targeted exercise training and vitamin D supplementation in reducing falls and injurious falls among older women?” “The study aimed at determining the separate and combined effects of multimodal exercise training and vitamin D supplementation in reducing falls and injurious falls and fallers as well as to assess their effects in improving bone density and physical functioning among older women at risk for falling” ROL: “Falls are the leading cause of unintentional injuries and fractures in older adults. Although less than 1 in 10 falls results in a fracture, approximately 20% of falls lead to injury requiring medical attention.1 Therefore, fall prevention is widely considered the most essential element in injury and fracture prevention programs in elderly populations.2,3 There is strong high-quality evidence from randomized clinical trials and subsequent systematic reviews and meta-analyses that regular strength and balance training can reduce the risk of falling in community-dwelling older adults by 15% to 50%.4,5” “In total, 409 participants were randomly assigned to 1 of 4 groups using a computer-generated list based on simple randomization with random allocation sequence to ensure equal group sizes. The groups were (1) placebo without exercise, (2) vitamin D (800 IU/d) without exercise, (3) placebo and exercise, and (4) vitamin D (800 IU/d) and exercise. ” (N=409) “This study was a 2-year, double-blind, placebo-controlled vitamin D and open exercise intervention trial with 4 arms (Figure 1). The trial was performed between April 2010 and March 2013. Eligibility criteria and recruitment of participants have been described in detail previously.12Briefly, home dwelling women 70 to 80 years old living in Tampere, Finland, were eligible if they had fallen at least once during the previous 12 months, did not use vitamin D supplements, and had no contraindications to exercise. Individuals who participated in moderate to vigorous exercise more than 2 hours per week were excluded from the study. The study protocol was approved by the ethics committee of the Tampere University Hospital, Tampere, Finland (approval R09090).” I.V “progressive group training classes 2 times a week for the first 12 months and once a week for the remaining 12 months of the 24-month intervention (trial protocol in Supplement 1)” D.V “Physical functioning assessed by the Short Physical Performance Battery” D.V reported falls and Injurious falls “Exercise intensity was estimated in metabolic equivalent tasks (METs) every 8 weeks (version 3.0.1.0; First beat Technologies). The exercisers also had a home-training program (5-15 minutes), modified from the supervised exercises, to be performed on all rest days. The non-exercising groups were asked to maintain their study level of physical activity” “Physical functioning was assessed by the Short Physical Performance Battery,17 which comprised static balance, 4-m normal walking speed, and 5-time chair stand tests and by the Timed Up and Go (TUG) test.18 Dynamic balance was assessed using backward walking.19 Maximal isometric leg extensor strength at a knee angle of 110° was measured by a strain gauge dynamometer (custom made; Tamtron). Each participant recorded her daily steps with a pedometer (HJ-112-E; Omron) over the entire 24-month study period. All tests are regularly used in our laboratory and have good reproducibility” “Training reduced injurious falls among home-dwelling older women, while the rate of falls was not affected by either treatment. Exercise improved physical functioning but vitamin D did not (contrary to initial expectations). However, vitamin D reduced bone loss at the femoral neck and increased trabecular density at the distal tibia” “Because of the fortification of fluid milk products in Finland, the baseline 25 (OH)D levels were likely too high to reveal all potential beneficial effects of the vitamin. It is possible that vitamin D has greater effects on fall risk among women with vitamin D depletion.9,10,31 On the other hand, all participants had fallen previously and thus were at increased risk of falling, and vitamin D supplementation is now recommended as a means to reduce the risk of falls irrespective of baseline vitamin D levels. Although the exercise program was planned to be suitable and safe for women with muscular skeletal problems, it was challenging to reach and recruit the frailest women. In other words, our participants were in good health and physical condition. Therefore, our results cannot be generalized to frail and institutionalized women or to men.” The researchers never made any suggestions for further studies Tsai, L. Y., Tsay, S. L., Hsieh, R. K., Yu, S., Tsai, J. M., Chien, H. H., & Liu, S. J. (2014). Fall injuries and related factors of elderly patients at a medical center in Taiwan. International Journal of Gerontology, 8(4), 203-208. “Why do elderly patients have a high incidence of falls and injuries in hospitals?” “The aims of this study were to explore the characteristics and factors associated with fall injuries among elderly patients.” ROL: “Patient falls are among the most common accidents in hospitals. Elderly inpatients have increased risk of falling because of chronic frailty or the treatment and medication for their illnesses. The resultant falls and injuries of elderly patients are generally more severe than those of younger patients.” “A medical center in Taiwan.” A retrospective survey study was employed by retrieving data from the patient safety reporting system querying for fall events of patients (N=378)  “65 years or older admitted to a medical center in the period from 2010 to 2012. A total of 378 qualified events were identified.” Intervention Group (N=200) “Analysis of factors related to falls or fall injuries in elderly patients.” Control Group (N=187) “Predictors of fall injuries for elderly patients.” “ A total of 378 qualified events were identified. Comparative analysis was conducted to examine the resultant falls and injuries of these events and their related factors. The TPR connected by the medical center is the major instrument used in this investigation. The TPR was designed and implemented to improve patient safety, to establish safe health care practice, and to promote experiences sharing and learning.” “The TPR contained records of 846 fall events from 2010 to 2012; 774 of these events happened in admitted patients (91.8%). Of these 774 events, 378 were for elderly patients (48.8%), 81 patients diagnosed with cancer (21.4%), and 297 non-cancer patients (78.6%). In addition, falls are more commonly experienced by men (208 events, 55.0%) compared to women (170 events, 45.0%).” I.V.: “fall history; level of consciousness; hotspots for falling; frailty; unsteady gait; weakened lower limbs; impaired limb mobility; high-risk patients insisting on unassisted movement; hypnosedative, antihypertensive, or antihyperglycemic agents; lack of family vigilance factors; not obtaining assistance; unsupported movement; obstructed pathways; wheelchairs or beds not locked in place; and assistive devices being out of reach.” D.V.: “Fall injury sustained” “Data retrieved from the TPR system were first coded and stored as Excel 2007 files and then imported to SPSS version 18.0 (SPSS, Inc., Chicago, IL, USA) for data analysis. All data underwent Kolmogorov–Smirnov test to ascertain normality. The statistical methods included frequency distribution, percentage, standard deviation, variance analysis, Chi-square tests, and logistic regression analysis. The descriptive statistics for demographic and fall-related variables were computed for frequency distribution and percentage.” “The risk factors for falling among elderly patients are increasing. This study also demonstrates that being in the high-risk group is a predictor of fall injuries among elderly patients, and that the odds of a patient in the high-risk group sustaining fall injuries are 1.770 times greater than that for patients not in the high-risk group. Patients who exhibit three or more risk factors for falling are considered to belong to the high-risk group. The deteriorating physical condition of elderly patients may cause systemic conditions, leading to increased risk factors, which corresponds to an increased risk of falling. Furthermore, interaction between multiple factors may result in a higher ratio of sustained injuries” “Reported cases of fall events involving elderly patients were used to analyze variables, and effective predictors of fall injuries in elderly patients were identified from among the independent variables. Because the data were obtained from a database of existing files, analysis was limited to existing cases. Determining whether the factors analyzed in this study are indeed the major predictors of fall injuries among elderly patients necessitates access to an assessment tool with sufficient reliability and validity and a prospective research plan that involves the cooperation of multiple hospitals. These represent the limitations of this study.” The researchers proposed further studies into the effective fall prevention plans that can be used to ensure that incidence of falls are reduced among patients Phelan, E. A., Aerts, S., Dowler, D., Eckstrom, E., & Casey, C. M. (2016). Adoption of evidence-based fall prevention practices in primary care for older adults with a history of falls. Frontiers in public health, 4, 190. “What are the best Fall Prevention Practices in Primary Care for Older Adults with a History of Falls.” “To assess the current state of primary care for falls in the United States and identify factors associated with fall risk assessment by primary care providers among persons at high risk of falls.” ROL:” Falls are the leading cause of unintentional injury-related deaths and non-fatal injuries in people aged 65 years and older. Falls predispose to injury, loss of independence, decreased mobility, hospitalization, nursing home placement, and early death. Each year, accidental falls result in over two million emergency department (ED) visits , and fall-related injury care costs exceed $30 billion annually. Of particular concern, rates of fall-related ED visits and hospitalizations are increasing, and the proportion of older adults in the population is growing, creating an epidemic of falls. Clearly, prevention of falls and the injuries that they cause is a pressing public health issue.” “A total of 256 patients were identified as having fallen during the study period. Of these, 140 were ineligible, for the following reasons: 99 patients had no clinic visit within 3 months after their fall, 4 were non-ambulatory, and 37 had documented dementia. The remaining 116 patients met eligibility criteria and were included in the analysis” (N=116) “Patients of general internists and geriatrics specialists were compared on baseline demographic, health, and fall-related health-care utilization. Chi-square and independent-samples t-tests were used to test for between-group differences on these variables. Bivariate two-tailed Pearson correlation coefficients were calculated for the primary dependent variable, i.e., the fall risk assessment score, and independent variables hypothesized to influence the number of assessments performed. Results were considered statistically significant at p < 0.05. To test for independent effects, variables showing significant associatio...