Fall Prevention among Older Adults

Aging is an inevitable process in the life of every human. From the physiological point of view, such a process is impossible to avoid or delay. Older adults are constantly at risk groups concerning many issues; however, one of the most serious and common is falling. With lower mobility and a higher risk of bone fracturing, adults over the age of 65, become at a high risk of being seriously injured after falling. Therefore, there is a vital need for the assessment and analyzing all the factors that lead to the falling of older people.

To correctly apprehend the information that is going to be researched, some terms must be defined:

Fall – can be explained as an accident, which results in a person-unwilling coming on the ground or other surfaces from a certain height that can lead to severe injuries. This notion excludes voluntary position adjusting to rest to furniture or other objects’ (Greenberg, 2020). Frith, Et al also explain it as unexpected descent that can or cannot cause damage (2019). It is usually an uncontrollable process and occurs rapidly.

Older adult age group – is a specific group of people age 65 and older, which can be considered as a vulnerable population because of their specific health needs (Gray-Miceli, 2017). Older age group people have a specific physical appearance that can be identified as a process of aging. The aging process is evident not only in physical appearance but also in social, psychological, functional, and emotional processes (Webb, 2017). People of older age groups tend to be at high risk of more health illnesses and injuries.

The statistics, demonstrating the number of falling accidents may seem shocking to many. Over 388 000 cases of falling among older people occur in the house every year, which is considered the safest place (“What’s tripping us up?”, 2019). A third of people over 65 fall every year, and most of the cases result in injuries. The probability of falling after being 80 rises to where one in two people inevitably falls (“What’s tripping us up? “, 2019).

The outcomes of falling for older people are certainly more dangerous than for younger individuals as the bone structure is not as strong, and the mobility decreases with age, the probability of getting severe injury is much higher. Fractures or head and traumatic brain injuries are the most common physical damage caused by falling (Greenberg 2020). The decrease in mobility functions may cause severe physiological trauma for older people even after one fall, and they might develop a fear of falling. Such fear often leads to an increase in avoiding physical activities and a decline in functioning (Miller & Hunter, 2016). As older people have reduced mobility, they do not usually perform physical or brain exercise, however falls often cause brain fracturing for older people, while younger adults’ would not experience it. (Frith, et al, 2019)

Musculoskeletal system provides the body with the ability to perform essential physical tasks that involve sitting, running, breathing, etc. Just like other systems in the organism, skeletal muscles face severe changes with aging. Numerous systems influence the transformation of muscles including nervous, vascular, and endocrine. Muscle tissue starts developing at a young age and stops at adulthood, however muscle fibers do not transform until the older age. With constant physical exercises, the musculoskeletal system can be kept in reasonable condition even in the older age (Nash, 2019). Some transformational muscular processes occur gradually with age, like the loss of muscle mass. It is apparent in the form of muscle tissue atrophies and decrease of muscle strength. Moreover, one more aging feature is that lean muscle tissue converts to fat (Webb, 2017). Such muscle strength loss phenomena is called sarcopenia, and it is most evident in the seventh decade of life (Nash, 2019). Another musculoskeletal system age-related transformation is muscle disability with the most common being a rheumatic disease.

Natural aging brings many risks, and falling is one of them. Both medical and physiological conditions put older people at high risk of falling. The decrease in muscle strength, which is accompanied by balance troubles, possess danger to the elderly and can be worsened by older people who experience continual loose of eyesight. (Frith, et al, 2019). Muscle loss is a natural process; however, it can be slowed down by constant exercises, which help with keeping muscles and bones toned longer. Due to the loss of bone density in the elderly, there is a high chance of apparent formation of the lower back curve, which negatively affects and changes the center of gravity (Webb, 2017). Fall risks increase when older people gradually lose joint stiffness and, in consequence, have deformed joints. With such poor conditions, more attention must be paid to safety, moreover, the absence of physical activity puts older people in a risk zone for falling. A problem of poor muscles strength is the most common danger factor for the weak musculoskeletal system (Miller & Hunter, 2016). In addition, with age, the delay in responses to various stimuli becomes visible; in combination with coordination loss, fall risks increase drastically (Webb, 2017). The loss of muscle strength, balance, and endurance are serious factors that affect the daily life of older people and becomes a high chance of experiencing falling. Such age-related transformations of an organism increase risks of falling and must be constantly assessed.

Health Quality and Safety Commission Falls Assessment Tool (HQSC) (2014) is initially created with a purpose to determine the health condition, restrictions, and impairment of a patient in order to discover any risk factors that may lead to falls. HQSC Assessment form consists of seven different blocks that help differentiate several risk groups. They include the history of falls, mobility, vision, hearing and language, cognitive assessment, continence, medication, and other risks.

The decrease in mobility for older people becomes a risk factor for falls. The lack of mobility does not allow them to complete daily tasks like before; therefore, it contributes to the reasons for falling. With reduced mobility, older people have higher chances of bone fracturing than younger ones (Miller & Hunter, 2016). A correct and thorough assessment of a person’s mobility level by the care providers helps the prevention of the risk of falling among older adults. Mobility’s risk factors lead to such disease as osteoporosis and contribute majorly to falls and fractures (Frith, et al, 2019). Information about the state of an individual’s mobility can help determine whether it is necessary to maintain the current state or work on its improvement, which in the end will increase the overall safety for older adults (Greenberg, 2020). Preventing falls among older people should be the primary goal for the healthcare system; it is more effective to promote physical wellness and focus on its maintenance rather than cure fracturing of bones and have an assistive device for the rest of their lives. Mobility is one of the most critical factors of an individual’s ability to perform any physical activity.

Many older adults suffer from mental problems, which put them at high risk for falling with conditions that include cognitive impairment. Therefore, proper assessment and determination of cognitive functions certainly contribute to falling risk prevention. The three most common cognitive conditions affect the elderly: dementia, delirium, and depression (Webb, 2017). A qualified nurse is obliged to be able to distinguish the difference between these impairments to provide proper treatment as each of them contributes to the risk of falling in a significantly different way. For example, older people with dementia have a twice-higher chance of falling than those with no evident cognitive diseases (“Interventions for reducing falls”, 2019). Cognitive impairments not only affect the brain of a person but also contribute to the problems with balance and mobility; therefore, these two functions are interrelated. Some restrictions come with the connection between cognitive impairment and mobility. It is a critical safety issue that may lead to unfortunate consequences if a nurse assesses an older patient’s balance when the individual already experiences cognitive impairment like delirium or sedation (Gray-Miceli, 2017). Assessment of cognitive impairment may have a significant impact on the fall risk among older adults as its discovery helps nurse practitioners to provide proper treatment.

To decrease the risk of falling for older people with mobility problems, caregivers usually resort to interventions. A proven effective intervention includes nurses creating an encouraging environment for older people to exercise and engage in physical activities. According to the analysis in “Interventions for reducing falls,” exercise-related interventions decreased the risks of falling among older people (2019). Physical exercises keep muscles toned and improve overall mobility, which are high risks of falling for older adults. Such interventions do not require any medication and not only reduce fall risks but also improve the overall health of older people.

Concluding, falls are too common among older people, according to the statistic. Healthcare givers need to provide proper assessment and treatment for older adults to minimize the risks of falling. Age-related changes inevitably change the physical abilities and put mental health in a more vulnerable position, accordingly increasing the chances of falling. Health and safety assessments must be an essential tool for nurses to apply to every incoming older patient as it majorly helps to determine what risk group of falling the person is. Many interventions help older people cope and decrease the risks of falling, which increase with every year of their life. Therefore, dealing with the problem of falling among older people should be one of the top priorities.

References

Frith, K. H., Hunter, A. N., Coffey, S. S., & Khan, Z. (2019). A Longitudinal Fall Prevention Study for Older Adults. The Journal for Nurse Practitioners, 15(4), 295–300. Web.

Gray-Miceli, D. (2017). Impaired Mobility and Functional Decline in Older Adults. Nursing Clinics of North America, 52(3), 469–487.

Greenberg, S. A. (2020). Falls in Older Adults. Advances in Family Practice Nursing, 2, 1–9. Web.

Health Quality and Safety Commission New Zealand. (2014). Web.

Interventions for reducing falls and harm from falls in older people with cognitive impairment. (2019). Health Quality & Safety Commission New Zealand, 1–20.

Miller, C., & Hunter, S. (2016). Chapter 22. Mobility and safety. In Miller’s Nursing for Wellness in Older Adults. (2nd ed., pp. 493–524). North Ryde, N.S.W.: Lippincott Williams &​ Wilkins.

Nash, D. (2019). Chapter 20. The structure and function of the musculoskeletal system. In: Understanding Pathophysiology AUSTRALIA AND NEW ZEALAND edition (3rd ed., pp. 486–512).

Webb, M. (2017). Chapter 15. Nursing care across the lifespan: older adult. In Tabbner’s nursing care: theory and practice (pp. 291–310). Australia.

How Kiwis are falling over. (2019). Web.

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