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Preventing Falls in the Elderly: A Strategic Plan

A fall refers to an unintentional forward, backward, or sideways move that occurs when an individual loses balance. It can result in injuries or collapsing as a person unintentionally rests on a lower surface. Falls are frequent for aging individuals because of rising conditions such as poor vision and impaired hearing, contributing to the high probability of falling. Bodies of aging people that suffer from multiple physical conditions also contribute to falls because of reduced balance and strength. Some medications for high blood pressure and insomnia for the elderly may also lead to falls.

Most older people have fragile bones because of the osteoporosis condition. Elderly falls cause numerous effects such as reduced mobility, early death, reduced independence, and placement in various nursing homes. Individuals who fall and experience severe injuries must visit hospital emergency departments for examination and treatment. As a result, falls put a significant strain on the resources available to both care providers and patients. According to González-Román et al. (2016), most older adults in hospital emergency wards are hospitalized because of falls, with most elderly falls in the United States being recorded from ages 65 and above. As a result of falls, injured older people encounter multiple challenges such as derailed life functions, challenges in climbing stairs, or walking downstairs. Whether in hospitals or homes, injured older people face difficulties in standing, walking, reacting to emergencies or dangers, and performing simple personal tasks.

The knowledge gap that has to be addressed when discussing elderly falls in the United States is the effectiveness of educational programs aimed at developing more vigilant behaviors in the target population. In the article written by Moncada and Mire (2017), this knowledge gap is discussed as one of the critical issues affecting hospital workers because their familiarity with the topic could be limited. This creates additional premises for addressing falls in the elderly and ensuring that they have access to all the required resources and acknowledge such training programs’ value. The statistics on the prevalence of falls in the elderly across the United States show that approximately 25% of all elderly population experienced mild and severe injuries caused by falls (Grossman et al., 2018). This turns elderly falls into a crucial public concern that cannot be evaded or ignored if care providers expect to improve US healthcare quality.

Elderly falls are common causes of sickness and death in multiple older Americans. A 2016 study by the Centers for Disease Control about elderly falls indicated that 28.7% of individuals aged over 65 had fallen at least once (Bergen et al., 2016). About 37.5% of them need medical attention and guidelines to prevent future falls (Bergen et al., 2016). The study projected that about 33,000 persons aged over 65 reported falling at least once. According to Shankar et al. (2017), the number of elderly falls keeps rising as the population continues to age.

Moreover, the treatment cost increases as the rate of elderly falls rises. Both fatal and non-fatal injuries caused by falls establish a severe financial burden for care providers where the amount of available resources might not meet patients and healthcare workers (Tricco et al., 2017). Ideas presented by McKenzie et al. (2017) show that rehabilitation, medication, and other professional services cannot be eradicated from the healthcare equation, making it reasonable to review the problem of fall prevention way more closely. The diagrams below represent the rate of elderly falls and deaths in the United States from 2007 to 2017. The statistics indicate that there are rising cases of elderly falls each year. Therefore, there is a need to design and implement a strategic plan to curb this trend.

The US falls from 2007 to 2017 
Figure 1. The US falls from 2007 to 2017 
 The number of deaths from falls (United States) 
Figure 2. The number of deaths from falls (United States) 

One of the activities older adults can do is moving or walking from one place to another, even within their premises. Activities that involve movement minimize the risks of elderly falls. They also improve flexibility, coordination, balance, and general body strength. Most older people lack sickness signs and symptoms before a fall. However, they develop multiple signs and symptoms such as broken bones, bruises, and dizziness after falling (Tricco et al., 2017). Up to 50% of the American population aged over 65 gets minor fall injuries such as abrasions and lacerations. Major fall injuries such as intracranial injuries consist of an approximated 10% of them (Tricco et al., 2017). Most reported fall cases happen on flat floors, washrooms, stairs, and slippery tiles. Many individuals have also reported falling when walking to the toilet. If the intended elderly population cannot walk due to an injury, they may be involved in a training program to gain more theoretical knowledge about falls or slowly restore their walking capability.

The strategic plan for preventing falls in the elderly would consist of four essential goals that would also be divided into several essential objectives:

Primary prevention:

  1. Increase personal awareness among the local elderly population
  2. Increase the number of safe homes and communities
  3. Increase coverage of and access to evidence-based fall prevention programs

Early detection:

  1. Establish complex fall prevention initiatives (lifestyle changes, required medication)
  2. Emphasize post-discharge transition for risk populations
  3. Improve care coordination among providers and stakeholders
  4. Implement non-clinical assessment strategies

Care and management improvements:

  1. Comprehensive and proactive strategies intended to improve care coordination
  2. Promotion of self-management and more complex strategies
  3. Active patient and family engagement
  4. Improve stakeholder access to required resources

Data-driven fall management and prevention:

  1. Develop standard sets of measures for fall prevention in the region
  2. Enhance surveillance and implement standardized metrics
  3. Support transformation of the healthcare system as a whole

At the community level, nurses and nurse leaders would become the most important players since they would be responsible for disseminating the information and ensuring that both community and health workers realize the issue’s gravity. The essential resources to be considered are financial assets available to the responsible parties, as most strategies discussed above require specific investments that cannot be evaded or ignored. Ultimately, community-related services should become way more data-oriented because of the growing prevalence of technology and numerous ways to monitor community trends in terms of fall occurrence.

The most significant step for clinicians to take in preventing falls is first collecting the historical data of falls. They should enquire about the elderly falls from when cases started being reported until now and note any trends. A study by the American and British Geriatrics Society established the guidelines and appropriate clinical practices designed to prevent elderly falls (McKenzie et al., 2017). The guidelines state that clinicians must ask the elderly over 65 the number of times they have fallen in past years. There must be an office assessment for the elderly with previous falls and difficulties, balancing, and body strength.

Clinicians must only use evidence-based interventions in obtaining favorable outcomes for elderly patients. For older people suffering from severe health issues such as dementia, muscle weakness, and delirium, it is essential to conduct interventions. The hospital or ward rooms where patients are admitted must not have any falling hazards to prevent further potential injuries. The way(s) towards the washroom and bathroom must be free of objects. Floors must not be slippery; they should be free and clear of clutter. When clinicians receive complaints or fall cases, they must always ask patients about their former falling history.

Hospital administration and clinicians must formulate policies associated with the American Geriatrics Clinical Practice Guidelines to prevent elderly falls. Patients’ questions must contain information concerning their previous history and the frequency of falls, why they fell, and whether they have difficulties walking. These inquiries are fundamental to successfully meeting the requirements of multi-factor fall risk assessments (Tricco et al., 2017). They should be performed on every patient’s admission before drug administration. Clinicians should record patients’ assessments during this assessment for quality conformance purposes.

Nurses and other clinicians should implement level and secondary bundles for high-risk patients whenever they are admitted to hospitals. Level one comprises of assessments associated with a client and their family’s fear of falls. It consists of removing clutter in any premises’ corridors and educating elderly patients and their families about the best practices of reducing falls. It also entails patients’ bed or chair assessments to ensure they are protected before, during, and after use. Clinicians and even family members must protect the use of chairs and keep patients’ items in reach.

The next significant aspect is secondary package interventions that include drug assessment. Secondary package interventions must assess the drugs, particularly opioids, that a patient used or is currently using to determine the probability of falls. Clinicians should also include drug-associated side effects during the assessment. They should guide and inform their patients about practices that can prevent or minimize potential falls (Grossman et al., 2018). Primary habits that prevent falls among the elderly include high hygiene standards, a healthy diet, and exercise. Therapy is also recommended to help the patients because the elderly are weak and may face difficulties moving from one place to another. Nurses and other clinicians should also assess a patient’s visual abilities.

The final multi-factor risk assessment is functional and physical practices. This category reinforces a patient’s well-being by promoting walking, muscle strength, body balance, intellectual functions, and mobility. The functional and physical assessment also comprises consuming vitamin D supplements and environment modification (Moncada & Mire, 2017). It should be compulsory for the patient to attain optimum recovery. Therefore, clinicians should ensure that patients implement the activities in this assessment in their daily routine.

The fundamental practice clinicians can use is customary fall prevention and minimization interventions. Fall prevention interventions should start from basic patient premises, such as wearing non-slippery footwear. These interventions should assess patients, their routines, and their immediate environment. Nurses and other clinicians have a duty of explaining and educating patients concerning best practices for preventing falls. Clinicians should also inform patients’ family members about the risks of falls and prevention strategies to keep their loved ones safe. These interventions avoid and reduce the probability of elderly falls and thereby saving on medical costs. The specific goals that will have to be achieved after implementing the proposed strategy are primary prevention, early detection, care and management improvements, and data-driven fall management and prevention. Upon achieving the goals presented above, both stakeholders and care providers will acknowledge the importance of the issue and motivate more elderly patients to gain additional insight into how they could protect themselves from fatal and non-fatal injuries.

Appendix A

Week 3 Community Strategic Plan: Part A, Community Assessment

Effective contemporary caregiving practices in nursing have changed to cope with patients’ needs. Many individuals now prefer community-based care services as opposed to hospitalization (Youens & Moorin, 2017). As a result, there is a need to understand particular community caregiving expectations to design appropriate programs to meet these needs. This paper identifies my community focus work area, the different health risks, and conducting a community assessment specifically on the selected focus area.

Preventing falls among the elderly is my area of focus in the community. Elderly falls have become a central health issue in the community because of the rising cases. These falls happen in multiple areas such as bathrooms, pathways, staircases, and even when stepping on some objects. According to the Centers for Disease Control and Prevention (2017), at least one out of four older people fall each year, totaling millions of patients. However, less than 50% of the total elderly falls inform their doctors (Centers for Disease Control and Prevention, 2017). This is an area of interest because the community needs to be educated on best healthcare practices (the elderly in particular) about the strategies of minimizing and preventing falls so that they can live injury-free lives.

Totality and holism form the foundation of Gordon’s functional health patterns framework. According to Gengo and Jones (2021), effective interventions lead to good healthcare and people’s well-being. Gordon’s functional health patterns include health perception management, whereby most older people in the community ignore to embrace primary care interventions resulting from falls. They primarily seek medical attention when they experience severe pain that develops gradually after falling.

Nutritional-metabolic patterns refer to persons at greater risk of falls, the elderly, because of their weakening bodies. A little exercise to make their bodies strong also contributes to severe injuries. Moreover, poor diet for some translates to a slow healing process. The sleep-rest ways of the elderly in the community are remarkable. They rest and sleep early and thus get quality sleep hours. Cognitive-perceptual patterns are concerned with a community of people with significant cognitive-perceptual ways, evident through appropriate memory and language developments. The self-perception-self-concept pattern is about self-esteem, which is gradually decreasing for community individuals. Lifestyle chronic diseases have negatively impacted many community members from their youth. As a result, negative attitudes continue to develop towards self.

Roles-relationships patterns are concerned with family bonding and family times. There are weak family relationships because of numerous single households. Accordingly, an increased number of falls among the elderly could be caused by their mental problems. The idea is that family satisfaction could be contingent on mental issues and their impact on the prevalence of falls among the elderly. Family satisfaction plays a significant role in mental peace. The community’s weak mental associations should be addressed to establish functional family relationships. Essentially, there will be minimal mental issues in the community.

Sexuality-reproductive patterns denote one is sexual lifestyle and health. The community has insignificant cases of people experiencing difficulties in their sexual abilities. The poor diet lifestyles and dysfunctional family relationships contribute to poor sexual reproductive patterns. So, healthcare practices should focus on solving poor diet habits and strengthening family unions. Coping-stress tolerance patterns are concerned with management and managing problems. Essentially, the community will experience improved sexual productivity that will translate to good health.

The vital resource that will help in conducting this assessment is people. The individuals in the community can play a crucial role in enabling the completion of the evaluation. First, they can be the source of crucial information needed to learn about their lifestyle, contributing to elderly falls. Secondly, they are a suitable option in helping with assessment through data collection on elderly falls. Therefore, they are essential in enabling the completion of healthcare evaluation.

The community’s core strength is the rising interest in promoting sustainable health care among the elderly. Although there are many unreported elderly falls, there is an increasing trend of reported cases nowadays. People are interested in different health care programs in the community because they have realized the necessity of good health. Therefore, exemplary healthcare services’ quest depicts a brighter future for elderly individuals and other community members.

The community, nonetheless, has limited quality diet programs for the elderly. As a result, unhealthy diet choices have led to lifestyle diseases. Elderly individuals are suffering from chronic diseases such as cardiovascular disease in their old age because of their poor diet consumption practices. There are also rising cases of obesity among children in the community. Therefore, diet programs are required to change their eating habits.

The central barrier expected is accessing the community to formulate and implement healthcare plans. The community is a closed one, having many people unwilling to change from their traditional habits. Most elderly community members have not realized the need to curb the numerous elderly falls impacting their everyday lives. Consequently, they may be reluctant to change from their old habits and adapt to healthy practices.

There is a need to implement two strategies in addressing the above community issue. First, creating awareness of the existing problem of elderly falls must be done. It is difficult to resolve a problem unless it is first acknowledged (Menkel-Meadow, 2018). Secondly, it is imperative to cooperate and work with community members to effectively implement and monitor the progress of the plan. There is also a need to involve the community individuals as a primary resource for program implementation because individuals will likely support the program when consulted.

In conclusion, it is imperative to work with the community to attain the anticipated objectives for a given healthcare program. Community individuals should be consulted and be part of the healthcare transformation process because they determine program success. Failure to involve the community members will not yield anticipated program objectives. Feedback and cooperation should also be encouraged for optimum results and monitoring purposes. Hence, community members should be perceived and treated as stakeholders of the healthcare program implementation.

References

Bergen, G., Stevens, M. R., & Burns, E. R. (2016). Falls and fall injuries among adults aged≥ 65 years—United States, 2014. Morbidity and Mortality Weekly Report, 65(37), 993-998. Web.

González-Román, L., Bagur-Calafat, C., Urrútia-Cuchí, G., & Garrido-Pedrosa, J. (2016). Interventions based on exercise and physical environment for preventing falls in cognitively impaired older people living in long-term care facilities: A systematic review and meta-analysis. Revista Espanola de Geriatria y Gerontologia, 51(2), 96-111. Web.

Grossman, D. C., Curry, S. J., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., Doubeni C. A., Epling, J.W., Kermper, A.R., Krist, A.H., Kubik, M., Lendefeld, S., Mangione, C.M., Pignone, M., Silverstein, M., Simon, M.A., & Tseng, C. (2018). Interventions to prevent falls in community-dwelling older adults: US preventive services task force recommendation statement. Jama, 319(16), 1696-1704. Web.

McKenzie, G., Lasater, K., Delander, G. E., Neal, M. B., Morgove, M., & Eckstrom, E. (2017). Falls prevention education: Interprofessional training to enhance collaborative practice. Gerontology & Geriatrics Education, 38(2), 232-243. Web.

Moncada, L. V. V., & Mire, L. G. (2017). Preventing falls in older persons. American family physician, 96(4), 240-247. Web.

Shankar, K. N., Liu, S. W., & Ganz, D. A. (2017). Trends and characteristics of emergency department visits for fall-related injuries in older adults, 2003–2010. Western Journal of emergency medicine, 18(5), 785-793. Web.

Tricco, A. C., Thomas, S. M., Veroniki, A. A., Hamid, J. S., Cogo, E., Strifler, L., & Straus, S. E. (2017). Comparisons of interventions for preventing falls in older adults: a systematic review and meta-analysis. Jama, 318(17), 1687-1699. Web.

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ApeGrade. "Preventing Falls in the Elderly: A Strategic Plan." September 7, 2022. https://apegrade.com/preventing-falls-in-the-elderly-a-strategic-plan/.

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ApeGrade. 2022. "Preventing Falls in the Elderly: A Strategic Plan." September 7, 2022. https://apegrade.com/preventing-falls-in-the-elderly-a-strategic-plan/.

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ApeGrade. (2022) 'Preventing Falls in the Elderly: A Strategic Plan'. 7 September.

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