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Nursing Research Falls of the elderly people are the main causes of severe injuries and complications. According to Mary E. Tinetti, M. D one third of 65 year old people or older fall each year and half of them fall several times (Mary E. Tinetti, M. D).
Due to the age of the people falls result serious injuries such as hip fracture, other fracture, subdural hematoma, other serious soft-tissue injury, or head injury. Falls are the main results of the hospitalization of the elderly people. The consequences of the falls cause temporal disability of the elderly people. They loose such natural functions as the ability to take care of themselves, to dress themselves, to move etc. The elderly people use various medications which may increase the risk of falls due to their side effects. Such medicines as neuroleptic agents, antidepressants and other normally used by elderly people increase the risk of falls substantially.
After the discharge from the hospital the risk of falls becomes higher due to the fact that the elderly people are frail enough and they require home care. The elderly people are subjected to the exacerbations of their chronic diseases and thus the risk of falls increases. There is no doubt the risk of falls of elderly people is very high. Certain measures should be taken to prevent the elderly people from traumatism resulted from falls. More than 30 % of people aged 65 or older living in the community fall each year, many fall more than once, and the risk of falling increases with age (Lesley Gillespie). According to researchers falls are the major health problems among elderly people.
In the United States one of three people aged 65 or more living in the community fall at least once a year. This proportion increases to one in two for those over 80 years. Worldwide elderly people especially female over 70 have a significantly higher fall related mortality than younger people (John T Chang). The total cost of complications after the falls is enormous. In the United States total cost of the fall injuries is supposed to reach $ 32. 4 bn (in 1994 US dollars) by 2020.
The prevention of falls among the elderly people becomes the nationwide problem. At the same time there is no clear vision how to prevent falls of the older people. Society requires certain interventions to prevent the falls of older people to reduce the fall injuries. Multiple studies have shown that the interventions can reduce the risk of falls of the older people. The various intervention programs are not effective in certain population groups, such as those with dementia (John Campbell). While defining the strategy of interventions to prevent the falls it is necessary to choose the multiple risk factors causing falls.
Such measures as balance retraining and withdrawal of psychotropic drugs have been as successful as those using multiple interventions. It is necessary to define which strategy of intervention is the most effective. One of the most significant risk groups are the people with the site impairment. They fall more frequently due to their vision defects. They do not identify the environmental hazards; they may not evaluate correctly various obstacles as well as not taking appropriate corrections after a stumble.
There are several intervention programs may be implemented to prevent falls of the elderly people with the sight impairment. People with the sight impairment are exposed to fall risk both at home and outside. Home safety program is one of the crucial part of intervention aimed to protect elderly people with the sight impairment. The therapists evaluate the peoples home behavior and give the recommendations to prevent the falls. They recommend on the corrections of the behavior to prevent from falls or reduce the risk of falls. Elderly people within the home intervention program are under the control of the therapists and the therapists correct the intervention programs being in permanent touch with their patients.
The elderly people are often partially physically impaired. Another program which may reduce the risk of falls is the program of specific muscle strengthening and balance retraining exercises that progress in difficulty and a walking plan modified for those with severe visual acuity loss, with vitamin D supplementation (John Campbell). Therapists work out the system of individual exercises which were combined with the prescription of the vitamin D. The home safety program indicated that the falls of elderly people and consequent injuries can be reduced substantially. There were 41 % fewer falls in the participants of the home safety program compared with those who did not receive this program (incidence rate ratio 0. 59, 95 % confidence interval 0. 42 to 0. 83). There was no significant difference in the reduction of falls at home compared with those away from the home environment (ratio of incidence rate ratios 0. 60, 0. 31 to 1. 17).
No adverse events were reported as a result of this intervention (John Campbell). Apart from the elderly people training the falls and injuries caused by them may be reduced by removing the environmental hazards. These actions may be difficult to implement because not all the hazards may be successfully removed but some actions in this direction can be taken. There are a number of various factors causing the risk of the falls by the elderly people. Older age, female sex, white race, living alone, lack of social support, physical and mental impairment, limitations on the ability to perform activities of daily living, and the presence of specific medical conditions have all been identified as predictors of placement in a skilled-nursing facility (Mary E.
Tinetti). Another problem connected with the risk of falls of elderly people is the psychological one. Elderly people experience fear to fall which in its turn limits their physical functionality. Problem of falls of people suffering of dementia becomes much more serious than that of elderly people without dementia. The problem is that the interventions similar to those described above are very difficult to implement to people suffering of the age dementia. The incidence rate of falls was twice as high at a psycho geriatric clinic than at a geriatric rehabilitation clinic (Kristina Kallin).
Complications of dementia range from balance disturbances to behavioral and psychiatric symptoms. The situation worsens because the elderly people with dementia have to take psychotropic drugs which cause dissemination. Behavioral and psychiatric symptoms may also lead to increased activity and higher risk of falling. There are difficulties of the appropriate intervention for the cognitively impaired older people. The studies show that of 2, 008 cognitively impaired residents, 189 (9. 4 %) had fallen at least once during the preceding week.
Twenty-seven of the fallers (14. 3 %) had sustained serious injuries, such as fractures, cuts needing stitches, head injuries, and injuries to internal organs, and 93 fallers (49. 2 %) had sustained minor injuries, such as bruises or minor cuts or abrasions. Only 69 (36. 5 %) sustained no registered injury from their fall. Seventy-two percent of the residents sustaining a fall in this study had suffered previous falls during their stay at the setting (Kristina Kallin). Cognitively impaired older people are more susceptible to injuries when falling. The study made a certain conclusion that people with the intermediate level of cognitive impairment are more subjected to falls. This can be explained by the fact that these people may possibly under evaluate their abilities which creates additional risk for them.
These people who could get up from the chair but needed the assistance while walking got injuries more frequently than those who could walk themselves and those who could not get off the chair. Use of antidepressants, as a whole, was not associated with an increased risk of falling among cognitively impaired older people (Kristina Kallin). This indicates that for cognitively impaired persons the use of medicine is not the main factor defining the risk of falls. The older people with cognitive impairment are exposed to a higher risk of injuries caused by falls due to their mental conditions (lost of memory, changes in gait, compromised ADL functioning, and prevalence of psychiatric symptoms). Prevention from falls should be combined program of psychiatric behavioral symptoms treatment as well as adjustment of drug treatment.
People with cognitive disability require more careful medical staff supervision. The problem of falls of the older people does exist and can be released partially by the certain intervention programs. These programs include complex measures directed to reduce risks of falls of elderly people. Such measures consist of generally medical means like adjustment of the drug treatment, treatment of the sight disability if such occurs and generally preventive training. Special attention should be paid to people with cognitive impairment. These people due to their partial mental disability (memory loss etc) can not accept adequate training and such training should be compensated by the medical care and supervision by the medical staff.
Well balanced drug treatment may reduce the risk of falls. Psychotropic drugs may become an additional risk factor for the older people. The statistics show that the falls of the older people and injuries caused by these falls may become the nationwide problem if the appropriate programs directed to reduce the risk of older people falls are not accepted. The appropriate interaction of the nursery staff with elderly people, monitoring of their physical and mental condition as well as their difficulties with balance or gait may contribute to the fall prevention considerably. Special attention should be paid to general disease treatment. All cases of falls should be the subject of the medical study and making the appropriate conclusions and corrections by the nursery and medical staff.
In case with the elderly people falls should be prevented or at least reduced because they may become the serious injuries which are very difficult to treat in case with the elderly people. Bibliography Mary E. Tinetti, M. D, Preventing Falls in Elderly Persons, The New England Journal of Medicine, January, 2, 2003, Volume 348: 42 - 49, Number 1, available at web retrieved 29. 10. 2005 Lesley Gillespie, Preventing falls in elderly people, BMJ 2004; 328: 653 - 654 (20 March), available at web retrieved 29. 10. 2005 John T Chang, Sally C Morton, Laurence Z Rubenstein, Walter A Monica, Margaret Maglione, Marika J Suttorp, Elizabeth A Roth, Paul G She kelle, Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials, BMJ 2004; 328; 680 - doi: 10. 1136 /bmj. 328. 7441. 680, available at bmj. com, retrieved 29 October 2005 John Campbell, M Clare Robertson, Steven J La Grow, Ngaire M Keys, Gordon F Sanderson, Robert J Jacobs, Dianne M Sharp, Leigh A Hale Randomised controlled trial of prevention of falls in people aged? 75 with severe visual impairment: the VIP trial, BMJ, doi: 10. 1136 /bmj. 38601. 447731. 55 (published 23 September 2005) Mary E. Tinetti FALLS, INJURIES DUE TO FALLS, AND THE RISK OF ADMISSION, The New England Journal of Medicine, Volume 337 Number 18, available at web retrieved 29. 10. 2005 Kristina Kallin, M.
D. , Yngve Gustafson, M. D. , Ph. D. , Per-Olof Sandman, R. N. , Ph. D. , and Stig Karlsson, R. N. , Ph.
D. Factors Associated With Falls Among Older, Cognitively Impaired People in Geriatric Care Settings, Am J Geriatr Psychiatry 13: 501 - 509, June 2005, available at web retrieved 29 October 2005
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Research essay sample on Elderly People Intervention Programs
