INSTABILITY AND FALLS

The elderly generally have more difficulty maintaining stability, which is manifested by the existence of a gear or senile cautious start (flexion, rigid posture, short and slow steps, block rotation, balance, wide support base, steps lower short arm swing)

Furthermore, with aging are lost or reflex normal protective responses against falls, as the extension of hands and arms.

WHO defines the fall as a result of any event which tumbles down the person against his will.

It is one of the most important geriatric syndromes by its high incidence and the impact on quality of life of the elderly.

The main trigger fall risk are:

-       Older than 75 years

-       Altering the stability and gait

-       Previous falls

-       Number of drugs consumed: 4 or more

-       Frail elderly

-       Living outside the family

-       Muscle weakness

-       Deficit gait and balance

-       Cognitive impairment (mental confusion))

-       Polymedication

-       Decreased vision

-       Chronic diseases (osteoporosis), acute (hypoglycemia, orthostatic hypotension)

-       History of falls

NURSING CARE PLAN

Pain

Related to fracture. It manifests as a verbal communication of discomfort.

The pathognomonic sign is the shortening and external rotation of the limb.

Nursing interventions (NIC) à

-       Environmental Performance: comfort

-       Performance at the pain

-       Administration of analgesics

-       Decreased anxiety

Result Criteria (NOC) à

-       Pain Management

-       Comfort level

-       Anxiety control

-       Acceptance: health

Care:

-       Recognize the presence of pain

-       Handle gently the affected limb, resting on pillows

-       Administer prescribed analgesia, placing the patient in a comfortable position and functional. The correct body alignment increases the comfort of the elderly

-       Help in frequent changes of position and pressure-relieving discomfort related

Impaired physical mobility

Related decreased strength, presence of pain, fear of falling snow.

It is manifested by difficulty in changing position in bed, changes in gait.

Nursing interventions (NIC)

-       Help self-care

-       Promoting exercise

-       Teaching activity / exercise prescribed

-       Exercise therapy: muscle control

-       Exercise therapy: ambulation

-       Exercise therapy: balance

-       Fall prevention

Result Criteria (NOC)

-       Active joint movement

-       Novel mobility

-       Personal Care: AVD

-       Level of pain

-       Ambulation: walking

Nursing:

-       Instruct the elderly and help in repositioning and transfer activities and

-       Instruct patient to practice isometrics quads and glutes, and flexion and extension of the unaffected limb, strengthening the muscles needed for walking

-       Start walking with short, frequent walks, and progressively increase the distance as tolerated by the patient to the activity

-       Instruct on the safe use of assistive devices and monitor the progress.

Risk of injury

Related to the lack of safety education, physiological or perceptual deficit

Nursing interventions (NIC)

-       Fall prevention

-       Physical Restraint

-       Security: Security

Result Criteria (NOC:

-       Safeguards: Personal

-       Security check: preventing falls

-       Risk Control

-       Security State: falls

-       State security: physical injury

Care:

- Install handrails in bed 

To sum up I want to say that falls are one of the greatest threats to senior health, and they can be life threatening. Each year, one third of people over 65 suffer a fall, and one third of these falls cause injuries requiring medical treatment. Even low-level falls (e.g., slipping while stepping off a curb or on a tile floor) can be life threatening in people over 70. These people are 3 times more likely to die from such injuries as younger people (Spaniolas et al., 2010). Fall-related injuries, particularly those requiring hospitalization, are the most frequent cause of developing new or worsening disability (Gill et al., 2010).

PREVENTING FALLS

Patients and families need to know how to prevent falls. The CDC recommends the following four essentials:

·         Encourage exercises that improve balance and coordination, such as Tai Chi.

·         Make the home or other environment safer.

·         Ask the healthcare provider to review all medications.

·         Take the patient in for a vision check.

To make the home safer, remove tripping hazards such as throw rugs from stairs and floors; place often-used items within easy reach so that a step stool is not needed; install grab bars next to the toilet and in the tub or shower; place non-stick mats in the bathtub and on the shower floor; add brighter lighting and reduce glare by using lampshades and frosted bulbs; and add handrails and lights on all staircases.

Seniors should wear shoes that offer good support and have thin, non-slip soles. They should avoid wearing slippers and socks (without shoes) and going barefoot.

BIBLIOGRAPHY:

1. GEORGE F. FULLER, COL, MC, USA; Falls in the elderly; Am Fam Physician. 2000 Apr 1;61(7):2159-2168. Available in: http://www.aafp.org/afp/2000/0401/p2159.html

2. HOFFMAN, Gloria Basic Geriatric Nursing 5th Edition. Elsevier 2012.

3. Tinetti ME; Instability and falling in elderly patients; Semin Neurol. 1989 Mar;9(1):39-45.