Many people assume that fall is a natural part of aging. While many think it is true, that does not automatically make it right. The North American Nursing Diagnosis Association (NANDA) define fall as the state in which an individual is shows greater risk of falling or losing balance which may potentially cause bodily injuries as an impact of the fall (NANDA International, 2014) . The Center for Disease Control and Prevention (CDC) identified fall as one of the leading causes of death as a result of injury for elderly Americans ages 65 and above (CDC, 2017) . Based on historical data, out of 29 million incidents of fall, 3 million have resulted to visit at the Emergency unit, 800,000 ended in hospital confinement, and 28,000 was fatal (CDC, 2017) . Furthermore, Medicare also reports that fall amongst the elderly is one of the costliest medical issue amounting to $31 billion in annual cost (Mott, 2017) . Considering all of these figures, the risk for fall amongst the elderly has become a serious medical concern. This paper would like to offer an effective approach to help prevent fall amongst the elderly. The effectiveness of the proposed intervention shall be assessed to help determine the relevance of the proposal as a preventive measure to address the issue of fall amongst the elderly.
Profile of the Aggregate
As individuals reach a certain age, numerous changes both the physical and physiological aspects take place in their body. In a study published in 2013, the author enumerated the different risk factors for falls amongst the elder (Ambrose, Paul, & Hausdorff, 2013) . Typically, these sample population are people above 65 years, living independently. Some of them experiences one or more pathophysiologic conditions, which makes them highly vulnerable to falling. Among these conditions include vertigo, Vitamin D deficiency, visual and hearing difficulties, impaired balance, vascular disease, loss of limbs, Orthostatic hypotension, and impaired physical mobility. There had also been studies revealing that older people who exhibits signs and symptoms of dementia, delirium, confusion and diminished mental status had also been related to factors causing fall amongst the selected aggregate (Dhargave & Sendhilkumar, 2016) .
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The Aggregates’ Strengths and Weaknesses
Perhaps it comes with aging that people at this age are already aware of their personal needs compare to the younger generation. They are also very highly independent and given that they are at an age where they have already served and worked, many believe that this aggregate already has financial independence or at least have savings that can support their health needs. It is also assumed that at this age, people already have a good sense of their limitations and it is also assumed that given this knowledge, they are less of a risk taker and take calculated steps to avoid the ill consequences of their actions.
Nevertheless, at this age also, they already experience physical limitations as far as movement and activity involvement are concerned. Some have medical conditions which is the result of poor lifestyle when they were still young. Amongst these health condition includes arthritis, hypertension, neuropathy, C Vitamin D deficiency, visual and hearing difficulties, impaired balance, vascular disease, loss and of limbs.
A Risk Assessment of the Aggregate
To assess the potential risk of patients from fall, this paper will utilize the Morse Fall Risk Assessment (Network of Care, 2006) . This form contains series of questions that assesses the susceptibility of the elderly to fall (Please refer to Appendix A for the Sample of the Morse Fall Risk Assessment). Among the questions asked is the history of fall. This verifies whether the patient is most likely to fall again. They are also asked to assess their gait, and their mental status. A second diagnosis is also secured or the possibility that the patient had been previously diagnosed with any of the medical conditions that put them at greater risk of falling. Patients are also observed for presence or use of ambulatory aid like wheelchair, crunches, walker or assisted by a nurse or a caregiver. Finally, patient will be noted for manifestation of saline shock or intravenous therapy.
Diagnosis Based on the Risk Assessment
There are six categories for which a patient is assessed for Risk for Fall using the Morse Fall Risk Assessment. These include: (a) history of fall, (b) secondary diagnosis, (c) ambulatory aids, (d) intravenous therapy, (e) gait, and (f) mental status (Network of Care, 2006) . History of fall immediately jump to 25 as soon as there is a history of physiologic fall. For the secondary diagnosis, if there is more than one positive diagnosis from the list of secondary diagnosis, then the patient’s score will increase to 15. For ambulatory, a patient can either get a score of 0, 15 or 30 depending on how the patient is able to walk independently. It is scored 0 if the patient is in bedrest or uses a wheelchair, even if the patient is assisted by the nurse or another person. The score jumps to 15 if the patient uses support like crutches, walker or cane. However, if the patient grabs or hold on furniture for support this increases the patient’s risk for fall. Hence, the score jumps to 30. If the patient has any heparin lock of IV attached to him or her, the patient will score 15 under the intravenous therapy category. There are also three scores for gait, 0, 10, and 20. A score of 0 is given to patients who are able to freely walk. Posture is normal and there shows no sign of difficulty or uncertainty in balance. The score would jump to 10 if the patient makes several attempts to stand, shows sign of uncertainty, unable to balance, or the steps are short and unstable. The score will jump to 20 if the patient is fully dependent on something or someone to stand and walk, showing signs that he/she cannot keep his/her balance. Finally, mental status is rated as either 0 or 15. If the patient’s personal assessment of his/her capabilities are consistent with the nurse’s evaluation, the patient will get a score of 0. However, if the patient overvalues or overestimate his/her own limitations the score will be 15.
Overall, a patient who earns a score of 0-24 at the Morse Fall Risk Assessment, this means that the patient is at no risk for fall. Scoring within the range of 25-50 suggest low risk. The need to implement the standard fall prevention intervention is required at this level. However, a patient with a score of ≥51 means that there is a high risk for fall. At this stage there is the need to implement a high-risk prevention intervention to ensure the patient’s safety.
Nursing Care Plan for Patients at Risk for Fall
|
Nursing Diagnosis |
Goal/Outcome |
Intervention |
Rationale |
Implementation |
Evaluation |
|
NANDA: Risk for Fall Related to: extremes of old age Impaired Physical Mobility |
Client-Centered Goals After 3 hours of nursing intervention, patient will be free from fall. Outcome: Patient will be free from injury Patient will start to demonstrate behavior and lifestyle modification that will reduce the risk of falling and protective measures to safeguard safe from injury |
Therapeutic Intervention Identify the risk factors that significantly affect patient’s safety needs. Provide signs like an ID bracelet that will immediately inform anyone that the patient is high-risk for fall (Gray-Miceli & Quigley, 2012) Secure that the patient’s bed is in the lowest possible position. |
For each Intervention This will allow appropriate interventions to be implemented. This will provide signals to people about the patient’s condition to foster the necessary behavior around the patient. By keeping the bed close to the floor lessen the risk for fall and reduce the intensity of serious injury |
- Assess using Morse Fall Risk Assessment Form to establish risk level - Give patient an ID bracelet that will serve as an alert for people around of the patient’s condition. Ensure that the community is aware of the purpose to ensure success - Position patient’s bed adjacent to the floor to reduce the risk of falling and lessen the impact of fall to prevent injury |
Goal Met. After three hours of intervention, the patient was free from fall and patient’s safety was ensured. Patient was prioritized during disaster because it was easy to identify them as having impaired physical mobility. |
Implementation Process
While it was ensured that the intervention is kept and followed, there are still factors that prevented the nurses and other healthcare professionals from effectively implementing the proposed intervention. One of the identified barriers to the intervention is the absence of adequate information campaign that would inform the public of the relevance of the ID bracelet that the elderlies wore around their wrist. While it is easy to implement this is a closed environment, like a nursing home or a hospital, it was not easy explaining the intervention to everyone outside this closed environment. Considering that disasters may strike at anytime and anywhere, it would be difficult to inform the community in general that people who are wearing a specially-designed ID bracelet means that they are at risk for fall given the various criteria that qualified them to belong under such category.
Furthermore, positioning the bed to the lowest possible position may not be the most comfortable situation to be in for elderlies especially when they are getting out of the bed. Some elderlies may need the height to be able to put their feet down first to assist them in properly getting up and not suffer from vertigo or arthritis. Consideration should be given to this aggregate since their joints are already brittle and starting to calcify.
Evaluating the Effectiveness of the Intervention
An indication that the intervention was successful is, when patients with higher risk for fall are easily identified in a crowd. In the event of a disaster, patients with higher risk for fall should easily be identified from the crowd based on their ID bracelet. Assistance should be given to these group in terms of walking aid or a wheelchair to prevent them from falling. Furthermore, another indication that the ID bracelet served its purpose is when people around the patient does not see this article as an accessory but an important tool that could save them from inflicting serious injury.
Another sign of success is when there are significantly lesser reports of patients falling off their bed when there is an emergency or a disaster. It is only natural that the most immediate reaction of people in this situation is to panic and leave their post. If the patient was in bed when disaster happens, the immediate reaction is to get up or to panic. When the patient starts getting agitated, the risk that they will fall is higher. Falling off a bed at a higher level will create a strong impact which may cause serious bodily harm or at times, that could be fatal. This can be avoided if after the patient roll over or roll off the bed, there would not be any serious harm on the patient.
Appendix A
Morse Fall Risk Assessment Form
References
Ambrose, A. F., Paul, G., & Hausdorff, J. M. (2013). Risk factors for falls among older adults: A review of the literature. Maturitas, 75 (1), 51-61.
CDC. (2017, September 27). Take a Stand on Falls . Retrieved August 8, 2018, from Center for Disease Control and Prevention Website: https://www.cdc.gov/features/older-adult-falls/index.html
Dhargave, P., & Sendhilkumar, R. (2016). Prevalence of risk factors for falls among elderly people living in long-term care homes. Journal of Clinical Gerontology and Geriatrics, 7 (3), 99-103.
Gray-Miceli, D., & Quigley, P. A. (2012). Evidence-Based Geriatric Nursing Protocols for Best (4th ed.). New York: Springer.
Mott, S. (2017, December 19). Does Medicare Cover Falls? Retrieved August 7, 2018, from Medicare Website: https://medicare.com/coverage/does-medicare-cover-falls/
NANDA International. (2014). Nursing Diagnoses 2015-17: Definitions and Classification (10th ed.). Hoboken, New Jersey: John Wiley & Sons.
Network of Care. (2006, August 29). Morse Fall Scale. Retrieved August 7, 2018, from Network of Care Organization Website: http://www.networkofcare.org/library/Morse%20Fall%20Scale.pdf
