The rate of falling has become a critical public health concern in the society today. Recently conducted research in the United States has shown that the life expectancy has significantly heightened from 75 years in 1990 to approximately 79 years in 2009 (Alamgir, Muazzam, & Nasrullah, 2012). Further studies have also revealed that people aged 65 and above will exponentially double by 2050. According to the World Health Organization (WHO), falls are the leading causes of admissions into a long-term skilled-care facility. Between 20% and 30% of those who fall sustain moderate to severe physical injuries including cuts, breaks, and bruises. Research has also shown that falls have a significant impact in causing long-term pain (Alamgir, Muazzam, & Nasrullah, 2012). Other than the physical implications, falls can also cause psychological problems as victims usually tend to worry about their future such as the loss of independence. Most fundamentally, as patients develop decreasing confidence and the ability to function physically, there is a likelihood that they will fall again. Falls among the elderly is a multifaceted problem that presents a wide range of issues including cultural, financial, legal, and ethical implications.
Definition of the Problem
A fall occurs when a person accidentally or without intention comes to rest on the ground or any other lower level place. An accident will not be classified as a fall if specific criteria are involved. Some of these conditions include the presence of a violent blow, the onset of paralysis, loss of consciousness, or an epileptic seizure. Falls are a significant and frequent problem associated with the elderly. Falls have a close association with morbidity, mortality, admission into hospitals, and reduced functionality. Falls primarily result in injuries due to the presence of an accompanying disease in the elderly. Research has shown that approximately 30% of people aged 65 years and above suffer falls every year. Additionally, half of these cases become recurrent. Ambrose, Paul, & Hausdorff, (2013) noted that 10% of the falls result in severe injuries including hip fracture, subdural hematoma, bone fractures, and traumatic brain injuries amongst others. Risk factors associated with falls can broadly be classified as either intrinsic or extrinsic. Intrinsic risk factors include a history of falls where people who have experienced previous cases are more likely to fall. Age is another significant reason to account for falls as older people have a reduced ability to respond efficiently compared to the younger adults.
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Gender plays a substantial role in falling as older women tend to be more susceptible compared to men. Other possible risk factors include a solitary lifestyle and medical conditions. Additional intrinsic factors that predispose an individual to falls include foot problems, attenuated vision, cognitive disorders, and psychological problems. Other than the intrinsic factors, environmental or extrinsic factors have also been implicated in causing the falls. Studies have revealed that between 30% and 50% of the falls happen due to environmental causes including slippery floors, poor lighting, and rough surfaces (Alamgir, Muazzam, & Nasrullah, 2012). Older people are frequently prone to trips, slips, loss of balance, and missteps that eventually lead to falls.
Specific Population Affected
It is almost obvious that the group of people most prone to falls is the elderly adults aged 65 years and above. Three main reasons are provided to explain why these people are more prone to falls than any other group. First, chronic health conditions such as dementia, heart diseases, dizziness, and low blood pressure increase the probability of these falls. Secondly, widespread impairments such as weak muscles and poor vision can lead to the falls. Certain illnesses are also known to affect the body balance including labyrinthitis. As the body ages, normal physiologically and anatomical changes occur making the falling increasingly possible.
Cultural Implications
Studies have demonstrated that certain culture-related factors have a relationship with falls amongst the elderly population. One of the cited reasons is marital status where research has shown that falls, and subsequent hip fractures occur at a lesser frequency among the married people. The reason provided for this is that the married individuals have a stronger physical and emotional support they receive from their spouses. However, the explanation differs from one culture to the other due to different perceptions regarding marriage and family. In a study conducted in an Iranian population, falls that result in hip fractures was closely associated with time pattern. Most elderly women experienced falls in the early morning as a result of the ritual customs practiced by the members of the Islamic religion where prayer is mandatory at dawn. In another research conducted in China, the result showed that older populations were prone to suffer the effects of falling due to their failure to report it to their close family members (Ambrose, Paul, & Hausdorff, 2013). The major reason provided was that the elderly avoided worrying their younger family members. Certain cultures value the power that comes with independence which influences their perceptions and thereby making them view falling as part of their normal lifestyle as aging adults.
Financial, Legal, and Ethical Implications
Treating falls, and associated illnesses have always been a costly affair. According to a research conducted in 2015, the total medical costs in treating falls accumulated to a whopping $50 billion. Most fundamentally, the US elderly population is ever increasing meaning that both falls and treatment costs will likely skyrocket. Each year, older adults in their late 60s receive treatment in the emergency department due to falls. More than 800,000 patients annually are hospitalized due to injuries associated with falls mainly the broken hip and head injury. Studies have further shown that injuries due to falls are classified as one of the 20 most costly medical conditions (Alamgir, Muazzam, & Nasrullah, 2012). The average cost to treat an injury associated with a fall is more than $30,000. As one continues to age, the financial requirements to treat falls increase exponentially. Medical costs include hospital and nursing home fees. Other areas where finances are required include the prescription of drugs, use of medical equipment, and rehabilitation amongst others. Falls also necessitate long-term treatment which could be costly to the entire family.
Legally, it is a basic requirement of hospitals to ensure that it creates an environment where the patient is protected from any foreseeable risk of harm. According to research, falls and resultant injuries reduced by 35% and 62% respectively for hospitals that showed adherence to the safety protocols (Alamgir, Muazzam, & Nasrullah, 2012). The standard of care further requires hospitals to assess patients and figure out their likelihood to fall. Depending on the individual requirements of each patient, the hospital has an obligation to implement fall risk precautions which also require updating when the conditions of the patient change. Not all falls that occur within the care setting as a result of the patient's problems when a fall occurs as a result of negligence by the hospital staff; the individual will receive compensation for the damages incurred. If the fall is in one way or the other relates to the medical treatment, then the person affected has an obligation to launch a medical malpractice claim. Research has also shown that the elderly can fall due to one of the following reasons including medication error, missed diagnosis, a mistake in the medical plan, and failure of a nurse or a doctor to adhere to a certain medical protocol.
According to the ethical guidelines for nurses and allied health professionals, treatment should at all times benefit the patient and mitigate any possibility of harm. As earlier intimated, falls can occur due to the negligence of health professionals or the hospital in general. The hospital has an ethical responsibility of protecting patients and ensuring that they receive treatment that best matches their needs. Hospitals must further ensure that they put several strategies in place that reduce falls. In respect for patient autonomy as listed in the nurses’ professional code of ethics, nurses must respect the patient’s choice regarding whether to receive help or not following a fall. Furthermore, they should remain keen to ensure that all patients’ decisions regarding treatment are put into consideration.
Interventions
The best and the most utilized clinical intervention in preventing falls among the elderly are to enhance easy identification. High-risk patients such as the elderly should be provided with markers to ensure that they are always on the watch of the clinicians. For instance, the patients in question should be given red socks, and visual cues should be installed outside the doors of the patient which will act to alert the patient of any risk. Easy identification of the patient ensures that all corrective measures are taken to reduce the risk of falling. Several hospitals have sought the services of safety companions who work to aid the patient from possible falls. Part of the job of the safety companions is to observe the patients continue to ensure that falls are prevented. The patient should be kept busy at all times to make them occupied and reduce the probability of them coming out of the bed (Ambrose, Paul, & Hausdorff, 2013). Staff members should ensure that they not only educate but also partner with family members in preventing falls. Setting bed alarms to show when the patient is out of the bed could be a viable strategy. Some hospitals also provide the patients with alert alarms that communicate with the nurses and doctors to show that the patient requires assistance as a result of a fall. Safety rounds should be thorough and frequent to ensure that proper monitoring of the elderly occurs. The hospital environment should at all times inspire safety, and any physical barrier that promotes falls should be thoroughly mitigated.
Some of the resources that will become handy in realizing these interventions include visual cues, human resources, alert bells, high technology beds, and CCTV cameras amongst others. It would also be necessary at some point to review the safety protocols which will require a total overhaul of the physical model of the hospital. As a result, the hospital will incur additional costs in accessing all these resources. Further, recurrent expenditure will be used in paying the extra staff members required and carrying out maintenance. The interventions used are sustainable because they guarantee patient safety by keeping track of the elderly who are prone to the falls.
In conclusion, fall among the elderly is a multifaceted problem that presents a wide range of problems including cultural, financial, legal, and ethical implications. As a primary public health issue, understanding it requires a keen assessment of its holistic implications in an individual. Many hospitals today have geared their health promotion towards preventing falls by ensuring that all risk factors are put on check. Falls come with a financial responsibility on the patient but also legal and ethical obligation on the health providers who must constantly ensure that the hospital environment is free from any harm. Interventions primarily focus on enhancing alert and vigilance as a way of monitoring the patients and providing them with timely assistance when the fall occurs.
References
Alamgir, H., Muazzam, S., & Nasrullah, M. (2012). Unintentional falls mortality among elderly in the United States: time for action. Injury , 43 (12), 2065-2071.
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.
