Preventing Falls in Older People, Article Critique Example

The problem of injury and premature death sustained by elderly people in the United States is a public health issue that is usually avoidable. Annually, one out of three adults age 65 and older falls, although less than half of those seiors talk to their healthcare professionals about it (Falls among Older Adults: An Overview, 2011.) Shame, embarrassment and fear of the loss of independence are all contributing factors to the secrecy involved in older people and falling. This paper will discuss an article that covers several significant aspects of the problem, “Preventing Falls in Older People: Assessment and Intervention,” including its relevance to the adult nurse practitioner.

The leading cause of accident-related deaths in older people, the article discusses the importance of developing strategies designed to decrease the number of falls that result in serious injury, as well as developing a successful treatment plan to assist the patient to recover. The article defines exactly what constitutes a fall– when an individual finds himself or herself involuntarily on the ground– and describes the many detrimental results that may occur. These can include both physical issues, such as mobility problems and difficulties performing ADLs, (activities of daily living), as well as emotional aspects of the fall, such as the loss of dignity and confidence that may result in curtailing one’s activities and social isolation (Whitaker, 2011.)

The article summarizes the range of factors that put people at risk for falling: drugs and alcohol, involving taking more than one medication or any drug therapy that causes a person to feel sedated or to experience impaired consciousness; age-related physiological causes, since muscle strength declines with age, impacting the ability to easily move from one position to another, and causing imbalances in posture and slower reflexes that make it harder to compensate for those changes; medical abnormalities, including any condition that affects gait, muscle strength, cognition, cardiac health, as well as changes in one’s sensory perceptions; and finally, environmental factors that increase the chance of falling, such as poor lighting, uneven flooring, poorly fitting footwear, furniture that is not a safe height or is in a location that obstructs one’s path, as well as someone being in an unfamiliar setting. Although occasionally, falls have a single cause, most often they result from a combination of factors, both long-and short-term, that interact to precipitate the falls (Tinetti, 2006.)

The article emphasizes the importance of utilizing effective tools in order to assess the fall risk of any and all patients over the age of 65; obtaining a thorough history of all falls is crucial, since the most accurate predictor of future falls is a person’s previous history of falling (Whitaker, 2011.) The assessment should include asking whether or not the person has had two or more falls in the previous 12 months, whether the person has had an acute fall, and whether the person has problems with balance and walking. The article emphasizes the importance of understanding what has caused the falls, how often they occur, what was happening before and after the fall occurred, and what symptoms or physical problems resulted from the fall. Another issue raised in the article is that because the elderly frequently have difficulty with memory, as well as the embarrassment of talking about their failing physical status, it is advisable to obtain a history that includes input from another family member or person who has regular exposure to the patient.

Two risk reduction strategies to decrease the incidence of falling are described: the multi-factorial strategy, in which a person is given a management plan designed to eliminate or reduce risk factors for that specific individual, as opposed to a multi-component plan that consists of a variety of interventions offered to all older people who are considered fall risks. According to the article, it is the multi-factorial strategy that has been proven to reduce significantly falls in the elderly (Whitaker, 2011.) Multi-factorial interventions nearly always include an exercise program, in order to improve balance and gait as well as strength training, and can often be designed to allow a patient to participate either in groups or individually at physical therapy or at home (Barclay, 2011.) The article also describes the need to thoroughly review a patient’s medication regime in order to eliminate any medications that may be contributing to the fall risk, as well as making a referral to a physiotherapist to evaluate the patient’s gait and balance.

This article is extremely valuable to the nurse practitioner in virtually any setting. Because the elderly constitute a growing segment of the population and may present themselves to a healthcare setting with other presenting problems, fall risk is an ongoing danger that may have been overlooked or underestimated by family members and even other healthcare professionals. The article made reference to the embarrassment and shame experienced by elderly people when they fall, since they frequently experience a loss of dignity and a feeling of fear about their ability to take care of themselves in the future. Because of this, it may not be easy to determine whether or not an older adult has fallen at all, let alone on a regular basis, hence the recommendation that other people who are involved with that adult participate in the assessment process.

Therefore, it is vital that nurse practitioners keep that possibility in mind as something to assess in every instance in which they are working with an older person.It has been widely recommended that the guidelines for fall screening need to be incorporated into all health care for older adults (Salamon, 2011.) While most people are aware that the elderly are at risk for heart attacks and strokes, the issue of fall risk is essential for any nurse practitioner, as well as any healthcare provider who has access to an aging population. It is crucial to understand fall risk in order to avoid enabling the elderly population to slip through the cracks, resulting in serious or permanent injury and in the worst case scenario, death that could have been prevented.

Bibliography:

Barclay, L. (2011, January 13). Updated Guidelines to Prevent Falls in Elderly. Retrieved January 21, 2012, from Medscape Today News: http://www.medscape.com/viewarticle/73576 8,

Falls Among Older Adults. (2011, June 27). Retrieved January 21, 2012, from Centers For Disease Control And Prevention: http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html

Jones, D. & Whitaker, T. (2011). Preventing Falls in Older People: Assessment and Interventions. Nursing Standard, 25 (52): 50-55.

Salamon, M. (2011, January 13). Fewer Meds, Balance Exercises May Prevent Elderly Falls. Retrieved January 21, 2012, from Lifescience.com: http://www.livescience.com/9294-meds-balance-exercises-prevent-elderly-falls.html

Tinetti, M. (2006, August 21). Preventing Falls in Elderly Persons. Retrieved January 21, 2012, from New England Journal Of Medicine: http://berkshirehealthsystems.org/documents/Internal%20Medicine%20Resident%20Curriculum/Appendix%20C%20-%20Supplemental%20Readings/Geriatrics/Preventing%20falls%20in%20elderly%20persons.pdf