Respond to the following 2 write ups, and discuss two separate resources they did not mention. One resource should be aimed at patient education and the second resource should be written for the health professional. Utilize at least two scholarly references per peer post. APA format.
The purpose of this discussion is to describe fall prevention measures in the geriatric population. Risk factors in the elderly, type of assessments, and health promotion for fall prevention will be explored. The term fall is an unintentional incident where an individual lands or rests on the floor from an upright or upper position (The Royal Children’s Hospital Melbourne, 2017). Fall risk is the susceptibility of an individual to unintentionally land on the floor from an upright position. Some individuals are more at risk than others. Fall risk is high in the geriatric population as reports show that one in three older adults fall each year (Slade et al., 2017). Once a fall occurs, the chances of a repeated fall is doubled (Bainbridge, 2019).
Specific Geriatric Risk Factors That Create an Increase in Fall Risks
According to Hamed et al. (2018), evidence show that biological decline related to age increases the incidence of falls among the geriatric population. Low extremity, core muscles, and an overall decrease in strength, contribute to falls in the elderly. Additionally, declines in flexibility, endurance, and vision changes are risk factors for fall (Bainbridge, 2019). Poor balance from factors of aging, foot pain, and inappropriate footwear, and certain medications further intensifies the risk. Deficient vitamin D is also a noted factor (Bainbridge, 2019). Geriatric factors such as chronic or medical illnesses, altered mental status, impaired mobility, elimination needs, past history of fall, and immobility are strong predictors of the risk for falls (The Royal Children’s Hospital Melbourne, 2017).
Types of Assessments in Outpatient and Inpatient Settings
Prior to implementation of any plan, an assessment is necessary to conduct. There are several types of assessment for fall risk factors in both outpatient and inpatient settings. Assessing fall risks includes a review of medication, history of falls, physical exam, and evaluation of the environment. If the patient have a history of falls, number of times in the last year, symptoms prior to falling, activity at the time of fall, fall location, use of glasses, type of footwear, getting up after falling, injuries, time of day, and treatment received should be obtained and documented (Phelan et al., 2015). Medication review can provide insight of the classes of medications that contributes to fall. Classes of drugs that poses the risk for falls are psychoactive medication (Phelan et al., 2015) such as Antidepressants, Barbiturates, Phenothiazines, Sedatives, and Hypnotics. Diuretics and laxatives escalate the risk of falling as well (The Royal Children’s Hospital Melbourne, 2017). Postural hypotension is a condition commonly seen with blood pressure medication that have orthostatic hypotension side effects and should be assessed (Phelan et al., 2015).
The environment is assessed in the home for factors such as stairs, lighting, throw rugs, clutter, and adequate lighting, and other hazards in the environment outside the home (Phelan et al., 2015). Stopping Elderly Accidents, Deaths and Injuries (STEADI) is a fall assessment tool that was created by Centers for Disease Control and Prevention (CDC). This tool is extensively used for elders who lives in the community, ambulates, and are able to respond to questions (Bainbridge, 2019). The Morse Fall Scale (MFS) screening tool is a valid assessment tool that is used in the hospital setting to identify patients who has a high risk for falls. In a study that was done, two other fall risk assessment tools found to be both specific and sensitive are the Schmid and St. Thomas Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY). These assessment tools are proven to be valid for fall assessment in the hospital setting (Watson et al., 2016).
Health Promotion to Decrease Falls in The Elderly
The Advanced Practice Registered Nurse (APRN) can recommend or implement health promotion measures to decrease falls in the elderly. Once the patient or community have been assessed, the next step is to plan for ways of preventing falls. Patient who are at risk should be counseled and encouraged to participate in an exercise program for primary prevention. According to Pender et al. (2015) strength and agility is improved with physical activity that is routinely practiced. Increased muscle strength helps to prevent falls among the elderly in community settings. Additionally, APRNs can place referrals for physical therapy (PT) services to include a home assessment where necessary changes can be made to facilitate a safe environment that would prevent fall (Bainbridge, 2019). This can be implemented as a secondary prevention. Tertiary prevention for fall prevention in which APRNs can implement is the use of assistive devices such as canes and walkers. Vitamin D is also recommended for fall prevention (Slade et al., 2017).
To conclude, the geriatric population are susceptible to falls as they continue to increase in age. “Falls are one of the leading causes of injury-related hospital admissions in this age group and are often followed by functional dependence, serious or fatal injuries, fractures, and high morbidity” (Hamed et al., 2018, p. 2). In order to avoid complications, prevention approaches are desirable and should be promoted by the APRN. There are many fall assessment tools that can be utilized to facilitate appropriate interventions. Nurse practitioners can help to decrease the chances of falling in the elderly that could lead to harm, functional decline, or fatality (Phelan et al., 2015). A multifaceted approach including exercise, strength training, flexibility techniques, and medication management (Slade et al., 2017) should be applied.
The topic surrounding medications and medication compliance is an important discussion for the advanced practiced registered nurse (APRN) to be apart of. The concept of Polypharmacy is an additional term that APRN’s should be familiar with. This definition pertains an individual taking multiple medications to treat a condition or ailment. Therefore, compliance is important to ensure patients achieve optimal success and outcomes.
When treating patients with a specific condition, often times they are placed on a wide variety of different medications to help treat different parts of their diagnosis or other conditions they may have. Therefore, medication compliance is extremely important for these patients to ensure all aspect of their conditions are being treated and managed appropriately. A recent study identified that medication compliance was impacted negatively because adherence changes as the social and environment context of individuals change, which ultimately leads to fluctuating levels of medication adherence (Rao, Maurer, Meyer, Zhang, & Shiyanbola, 2020). In addition, the lack of adherence can further enhance their disease process and lead to undesirable outcomes. When compliance suffers, it leads to an increased risk of adverse effects and can place the patients life in danger. Another article identified the lack of medication adherence was more prevalent in populations who did not earn an income above the poverty level, reported high levels of stress, and therefore suffered adverse effects and outcomes (Oats, Juarez, Hansen, Kiefe, & Shikany, 2020). Adverse effects are linked synergistically to medication compliance and it is important for patients to understand the risks associated with medication non-adherence.
In addition, patients may also experience creatinine clearance level that is less than 50 mL/min. This essentially means that the patients kidneys are not functioning effectively at filtering out excess waste. Therefore, leading to an accumulation and can significantly alter an individuals health status. Polypharmacy plays an important role with renal function. A recent article identified that patients who suffer from kidney disease are at an increased risk for nephrotoxicity due to some specific medications and build-up or accumulation of a medication that can be fatal (Azhar, Hussain, & Majid, 2019). This information is important for the APRN and their ability to prescribe certain medications to patients. In doing so, it is crucial the APRN be aware of a patients medical history and renal function, along with providing proper education regarding compliance.
APRN in Practice
As an APRN, it is important to understand how to effectively manage patients who are not compliant with their medications. The APRN can address this growing problem by scheduling routine follow-up appointments, providing detailed education regarding medication adherence, and explaining the risks and complications that can occur when non-compliance takes place. Educating is a crucial component to medication compliance and the APRN should be well-equipped and knowledgable about the risks associated with medications. The type of surveillance that can be put in place within the APRN own practice are questionnaires, pill counts, number of prescription refills, and routine laboratory tests or vital signs to ensure they are within normal limits. Incorporating these surveillance tactics will help improve medication compliance within the practice of the APRN, and improve the quality of life of the patients they serve. Within the community of Southern California, the APRN can advocate for this concern by ensuring all primary care offices have some type of record, education, or their own surveillance plans in place to improve medication compliance. In doing so, will help improve awareness to medication compliance and increase the rate of compliance.
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