Nursing and Issue of Falls Are Responsible

Nursing and Issue of Falls

Falls are responsible for considerable morbidity, immobility, and mortality among older persons, especially those living in nursing homes. Falls can occur in a home, community, long-term rehabilitation, or acute care Setting (Laurence Z.R. et.al, 1994). The risk of falls can be related mostly to mobility status, exposure to hazardous environments and risk-taking behaviors such as climbing ladders for seniors living in the community setting. Factors for a fall in hospitalized adults are greatly influenced by acute illness that often has a marked, albeit temporary, impact on physical and cognitive function compounded by care provided in unfamiliar surroundings in the long-term care setting, the risk factors for falls are influenced by impaired cognition, wandering or impulsive behavior, use of psychotropic medications, incontinence and urgency, lack of Exercise, unsafe environments, and low staffing levels. Patient falls are serious problems

In acute care hospitals and are used as a standard metric of nursing care quality (Dykes et.al, 2009).

Causes of fall

Gait disorders, weakness, dizziness, and confusion, are some of the causes of fall in Frail, high-risk persons living in institutions, whereas the falls of community-living persons are more related to their environment. In the nursing home for instance, gait problems and weakness account for most of the falls .investigators of case control studies in nursing homes have reported that more than two thirds of persons who have fallen have substantial gait disorder.

Aging is associated with other deteriorations that impair gait, including increased postural sway; decreased gait velocity, stride length, and step height; prolonged reaction time; and decreased visual acuity and depth perception. Gait problems can also stem from dysfunction of the nervous, musculoskeletal, circulatory, or respiratory systems, as well as from simple reconditioning after a period of inactivity.

Dizziness has also been commonly reported by elderly persons who have fallen. This symptom however is often hard to evaluate since the term "dizziness" may means different things to different people. However, True vertigo, a sensation of rotational movement, is believed to show a disorder of the vestibular apparatus, for instance benign positional vertigo, acute labyrinthitis, or Meniere disease. Symptoms described as "imbalance on walking" often reflects a gait disorder.

Major causes of reported falls at both the nursing home and the community stem from environmental hazards or accidents. Circumstances in which these accidents occur are difficult to verify, and many falls in this category may actually stem from interactions between environmental hazards or hazardous activities .Factors such as decreased lower-extremity strength, poor posture control, and decreased step height all interact to impair the ability to avoid a fall after an unexpected trip or while reaching or bending. Age-associated impairments of vision, hearing, and memory also tend to increase the number of trips.

Studies have shown that most falls in nursing homes occurred during transferring patients from a bed, chair, or wheelchair as well as attempting to move them to or from the bathroom. Confusion and cognitive impairment have also been frequently cited as the causes of falls and they may reflect an underlying systemic or metabolic process (for example, electrolyte imbalance or fever).

Falls also can occur when persons with dementia wander, attempt to get out of wheelchairs, or climb over bed side rails (Laurence Z.R. et al.). Other cited causes of falls include visual problems, arthritis, acute illnesses, disorders of the central nervous system, side effects associated with drugs and alcohol. Central nervous system disorders (for example, cerebrovascular disease, dementia, normal pressure hydrocephalus, and Parkinsonism) often result in falls by causing dizziness, orthostatic hypotension, and gait disorders.

Therapy and Prevention

Once the possible cause or causes of the fall has been discovered and additional risk factors configured the aspect of the fall evaluation process takes effect, this begins with prescribing effective treatments and interventions to prevent future falls. Since falls are in nature multifactorial note should be taken by the clinician responsible to develop an independent individual plan for each patient considering the intrinsic factors, the functional level of the patient and how the treatment will affect the quality of life of the patient. In any case when a fall is caused by an obvious problem, the treatment is relatively simple thus it should be effective and direct (Anuradha T. ).

In most cases however chronic interacting conditions cause most falls in patients and in this regard therefore treatment will require a combination of medical, rehabilitative, environmental, and behavioral intervention strategies such as treating an underlying cause of syncope, lowering bed height, and advising a patient to wear safe footwear. In some instances however for instance limiting ambulation and using restraints will be hazardous to the patient than the fall itself.

Gait and Balance Impairments

Gait and balance impairment disturbances patients should be evaluated for the underlying process which can be evaluated after examination into problems with strength, sensation, pain, joint mobility, spasticity and/or central processing. Once investigated the treatment process should be tailored to involve programs of gait training, specific exercises, and prescription of assistive devices. Training of gait should normally be under the supervision of a professional therapist, this training is basically helpful to persons suffering from stroke, hip fracture, arthritis, or Parkinsonism. As for assertive devices they should be tailored to individual specifications and should be prescribed in consultation with a physiatrist or a physical therapist,

Dizziness Syndromes

Treatment approaches to dizziness also depend on the underlying cause may it be

Hypo fusion (hypotension, arrhythmias, or local ischemia), vestibular problems, drug effects, or other less common disorders. Caution however should be taken when using Antihistamines and antiemetic agents, since they have a tendency to sedate and cause confusion in elderly persons

Postural Hypotension

Autonomic dysfunction which causes postural hypotension seems much more difficult to treat and it is common among patients who suffer from diabetes and Parkinsonism. Several techniques have been however found to be of help to persons with persistent orthostatic hypotension caused by autonomic dysfunction, they include among others: sleeping in a bed for example with the head raised in order to minimize a decrease in blood pressure on rising; wearing elastic stockings to minimize venous pooling in the legs; avoiding heavy meals and activity in days when the weather is hot.

Environmental Assessment

Potential hazards are minimized when the environment is carefully assed, in this regard therefore specific environmental assessment interventions should be considered, this include: adequate lighting in all hallways and stairwells, bathroom grab bars next to the toilet and in the tubs or shower, nonskid mats in tubs or shower, raised toilet seats, handrails in the hallways, secure stairway banisters, and furniture that is easy to rise from.