Recommendations for improvement in organizational processes

Long-Term Care Facility Safety: Prevention and Reduction of Injuries Due to Falls

One out of every three adults ages 65 and older experiences a fall annually however, only about 50% of health care providers discuss falls with these individuals. Falls are the leading cause of injury death in adults 65 years of age and older. More than 19,700 adults died in 2008 form accidental fall injuries and in 2009 out of the 2.2 million nonfatal fall injuries in older adults in excess of 581,000 individuals had to be hospitalized. The direct medical costs were over $19 billion in 2000. (Centers for Disease Control and Prevention, 2012) According to the National Council of Certified Dementia Practitioners, "One of the most challenging, life-threatening issues related to care of the person with cognitive loss is the occurrence of wandering, wherein the person strays into unsafe territories and may be harmed." (2012) It is reported the long-term care facility is required to maintain a system that ensures that all equipment including "alarms, tracking devices and monitors are periodically checked and maintained for adequate functioning." (NCCDP, 2012)

I. Prevention of Falls Among Older Adults

The Centers for Disease Control and Prevention report that older adults are able to remain independent and reduce the chances of taking a fall through regular exercise that have a focus on bringing about an increase in the strength of the individual's legs and exercises that improve the individual's balance. Also stated is that the medications taken by older adults should be reviewed by their doctor or pharmacists due to the side effects of medications that may cause the individual to be dizzy or drowsy. Older adults should also have their eyes checked once per year and have their eyeglasses updated. Finally, the residence of the older adults can be safety-proofed through reducing hazards of tripping, adding grab bars in the bathroom and adding railings on stairs as well as improving the lighting.

II. Risk Factors for Falls in the Elderly Population

The work of McCarthy, Adedokun and Fairchild (nd) report that factors that predispose older adults to the risk of falling include such as "…unsteady gait and balance, weak muscles, poor vision, medications, and dementia. In addition, other factors such as poor lighting, loose rugs, poorly fitting shoes, floor clutter, and beds or toilets without handrails, also may cause falls ." In addition, medical conditions including "…low blood pressure, stroke, Parkinson's disease, arthritis, Meniere's disease (affects the middle ear - causes vertigo), poorly controlled diabetes, poorly controlled epilepsy, brain disorders and thyroid problem increase the elderly client's risk for falls." (McCarthy, Adedokun and Fairchild, )

Previous study findings show that exercising including warm-up, static stretching, muscle strengthening in the lower extremities, toe exercises, proprioceptive neuromuscular facilitation, and cool-down served to increase motivation and to increase care-giving skills. (Kato, et al., 2008) The injuries due to falls were reduced from 41.9% to 9.7%. In a separate study conducted by Sherringoton, Whitney, Lord, Herbert, Cumming and Close (2008) it was found that fall prevention exercises reduced the rate of falling by 17$ and it was concluded by the researchers that exercise programs do indeed reduce fall rates in older people.

In another study reported by Wiens (2001) the role of the pharmacist in preventing falls in the elderly population as examined. The conclusions stated is that the interventions "that include medication review with appropriate modifications to the elderly client's medication regimen support a pharmacists as a participant on a multidisciplinary team that reviewed medication, provided suggestions focused on the reduction of medications know to put the older population at a higher risk for falls.

A study conducted by Hartikainem, Lonnroos and Louhivuori (2007) examined whether medication put the older individual at a risk for falls. The study is reported to have concluded "that central nervous system drugs, especially psychotropics, seemed to be associated with an increased risk for falls." The elderly person's individual physiological factors also result in an increased risk for falls.

Koski, Luukinene, Laippala and Kivela (1996) report that conditions that place the older patient at a higher risk for falls include "lower-extremity muscle weakness, peripheral neuropathy, lower pulmonary capacity, difficulties in gait and use of long acting benzodiazepines and cardiovascular medications." Additionally noted is that the primary occurrence of falls was when the older individual was either "walking or taking a seat" and it is stated that this indicates "training of lower extremities and supervised walking could be an effective nursing intervention for elderly clients." (Koski, Luukinene, Laippala, and Kivela, 1996) Individual Risk Factors that are modifiable and non-modifiable and the environmental risk factors for falling that are modifiable and those that are nonmodifiable are stated by the Long-Term Care Imperative as follows: