Essay
Needs Assessment and Rationale
Falls are a serious public health issue in the United States because it is the main cause of trauma-related incidents and injury-related emergency cases, and the leading cause of unexpected deaths among the elderly. People aged 65 and above comprise the majority of casualties from falls (Al-Faisal, 2006). The prevalence of falls rises continuously with age irrespective of gender and racial/ethnic affiliation. As reported by Stevens and colleagues (2010), “each year, about one-third of all older adults fall. In 2007, an estimated 1.9 million fall injuries among persons aged 65 years and older were treated in hospital emergency departments” (p. 16). The prevalence of fall-related injuries is highest among individuals aged 85 and above. The Centers for Disease Control and Prevention (CDC) released national statistics showing that falls among the elderly is a major public health issue (Arenson & Reichel, 2009), mainly due to the fact that falls lead to more severe injury among older adults.
Recent national statistics reported that falls is one of the main problems for home care facilities. As shown in the reports, nursing home residents and and community-dwelling older adults fall every year; most of these who fell had frequent episodes. These falls, as explained by the CDC, can lead to disability, impaired physical functioning, and poorer quality of life. Fear of falling and weakened self-reliance can result in social isolation, feelings of vulnerability and unworthiness, depression, and more serious functional deterioration (Arenson & Reichel, 2009). Falls happen more frequently in nursing homes due to the fact that, generally, nursing home residents are more fragile than elderly people residing in a community. Nursing home residents have a tendency to be older, experience more deficiencies in their daily functioning, and endure more serious cognitive disabilities. In addition, residents are more prone to severe diseases or disorders, have a greater risk of walking difficulties, and be physically vulnerable and dependent (Cannard, 2011).
Even elderly people who seem to be able-bodied and healthy can fall. The natural occurrences that come with aging, like impaired hearing or eyesight, can make an older adult more prone to falls. Falls and accompanying vulnerability can be indicators of deteriorating function and impaired health. In elderly recipients of care, a fall could be a general featuring symptom of numerous serious diseases, like myocardial infarction, urinary tract infection, pneumonia, or it could be the symptom of a serious worsening of a long-term illness (Cannard, 2011). As shown in the study of the American Academy of Family Physicians (AAFP), physical conditions and diseases can affect an individual's symmetry, stability, balance, and strength (Arenson & Reichel, 2009), raising his/her danger of falling.
Environmental aspects like satiny floor coverings or inadequate lighting in the house or in a formal care facility can make an individual more at-risk of slipping or tripping. As explained by the CDC, gait or walking difficulties and weakness are the most widespread reasons of falls among care recipients in nursing homes. In addition, the CDC found out that environmental factors are also one of the major causes of falls in nursing homes (Arenson & Reichel, 2009). It has also been observed that the side effects of certain medications can adversely affect an individual's balance and heighten the risk of falling. Medicines, particularly psychoactive medications like anti-anxiety drugs and sedatives, can raise the possibility of falls and accompanying injuries. Medications for such problems like high blood pressure, sleep disorder, and depression (Stevens et al., 2010; Kronfol, n.d.) can increase an individual's risk of falling.
Behavioral and Environmental Determinants of the Issue
Behavioral and environmental risks factors of falls among elderly have been identified in the empirical literature. Behavioral determinants include improper shoes, substance abuse, and inactive lifestyle. Choice of footwear is a likely changeable aspect that is believed to contribute to certain falls. One research discovered that many elderly people do not have proper footwear at home and other indoor settings. Wearing socks alone or walking without any footwear heightens the danger of falling indoors (Yoshida, 2012). Moreover, high-heeled footwear could adversely affect the balance of elderly women and raise their susceptibility (Yoshida, 2012; Cannard, 2011) to falls.
Studies have also shown a connection between falls and alcohol intake. Consumption of alcohol is linked to postural hypotension, which is then linked to falls. Long-term consumption of alcohol, alongside deterioration in the part of the brain that regulates balance and posture as caused by advanced aging, can heighten postural imbalance and boost the risk of falling. Furthermore, alcohol consumption can speed up the weakening of postural balance (Yoshida, 2012). It can also increase the danger of sustaining hip injury. This could be caused by the greater risk of falling while inebriated, alongside a weakened bone density (Arenson & Reichel, 2009) linked to aging and long-term alcohol use.
In addition, normal muscle function is directly correlated to physical lifestyle. Older adults who fall have a tendency to be more sedentary which brings about increased muscle atrophy. Elderly people who are sedentary or physically inactive are more at-risk of falling than those who have a physically active lifestyle (Al-Faisal, 2006; Kronfol, n.d.). Fear of falling is another behavioral determinant of falls among the elderly. Fear of falling is strongly correlated with muscle deterioration, and changes in mobility and balance. It is also linked to weakened gait pace, poor one-leg balance, and heightened voluntary sway (Zijlstra et al., 2007). A current research of elderly women with reduced bone mass discovered that fear of falling, as identified by falls self-esteem, was individually linked to mobility and balance after controlling performance in several physiological activities, level of physical activity, and age. Moreover, the research proposes this relationship was greater in elderly with a previous experience with fall-related injuries.
Risks of falling among the elderly can also be attributed to environmental factors, which include the presence of disarray or litter, location, structural features of the house or nursing home facilities, and inadequate lighting. When findings for both institutionalized and community-dwelling elderly people are merged, cognitive impairments, orthostatic hypotension, impaired hearing and/or eyesight, defective functional capability, intake of medications, weakened balance, and hip fragility (Cannard, 2011) are major determinants of falling.
Falling is a serious risk episode for older adults and, consequently, elderly people necessitate a much greater attention in terms of trauma care. The 'post-fall syndrome' or the extreme fear of falling can result in loss of self-reliance and activity limitations beyond that caused by physical injuries brought about by the fall (Yoshida, 2012). Tinetti and colleagues (1990) explained fear of falling as reduced levels of perceived self-efficacy as regards posture and balance. This explanation is derived from Bandura's social cognitive theory wherein self-efficacy is defined as one's perception of his/her capability to prevent a fall.
This theoretical explanation of fear of falling among the elderly would be beneficial because self-efficacy is a notion derived from established theoretical models concerning the cognitive mechanisms that determine emotions. Hence, numerous reliable assessment methods have been formulated to evaluate self-efficacy with regard to various areas. Home-based multi-factorial interventions and home-based exercise programs have been found out to be beneficial ( Zijlstra et al., 2007). Fear of falling could be a defensive mechanism to an actual threat, discouraging older adults from engaging in fall-risky activities and possible injury, even though fear of falling leading to activity limitations that an elderly person could safely carry out may result in avoidable detrimental outcomes concerning physical, mental, and social wellbeing. It is thus crucial that prospective fall-related research and interventions adopt a practical and flexible approach to risk of falls among the elderly and educate and train older adults to carry out activities or tasks safely.
Potential Approach to Intervention
The experience of carrying out and completing tasks safely could result in stronger fall-related self-efficacy and a practical perspective of the threat of falling. Even though eradicating or preventing fear of falling is a crucial objective in itself to enhance the elderly people's psychological wellbeing, beneficial outcomes for the elderly themselves, their families, communities, and the larger society could improve if such development also leads to or is attended by greater social involvement, safe behavior, and sustenance or restored vitality (Arenson & Reichel, 2009). Hence, besides evaluating falls and fear of falling among the elderly, examining activities in fall-related studies is vital as well. This intervention must not simply examine physical activity but must also encompass a wider area of activities, like social participation and daily life activities. Home-based multi-factorial interventions and home-based exercise have been proven to prevent or eliminate fear of falling in elderly people living in community settings (Zijlstra et al., 2007; Stevens et al., 2010). Additional well-planned studies on interventions that prevent or could prevent fear of falling among the elderly are needed.
Nonetheless, the initial measure in preventing falls in older adults is thoroughly and appropriately assessing and reassessing an elderly person's susceptibility to falls. Numerous organizations formulate and integrate such risk assessment into the preliminary nursing evaluation carried out prior to admission. This evaluation process may involve correct unit allotment for older adults with cognitive impairment to areas where access points are secured. As stated beforehand, risk factors involve emotional disturbance, medications, auditory and sensory impairments, mental condition, and previous experience with falling (Cannard, 2011; Al-Faisal, 2006). A comprehensive reassessment procedure guarantees that personalized interventions derived from the preliminary assessment are fulfilling established objectives. Regular monitoring provides health care practitioners chances to determine how an elderly patient's condition is improving (or worsening).
Conclusions
Falls among the elderly population are identified as a serious public health problem due to the potential severity of its physical, emotional, and psychological impact. The results of falls in older adults may go beyond physical injuries and could in fact adversely affect their emotional and mental wellbeing. There are behavioral and environmental risk factors of falling among the elderly identified in the empirical literature. Existing interventions and future ones must take into full account these major risk factors, especially the fear of falling, in order to reduce or prevent falls in older adults.
References
Al-Faisal, W. (2006). Falls prevention for older persons. Eastern Mediterranean Regional Review. Retrieved from http://www.who.int/ageing/projects/EMRO.pdf
Arenson, C. & Reichel, W. (2009). Reichel's care of the elderly: clinical aspects of aging. Cambridge, UK: Cambridge University Press.
Cannard, G. (2011). Fall prevention for older people: a survival guide. UK: Paragon Publishing.
Kronfol, N. (n.d.). Biological, medical, and behavioral risk factors on falls. Retrieved from http://www.who.int/ageing/projects/2.Biological,%20medical%20and%20behavioural %20risk%20factors%20on%20falls.pdf
Stevens, J. et al. (2010). Older adult fall prevention: perceptions, beliefs, and behaviors. Clinician's Corner, 16-20. Retrieved from http://journals.sagepub.com/doi/pdf/10.1177/1559827609348350.
Tinetti, M. et al. (1990). Falls efficacy as a measure of fear of falling. Journals of Gerontology, 45, 239-243.
Yoshida, S. (2012). A global report on falls prevention epidemiology of falls. World Health Organization. Retrieved from http://www.who.int/ageing/projects/1.Epidemiology%20of %20falls%20in%20older%20age.pdf
Zijlstra, G. et al. (2007). Interventions to reduce fear of falling in community-living older people: a systematic review. Journal of the American Geriatrics Society, 55(4), 603-615.
