Safety measures for elderly and geriatrics

OUT LINE

• introduction• safety• risk factor - why the elderly ?• Most common hazards• assessment methods • prevention

Objectives

• After completing this seminar the students will be able to :• 1.Discuss factors that affects people's ability to protect

themselves from injury• 2. Describe methods to assess a client's risk for injury• 3. Identify common potential hazards through the life span• 4.Give examples of Nursing

diagnosis,interventions,outcomes for a client at risk for accidental injury

• 5.Explain interventions to prevent falls

Safety why its important• Safety: The condition of being safe; freedom

from danger, risk, or injury.• Safety : a contrivance or device designed to

prevent injury• - its important to take care about elderly

safety because of their poor health status and body movement abilities .

introduction

risk factor - why the elderly?

• 1- poor vision• 2- cognitive dysfunction (confusion, disorientation, impaired memory or

judgment )• 3- impaired gait or balance and difficulty walking because of lower

extremity dysfunction (e.g arthritis )• 4 – difficulty getting in and out of chair /bed• 5-orthostatic hypotension : These• individuals should be instructed to move slowly• and to remain seated until the dizziness passes.• 6- urinary frequency or receiving a diuretics • 7- medication effect ( sedatives, hypotonic, narcotic analgesics , diuretics ) • 8- reflexes may also be slower than younger. The increased amount of time

it takes to react may make it harder to catch balance if you start to fall.

Common hazards

• Falls• Burn• Polypharmacy• Pedestrian• Choking• Automobile accidents

Fall

• fall is defined as “an event which results in a• person unintentionally coming to rest on the• ground or another lower level; not as a result of• a major intrinsic event (such as a stroke) or overwhelming

hazard

• Falls are the most leading cause of both fatal and nonfatal injuries in older adults.

• Over 95% of hip fractures are caused by falls.• Any fall is the best predictor of future falls. Two thirds of those

who have experienced one fall will fall again within 6 months

• Many falls are linked to a person's physical condition or a medical problem, such as a chronic disease. Other causes could be safety hazards in the person's home or community environment.

• Falls can result in• injury, loss of independence, reduced quality of life, and

death in the elderly.

•Fractures are the most serious health consequence.. • The most common fractures are of the vertebrae, hip,

forearm, leg, ankle, pelvis, upper arm, and hand

Risk factors

• hypotension, unsteady gait, altered mental status, poor vision, cognitive change, fear ,

• • Impaired physical mobility• • Sensory deficits• • Lack of knowledge of health practices or safety

precautions• • Hazardous environment• • History of accidents or injuries• • In the home or community setting

Older adults have trouble seeing the edges of stairs .

Painting white stripes on the edges of the steps will help increase contrast and

may prevent falls

SAFETY ALERT

• Nurse cane use an assessment tool called Get Up And Go in hospital o r home sitting – kimbell 2011

Falls can break bones and self-confidence, leading to fear of falling causing decreased activity level and

decreased muscle strength .

CLINICAL ALERT

Falling prevention

• 1-Exercise regularly. It is important that the exercises focus on increasing leg strength and improving balance, and that they get more challenging over time. Tai Chi programs are especially good.

• 2-Make their homes safer by reducing tripping hazards by:

• • .Assess for potential personal cause of falls:• hypotension, unsteady gait, altered mental status, poor vision,

cognitive change, fear. • • In the home or community setting, assess for potential

environmental causes of falls• Lighting: inadequate amount, • inaccessible switches Floors: presence of electrical cords• slippery surfaces Stairs: absent or unsteady railings, uneven step

height or surfaces • Furniture: unsteady base, carpets are too high or too low, chairs

with wheels • Bathroom: inappropriate toilet height, slippery floors or tub.• Absence of Grab Bars• fall out of bed : Place the matters directly onto the floor Place

padding on floor next to bed or between client and side rails

Polypharmacy and Medication ErrorsOlder adults take considerably more medications than younger people

The act of taking many medications 5 or more concurrently is termed polypharmacy

“concurrent use of several drugs”. -Nonadherence is defined as the extent to which

patients are not willing to follow the instructions they are given for prescribed treatments

• An elderly person experiencing polypharmacy• is more susceptible to medication errors,• defined as taking the wrong medication or the• wrong dose at the wrong time or for the wrong purpose

• There is an increased incidence of drug–• drug interactions in a patient experiencing• polypharmacy

• Clinical manifestations .• may include varying degrees of• nausea, constipation, gastrointestinal bleeding

• urinary incontinence, muscle aches, sexual dysfunction,

• insomnia, confusion, dizziness, orthostatic• hypotension, and falls

Reducing medication risks in older adults

 .Discuss with patients the need to:-keep an accurate list of all medications, including generic and brand names,

dosages, dosing frequency, and reason for taking the drug-keep a complete list of medical providers and their contact information

. Teach patients about:- Supported self-administration of medications if possible- importance of taking medications exactly as directed- avoid sharing medications

Also, if appropriate, help patients establish memory aids. For instance, advise patients to link drug administration to their daily routine or to use color-coded charts, automatic dispensers with bells, or voice-activated message services to remember to take their doses

Ensure that the patient/caregiver is an informed

Burns• A study of elderly burn victims in the Journal of Burn

Care and Rehabilitation observed that 70 percent of the burn victims surveyed were burned in their homes ("A Survey of Risk Factors for Burns in the Elderly and Prevention Strategies," 2002).

• Burns are common injuries in case of explosions and fires. Specifically, thermal burns are caused by contact with sources of high heat, such as flames, hot liquids and hot surfaces,

• contrary to what happens with chemical and electrical• burns. Every year over 1,000 deaths due to burns

among elderly are reported in the United States

RISK FACTORS FOR BURN INJURIESAMONG ELDERLY PEOPLE

• The main risk factors for fatal burns among elderly people Are:

• Careless smoking, especially in the bedroom• Absence of a smoke detector• Winter time• Electrical blanket of poor quality• Excessively hot water used when showering• or cooking oil or butter used when cooking

Elderly are at higher risk for house fire death for a numberof reasons:

• Reduced sensory and cognitive abilities, such as smell,• touch, vision and hearing, and mental diseases such as• dementia, Alzheimer and depression leading to slower• reaction or complete inactivity

• Prescription drugs, when elderly alone and especially when combined due to decreased alertness

• Mobility impaired, slowing or completely preventing escape and slow response time can diminish an older adult's ability to sense a burn when it happens

• Lack of financial means for environmental improvements• aim to reduce risk of fire (portable heaters or heating blankets, older homes,

etc.)

Choking

• is one such real risk. Even though statistics show that the use of dentures has lessened due to attentive dental care, certain foods still pose a problem.

• Here is a list of common choking hazards and easy substitutions

• 1 -MeatLarge chucks of meat can be very hard to chew, and as such swallow safely. It is highly recommendable to avoid hard meats, like steak, and big pieces of meat in general.

• FruitLarge chucks of fruit pose a serious danger to eating elderly. Fruit that are especially hard, like apples, pineapples and plums should peeled completely and cut into easy to chew bites. Pureed versions of these fruits, like applesauce or blended plums might also be a great option to consider.

• BreadBread poses to a threat because if it gets stuck in the airway, water can cause it to swell and block the air passage. Cake and milk together poses a similar issue

• LiquidsSome liquids, like water, can pose choking hazards because of the lack of thickness.

• Better Choices: Foods With Low Choking Risks• Here are some food choices that are easier to swallow:• Fish, if it’s filleted• Ground meat• Soups• Chocolate (if it gets stuck, it melts)• Applesauce, pudding and Jello• Lightly toasted bread with butter or jelly

• Dos and Don’ts of Eating

• These tips will also help reduce incidences of choking:• Don’t drink fluids while you’re eating. People do this to make the

food go down and it can lead to choking.• Don’t talk while you eat. The epiglottis—the hinge like flap at the

base of your tongue that keeps food from entering your windpipe—doesn’t know whether to open or close because it doesn’t know whether food or air is coming.

• Don’t eat lying down.• Do learn to eat more slowly.• Do put less on your plate so you can’t eat too much too fast. Have

a second helping afterward instead.• Do julienne the food.• Do peel apples before serving or, better yet, serve applesauce

conclusion

• Finally , elderly need holistic care to cover every weakness in there health or hazard in there environment.

Video

referanses

• Fundamentals of Nursing_Kozier & Erb's 9th Edition

• CDC• Gerontocological nursing • Community of Public health Nursing

ARTICLEEngaging Adolescents to Care for Elderly Safety in the

Community

• Asia Pacific International Conference on Environment-Behaviour Studies, Grand Margherita Hotel, Kuching, Sarawak, Malaysia, 7-9 December 2010

• In Hong Kong, a study of the trends and characteristics of accidents involving older persons was undertaken in a railway system.

• Participant: A team of gerontologist and psychologists and their students was engaged.

• Purpose: Conducting a community project with older railway passengers to identify key factors related to accidents including physical environmental conditions.

• Sample and procedures: A total of 32 undergraduate students in Lingnan University was recruited to participate in the project.

• Students Role: They were briefed the objectives of the study, and trained basic skills in conducting field observations and face to face interviews.

Results:• There has been a slight increase in accidents among older persons

in the past two years. The accidents involving older passengers tended to occur between 9am to noon since many of them needed to travel to a hospital. The major types of accidents are ‘lost balance and fell inside the train compartment’, ‘struck by the train doors’ and ‘stepped into the platform gap’. There may be under-reporting of accidents or near-miss accidents. The participants did not have a good knowledge of the rail routes, more than 20% had chosen a longer and/or indirect route that involved unnecessary change(s) of trains. Elderly passengers are in general satisfied with the rail services. The three aspects that received relatively low ratings were: train frequency, train seat availability, and elderly train seat arrangements.

• Fnidings:• According to the safety attitude model, the

railway corporation can impart more safety knowledge to elderly passengers

• In the end, safety behaviour of elderly passengers can be enhanced.

• DATA CLUSTER Mr.P.S suffered a stroke resulting in left-sided Weakness.As a result his gait is unsteady . The nurse noticed that his home has several throw rugs and furniture impending mobility .The bathroom doesn't have grab bars by the toilet

• Nursing. Diagnosis Risk for injury r/to impaired mobility and potential home hazards /At risk of injury as a result of environmental conditions interacting with the individual's adaptive resources

• Interventions : Environmental Management : Safety /Monitoring and manipulation of the physical environment to promote safety .

• Sample Activities :• . Identify safety needs of client• Identify safety hazards• .Modify the environment to minimize hazards & risks• .Monitor the environment changes in safety status• Educate about enviromental hazards• *environmental• Outcomes:• Safe Home Environment