Fall Prevention in the Elderly
Assignment: Capstone Project Selection and Approval
You will identify a specific evidence-based practice proposal topic for the capstone project. Consider the clinical environment in which you are currently working or have recently worked. The capstone project topic can be a clinical practice problem, an organizational issue, a quality improvement suggestion, a leadership initiative, or an educational need appropriate to your area of interest as well as your practice immersion (practicum) setting. Examples of the integration of community health, leadership, and an EBP can be found on the “Educational and Community-Based Programs” page of the Healthy People 2020 website.
Write a 500-750 word description of your proposed capstone project topic. Make sure to include the following:
1. The problem, issue, suggestion, initiative, or educational need that will be the focus of the project
2. The setting or context in which the problem, issue, suggestion, initiative, or educational need can be observed.
3. A description providing a high level of detail regarding the problem, issue, suggestion, initiative, or educational need.
4. Impact of the problem, issue, suggestion, initiative, or educational need on the work environment, the quality of care provided by staff, and patient outcomes.
5. Significance of the problem, issue, suggestion, initiative, or educational need and its implications to nursing.
6. A proposed solution to the identified project topic
This week you are required to retrieve and assess a minimum of 8 peer-reviewed articles but you don’t necessarily have to cite them all in your week 2 paper. You will, however, need all these articles for the week 4 assignment. Please note that all capstone written assignments in this class will be about the topic that you choose this week. In other words, every assignment is about the same topic. For the final capstone paper, you will be combining all the papers/assignments into one document and then adding a small amount of new information.
Study materials available on grand canyon university online
Read “Adopting Evidence-Based Practice in Clinical Decision making: Nurses’ Perceptions, Knowledge, and Barriers,” by Majid, Schubert, Luyt, Zhang, Theng, Chang, and Mokhtar, from the Journal of the Medial Library Association (2011).
Fall Prevention in the Elderly
Fall Prevention in the Elderly
Course Name: Course Code
Fall Prevention in The Elderly in A Nursing Home
Falls in nursing care facilities occur mostly in older individuals, and the rate escalates with age. Falls mostly occurs in the senior population that suffer from various cognitive impairments, sensory impairments, and gait domains. Therefore, falls usually occur among the elderly being cared for in nursing homes, and acute homes or rehabilitation centers. According to Zanker & Duque, 2019, the fall rate is higher for seniors living in nursing homes, acute and rehabilitation institutions than residents living in the community.
Characteristics of Falls in Nursing Homes
The most common fall is the bedside fall, especially when the patient is being transferred around the bed. Bathroom falls are the second most common when toileting. Most of the time, the falls happen during the day, when care providers are busy and not available because of increased care demands and shift changes (Medscape, 2020). The majority of the falls happen unwitnessed. Older men are more than women in a nursing home, but women get fractures associated with falls most of the time.
Causes of Falls in Nursing Homes
The majority of the falls among the elderly in nursing homes are due to neglect. Others are accidental and physiological falls. Falls because of neglect in nursing homes result from leaving physical obstacles on the floors, inadequate supervision, poor internal design, lack of maintenance of a nursing home’s safety equipment, and inappropriate assessment of risks. Physiological falls are due to ailments, age, and medications. Chronic illness such as Parkinson’s disease is characterized by posture instability, while arthritis reduces the knee strength. Foot disorders lead to impaired balance. Medications such as benzodiazepines and psychotropics cause dizziness, drowsiness, and increase the risk of falling (Medscape, 2020). Accidental falls occur to a person who is least likely to fall but falls due to the environment, such as low lighting and slippery floors.
Significance of Falls of The Elderly
Falls are the main health concern as they result in physical injuries such as fractures and prolonged length of stay at healthcare institutes and cause a physiological burden that decreases life quality (Koike, 2015). Falls in nursing homes can cause hip fractures, head injuries, or even result in death. Frequent falls may result in permanent disability.
Risk assessment should be done to all senior residents on admission and after a fall, to determine the cause. Risk assessment helps provide individualized care to each elderly resident in the nursing home and prevents future falls. Assessment should be comprehensive and identify the history of a patient’s fall, walking aid review, balance, gait and muscle strength, medical history, and environmental modifications (Medscape, 2020). A risk assessment identifies each elderly resident’s cause of falls.
Prevention of Falls
Every senior patient in long-term care is at risk for falls. Although not all falls can be avoided, most of the falls in nursing homes are preventable. A safe physical environment reduces the risk of falls significantly. Cleaning spills, proper lighting, removing rugs to prevent slipping, and maintaining the premises must be emphasized. Nursing home staff must inspect various nursing home areas to ensure that there are no potential environmental hazards in elderly people (Koike, 2015). Good contrast light in the background is necessary to show details of the environment.
Daily exercises improve the balance, strength, and gait of residents, preventing falls. Promoting exercise will reduce the number of residents in wheelchairs. Skilled personnel should help with the exercises (Zanker & Duque, 2019). Nurses should ensure proper footwear, such as rubber-soled shoes that fit perfectly to prevent slipping.
The elderly must be educated on falls and fall prevention measures. Client education reduces the fear of falling and increases safety awareness in the nursing home. Nurses should identify patients at a high risk of falling, such as patients with gait or foot disorders, patients with diseases that affect gait and posture such as Parkinson’s disease, and patients on medications (Christy, 2017). Clients taking benzodiazepines and antidepressants should be monitored regularly, and medical review should be conducted to prevent falls (Koike, 2015). Nurses should also monitor the elderly to prevent fainting due to a drop in blood pressure or medication. The records of the residents should be updated on a regular basis as medications change.
Bedside alarms such as chair or bed alarm helps reduce fall of the elderly patients in nursing homes by alerting the nurses or nursing home personnel when patients who are at risk of falling attempt to leave a bed or chair without being helped. Bedside alarms reduce the use of restraints which causes falls.
Nursing homes should provide restraint-free care. Restraints inhibit the mobility of a resident and may not be easily removed (Medscape, 2020). Restraints include belts, vest restraints, and side rails and may impede a person’s ability to get out of bed, causing them to fall.
Nursing homes should modify their environment to accommodate the elderly. The bed’s height should be adjusted and a nonskid mat placed on the bedside or in the toilet to prevent slips (Medscape, 2020). Grab bars should be strategical, such as on beds and in the bathrooms.
Nurses must undergo the necessary training on how to handle the elderly and help prevent falls since they are at the ones who interact most with the residents. A training procedure should be developed and standard operating procedures to manage clients who are most likely to fall.
Falls in nursing homes can cause unexpected complications to the elderly and can be easily prevented.
Christy, R. (2017). Preventing falls in hospitalized older adults. Nursing, 47(7), 1-3. https://doi.org/10.1097/01.nurse.0000520711.64646.28
Koike, T. (2015). Role of care for the prevention of falls and fractures among elderly persons living in long-term care facilities. Journal of Nursing & Care, 04(03). https://doi.org/10.4172/2167-1168.1000247
Medscape. (2020, September 20). A nursing guide to the prevention and management of falls in geriatric patients in long-term care settings. https://www.medscape.org/viewarticle/504373_4
Zanker, J., & Duque, G. (2019). Approaches for falls prevention in hospitals and nursing home settings. Falls and Cognition in Older Persons, 245-259. https://doi.org/10.1007/978-3-030-24233-6_14