UHS ARISE Nursing Newsletter August 2018

ARISE NEWSLETTER ISSUE 16 | AUGUST 2018

KEEPING OLDER

ADULTS SAFE

INSIDE THIS ISSUE

INTRODUCTION ADULTS AND FALL RISK

ACUTE CARE SETTING

NURSING SKILLS

AND INTERVENTIONS

INTRODUCTION We can expect health problems to increase as our society ages. This article focuses on assessing older adults and intervening to improve safety, mainly it addresses fall prevention. Falls are the second leading cause of accidental or unintentional injury deaths worldwide. Each year an estimated 646, 000 individuals die from falls globally of which over 80% are in low- and middle-income countries. Adults older than 65 years of age suffer the greatest number of fatal falls. Falls are the primary cause of injury-related deaths in this population, and many of these deaths occur after months of medical care and treatment.

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ARISE Newsletter |August 2018

Hospitalization can be an overwhelming experience for older people and it can make them vulnerable to a mixed of complications, adverse events and functional decline. Older people, who are admitted to an acute care setting such as hospital, face particular challenges that require special consideration. For example, if not carefully managed, they may lose their usual condition and level of function, as a result of reduced activity and stimulation. Admission to hospital can also present major challenges in terms of an older person’s confidence, independence, and change of routine.

Maintaining patient safety in acute hospitals is a global health challenge. Traditionally, patient safety measures have been concentrated on critical care and surgical patients. In this review the medical literature was reviewed over the last ten years on aspects of patient safety specifically related to fall. Patients do badly in hospital with frequent adverse events resulting in the geriatric syndromes of falls, delirium and loss of function with increased length of stay and increased mortality.

Contributory factors include inadequate assessment and treatment, inappropriate intervention, discrimination, low staff levels and lack of staff training. Unfortunately there is no simple solution to this problem, but what is needed is a multifactorial, multilevel approach at the levels of care – patient, task, staff, team, environment, organization and institution.

Many older adults have sensory impairments, including impaired hearing and vision, which contribute to fall risk.

Their ability to adjust to night vision is decreased, and they need up to three times the amount of light that younger adults need to see well.

Older adults may experience altered depth perception that can put them at risk for falls.

Functional limitations that impede their mobility and ability to engage in activities of daily living also increase the risk of falls and may ultimately contribute to placement in a long-term-care facility.

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ARISE Newsletter |August 2018

ASSESSING OLDER ADULTS FOR FALL RISK

Assess your older adult patients for fall risk factors that are intrinsic such as: 1. Advanced age, especially age greater than 75 2. A fall in the recent past 3. Coexisting conditions that are associated with falls, including dementia, depression, hip fracture, arthritis, type 2 diabetes, parkinson disease, and osteoporosis 4. A functional disability or impaired gait, balance, or vision 5. Use of an assistive device or a physical restraint 6. Altered level of consciousness or impaired cognition 7. Use of medications associated with a high risk of falls, such as alprazolam and amitriptyline 8. Use of medications associated with a high risk of injury from a fall, including anticoagulants such as aspirin, warfarin, or clopidogrel 9. Urge incontinence 10. Use of inappropriate footwear or lack of footwear.

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ARISE Newsletter |August 2018

Routinely assess and document the patient's environment for fall risk factors that are extrinsic, then take corrective actions. Make sure that:

1. Floors are dry and level 2. Lights, including night lights, are bright enough and functional 3. Furniture, such as tables and beds, are sturdy and in good repair 4. Grab rails and grab bars are placed appropriately in the bathroom 5. Adaptive aids work properly and are in good repair 6. Bed rails used for transitioning or support are sturdy 7. Patients' clothing does not cause them to trip 8. I.V. poles used for support while ambulating are sturdy 9. I.V. tubing does not cause the patient to trip.

10. Taking medications safely

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ARISE Newsletter |August 2018

ASSESSMENT IN THE ACUTE CARE SETTING

When an older person comes into acute care, a whole range of data must be collected in a standardized and comprehensive way. For this reason, an assessment tool is usually used. Illnesses in older people can be misdiagnosed, overlooked or mistaken as normal ageing processes, especially when health professionals do not recognize the ways that diseases and drugs can aect older patients. A thorough admission assessment can help ensure that assessment is accurate and useful.

However, it is important to realize that assessment is not a one-o activity, but an ongoing and dynamic process. The health status of older patients can often change several times during one admission.

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ARISE Newsletter |August 2018

NURSING SKILLS AND INTERVENTIONS Hospital-based nurses can help to ensure that older people regain a level of functioning that is as close as possible to, or even better than, what it was before their admission. To achieve this, you will need to ensure that the older patient is assessed holistically, interventions are appropriate, and care is coordinated.

The acute care of older patients requires nurses to develop and utilize a range of interrelated skills and interventions.

The nurses in the hospital setting must: 1. Ensure a safe environment, e.g. dry oors, adequate lighting, stable furniture, uncluttered rooms and proper use of bedrails.

2. Communicate eectively with the older patient and their family in order to conduct a holistic assessment, coordinate members of the multidisciplinary team to ensure that assessment and interventions are complete.

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ARISE Newsletter |August 2018

3. Closely monitor at-risk patients 4. Correctly assess risk of falls 5. Assess and manage pain 6. Manage continence issues 7. Care for wounds 8. Manage cognitive impairment (both temporary and progressive) 9. Provide health education and promotion and patient advocacy 10. Orient patients to the immediate environment and telling them how to obtain assistance 11. Ensure that aged-friendly principles are in place. For example, written information should be provided in large print, lighting should be adequate for ease of navigation at night, beds and chairs should not be too low, and mobility aids should be available.

12. Ensure quality use of medicines, for example, adverse eects and drug interactions are more likely in older people because of the types and combinations of drugs they may be prescribed, and because of altered drug tolerance and absorption in older age.

REFERENCES: Queensland University of Technology, School of Nursing Accessed site: http://www.workingwitholderpeople.edu.au/modules/older-persons-in-the-acute-care-setting/falls-risk-assessment.jsp Falls, World Health Organization Accessed site: http://www.who.int/news-room/fact-sheets/detail/falls

ARISE Nursing Newsletter from University Hospital Sharjah

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ARISE Newsletter |August 2018

Don’t Forget To Check UHS Medical Times For

AUGUST

The August edition brings focus to the field of Aesthetic Gynecology services. Many females are unaware of options like these.

This edition describes briefly the services under Aesthetic gynecology, the various surgical and non surgical procedures available and clarifies various questions on this subject.

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ARISE Nursing Newsletter from University Hospital Sharjah

Call: +971 6 505 8555 or Mail: info@uhs.ae