Does Immobility Lead to Death among Elderly Women - Research Paper Example

NURS 5151 Qualitative Design for Nursing and Health Research Assignment 1 40% (2,500 words) STUDENT NAME: STUDENT ID: PLEASE DO NOT RE-FORMAT THIS TEMPLATE Introduction (500) Immobility among the elderly people has been established as the main cause of their early death. Old people are at a high health risk is not attended to or if they do not receive the necessary medical attention. In spite of their poor health, old people with a hip fracture are at a greater risk of dying within a year if they do not seek proper medical care. Research shows that, hip fracture increases the risk of early death among the elderly (Coughlan & Dockery, 2014). Women aged above eighty years and above and in excellent health have a greater risk of dying within a year due to hip fracture. The elderly have very limited movements and this immobility exposes them to poor health and especially when they have a fracture at the hip or leg (Leblanc, Hillier, Pedula, Rizzo, Cawthon, Fink, Cauley, Bauer, Black, Cummings & Browner, 2011). In the case of Mrs. Piro, at ninety one years of age, immobility was the cause of her thrombosis which in turn ultimately led to her death. She has a fracture on her upper thigh that dislocated her right ankle. The fracture had evidently not been treated medically and had healed with permanent deformity. The skin over the medial malleolus of the displaced lower tibia had ulcerated. Further examination of the leg showed disuse atrophy of the muscles of the right calf, diffuse subcutaneous oedema of the right calf and foot and antemortem thrombus was noted in the right external iliac vein. The doctor reported that the pressure sores had been present for in the order of a few weeks, if not significantly longer. Therefore, the fracture would have precluded weight bearing and, consistent with this, he noted that the muscles of the right calf had not been active for quite some time, in the order again of weeks or months. It is important to note that, the first year of a hip fracture among the elderly people and especially women calls for more attention to reduce incidents of early death (Permanente, 2011). Much needs to be done to prevent the occurrence of hip fractures among the elderly women and better ways of preventing their early deaths resulting from these fractures. In the case of Mrs. Piro, according to Dr Gilbert, Mrs Piro was 91 years of age and thus very elderly. However, she need not have died the way that she did. What she required was medical treatment for her ankle and bed pressure sores. After experiencing hip fractures, older women are at a greater risk of early death. However, the risk of early death is not due to the hip fracture but due to the underlying health conditions exposed by their immobility. Immobility of older women with hip fracture exposes them to thromboembolism complications that results to their early death. Older women at the age of eighty and above are already at the risk of dying since most of them are already sick with other health conditions. Hip fractures increase their chances of dying three times because many of them do not recover (Leblanc et al, 2011). Therefore, this article aims at establishing whether immobility among older women leads to their early death. Research Question Does immobility lead to death among the elderly women? Critical appraisal of the qualitative literature (1,600 words) A study carried out on Osteoporotic Fractures revealed that, older women who had broken their hip died within three months to six months after the occurrence of the hip fracture. Elderly women are exposed to hip fracture due to osteoporosis. Osteoporosis is the weakening of the bone and causes the bones of elderly people break more easily (Coughlan & Dockery, 2014). It is therefore recommended for older women with risks of smoking, long term use of alcohol, low body weight to get a scan on their bone density. This will enable them establish whether they are at risk of developing osteoporosis. After diagnosis, they should begin taking their medication for the purpose of strengthening their bones and decreasing risks of fractures. In Mrs. Piros case, she loved alcohol and took much of it towards the end f her life. As a result of drinking she slipped off the couch and injured her foot. This evidence was given by Susan Piro who gave evidence of Mrs Piro having slipped off the couch causing an injury to her foot which became swollen. For those taking care of the elderly, it is important to ensure that they have adequate intake of calcium as well as vitamin D. doing a weigh bearing and exercises balancing will help a lot in building the strength of bones for old people. They should discourage the elderly to avoid smoking cigarettes. They should also have a thorough assessment of their home and ensure that it is fall proof (Center of Excellence for Fall Prevention, 2014). In Mrs. Piro’s case, Susan Piro attended to her mother’s needs including checking her blood pressure. She said that her mother had a liking for alcohol and, despite being told by the doctor to ‘lay off a bit’, she would not do so and in fact drank more towards the end of her life. Susan Piro had the responsibility of encouraging her mother to stop drinking alcohol. To ensure good care of her mother, Susan Piro arranged for her mother’s care, including by the purchase of a shower chair, a toilet raiser, a walker and a walking frame. There was a commode in the bedroom and a telephone by her mother’s bed. She also purchased a wheelchair for her mother to go on outings or in to the garden. After experiencing a hip fracture, the elderly must seek medical care to ensure that they are treated and stop the risk of dying early (Fox News, 2014). The case of Mrs. Piro was different because, she declined medical treatment and responded that it was merely a torn sinew. This was evident when, Susan Piro made some effort to call a doctor but did not persist and no medical treatment was obtained. At one stage Susan Piro picked up the phone to call the doctor after discussing the matter with her mother and was determined to ring for a doctor, but her mother snatched the phone out of her hand and told her not to do it and was very angry. At that point Susan Piro abandoned the matter. She said her mother was mentally alert and decisive about what she wanted to do and what she wanted about her care. Susan Piro further demonstrated her mother’s decline to seek medical attention by describing an unfortunate experience that her mother had when undergoing a cataract procedure. Statistics show that, one third of the elderly people falls every year and experience fractures. The risk of falling increases with the age of a person (Yale Study on Falls Risk, 2012). Many of the incidents of falling go unreported and most of the families do not recognize such falls. Those who fall have a high probability of falling again. Information shows that, older people discharged from hip fracture treatment have high chances of falling again within the next six months. Elderly people falling are the main cause of hip fractures and death. Those admitted in hospitals or being taken care of at home due to hip fracture die within a year. After falling, many of the elderly patients do not get injured but are found not able to get up without being assisted (Center of Excellence for Fall Prevention, 2014). This statement is clearly described in the case of Mrs. Piro, who after slipping off an injuring her foot, there were no visible breakage of the skin nor was any bone. Susan Piro only suspected that the foot was broken. The hip fracture health outcome of those who are able to get up after falling is affected by their immobility. The reason is that, the compression as a result of falling leads to breakdown of the muscle cell within thirty to sixty minutes. This results to complication of dehydrations, hypothermia, pneumonia and pressure sores (Moyer, 2012). In Mrs. Piros case, Dr Gilbert said that the pressure sores had been present for in the order of a few weeks, if not significantly longer. Dr Gilbert said that the fracture would have precluded weight bearing and, consistent with this, he noted that the muscles of the right calf had not been active for quite some time, in the order again of weeks or months. Hip fractures resulting from falling make it hard for older women to move around or even live independently. This increases their risk of dying early. The fracture limits their activities which reduces mobility. They are therefore not physically fit and at a greater risk of even falling again (Coughlan, 2014). Older women fall more frequently than their men counterparts. Deaths among the elderly occurring due to hip fracture after falling have been on the increase. Fox News (2014) describe that, patients who nurse their hip fractures from home die or even lose their walking capability within six months after the occurrence of the injury. Patients older than ninety years of age and did not perform a surgery on their hip fracture have high risks of dying early or even becoming disabled completely. In the case of Mrs. Piro, no medication was sought to deal with her fracture and this increased her dying early. A hip fracture surgery would have helped in lengthening her life span. Patients who nurse their hip fracture at home usually experience worst outcomes of surviving or bad status functionality (Fox News, 2014). These patients with hip fractures have difficulties in moving from the bed, their personal hygiene decreases and are not able to use the toilet. If they are not taken care of, they end up dying early. After Susan Piro left her mother, she was not able to do most of the things by herself, her hygiene worsened affecting her health status and finally she died. After an immobilizing fall, it is important for elderly people and in this case women to get help. This improves their chances of surviving to a greater percentage of eighty percent and their likelihood of returning to living independent is also increased. In the case of Mrs. Piro, she was reluctant to seek medical care and this contributed greatly to her earlier death. According to the National Center on Injury Prevention and Control (2012), hip fracture resulting from falls is a national health priority. Many families as well as the government are spenting a lot of money on hip fractures among the elderly resulting from falls. The cost of treating hip fractures is also increasing. Passing an Act for the preventing falls among the elderly is important to educate caregivers on best preventive practices of falls among the elderly people and expanding these services is important. It is impossible to remove some factors that increase falling among the elderly people. Some of these factors include; age and experience from previous falls. However, it is possible to remove other factors that can lead to falling, such as mobility problems. It is important to ensure the elderly walk, move around, transfer sitting or standing position carefully. Avoid foot problems, correct footwear must be used. When getting up, blood pressure should not be too low, ensuring their blood pressure is frequently checked (Yale Study of Falls Risk, 2012). Avoid vision problems and environmental hazards such as obstructions at home. Treating as well as correcting the above mentioned problems helps a lot in reducing falling rates among the elderly people. To ensure mobility and good care of her mother, Susan Piro arranged for her mother’s care, including by the purchase of a shower chair, a toilet raiser, a walker and a walking frame. There was a commode in the bedroom and a telephone by her mother’s bed. She also purchased a wheelchair for her mother to go on outings or in to the garden. Family members are advised to encourage a hip fracture surgery on the patient and plan for their future health care (National Institute for Health and Care Excellence, 2012). Undergoing a hip fracture surgery will improve their health and increase their years of living. For those patients who do not approve for hip fracture surgery, a decision for the surgery must be undertaken. For old people and in this case elderly women, a reparative surgery would be more appropriate not only to extend their life span but also improve mobility. In addition, an unrepaired fracture can be painful as a result of pieces of bones that are broken rubbing together. The reparative surgery should be undertaken to help in alleviating the pain from the patient (Fox News, 2014). Doctors are advised to work together with family members in determining whether the patient must be taken to the hospital for a surgical repair. In such a case, the patient may no support this decision but as long as it is viable, surgery for a hip structure is the best option. Conclusion (400) Elderly people, in our case old women have a low bone mineral density that exposes them to accidents. These accidents cause fractures that increase immobility among old women leading to their early death due. Accidents in the old age may be due to balance disorders, poor vision and reflexes that are slow. Therefore, it is important to take precautions in order to prevent accidents such as small falls among old people. In our case, Mrs. Piro had a fracture that resulted from her slipping over and injured her leg on the upper thigh. This is a hip fracture and worsened due to her immobility that led to her death. To effectively take care of hip fracture and reduce early deaths among patients, doctors and caregivers have the responsibility to increase the physical activity of the patient. By excising regularly, the patient will increase the strength of the leg and therefore improving their balance and healing fast. Reviewing the medication given to patients is important to ensure that they are alert and not having the side effects of drowsiness. Mrs Piro could not get the necessary medical care since she rejected any medical attention suggested by Susan Piro and the doctor. Successful prevention of hip fracture involves managing mobility of the patient by balancing their physical activity, medical care, environment as well as modification of homes. This will improve the health of the patient hence reducing the chances of early deaths. Patients with hip fracture cannot ambulate and spent most of their time in bed. They have no capability of participating in activities. Their increased immobility increases their frailty. Therefore, it is important for family members to understand that, after experiencing hip fractures, many patients do not go back to their former health status. Without appropriate care like taking the patient to the hospital or nursing home, dying of the patient will occur within a year after the hip fracture. Susan Piro was obedient to her mother and listened to her suggestions. She did not take the initiative to question the decisions made by her mother. If at all she could have gone against her mother’s will, Mrs. Piro would not die early. By understanding that her mother will never go back to her pre fracture condition, Susan Piro would have suggested to the doctor a reparative surgery to be done on Mrs. Piro. Mrs. Piro could no longer move by herself; she was always on her bed which increased her immobility. Due to immobility, she developed thromboembolism complications and this led to her death. Therefore, it is true that, immobility leads to death among the elderly women. References Centers for Disease Control and Prevention, (2013), National Center for Health Statistics, Health Data Interactive, Retrieved from www.cdc.gov/nchs/hdi.htm. Accessed: [25-09-2014] Center of Excellence for Fall Prevention, (2014), Information for Individuals & Families, Retrieved from http://stopfalls.org/individuals-families/ Accessed: [25-09-2014] Coughlan, T & Dockery, F (2014), Osteoporosis and fracture risk in older people, Clinical Medicine, Vol 14, No 2: 187–91. Retrieved from http://www.clinmed.rcpjournal.org/content/14/2/187.full.pdf Fox News, (2014), Death or Immobility Often Follows Hip Fractures in Nursing Homes, Retrieved from http://www.foxnews.com/health/2014/06/25/death-or-immobility-often-follows-hip-fractures-in-nursing-homes/ Accessed: [25-09-2014] Leblanc, ES, Hillier, TA, Pedula, K, Rizzo, JH, Cawthon, PM, Fink, HA, Cauley, JA, Bauer, DC, Black, DM, Cummings, SR, & Browner, WS (2011), Hip Fracture and Increased Short-term but Not Long-term Mortality in Healthy Older Women, Archives of Internal Medicine, DOI: 10.1001/archinternmed.2011.447 Moyer, VA (2012), Prevention of Falls in Community-Dwelling Older Adults: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine. 157(3):197–204. National Centre on Injury Prevention and Control, (2012), A Tool Kit to Prevent Senior Falls, Retrieved from http://www.cdc.gov/injury/index.html Accessed: [25-09-2014] National Institute for Health and Care Excellence, (2012), Denosumab for the prevention of osteoporotic fractures in postmenopausal women, technology appraisal guidance 204. London: NICE. Permanente, K (2011), Elderly Women Who Break a Hip at Increased Risk of Dying Within a Year, Retrieved from http://share.kaiserpermanente.org/article/elderly-women-who-break-a-hip-at-increased-risk-of-dying-within-a-year/ Accessed: [25-09-2014] Yale Study on Falls Risk, (2012), Remove the blocks one-by-one, and you lower the risk of falling, Retrieved from http://www.learnnottofall.com/content/yale-study.jsp Accessed: [25-09-2014] NURS 5151 Qualitative Design for Nursing and Health Research Assessment Feedback Assignment 1: Critical Appraisal of Published Research Weighting 40% of final grade 2,500 words (approximately) Marking Criteria HD D C P1 P2 F1 F2 Introduction (500 words) Includes all requirements of a Distinction AND presents an exceptional description and analysis of the nature and importance of research problem from a qualitative perspective, with synthesis of multiple perspectives and evidence of original thought. Supported by a wide range of relevant literature. Includes all requirements of a Credit AND presents in-depth comprehensive description and analysis of the nature and importance of the research problem from a qualitative perspective, supported by a wide range of relevant literature. Includes all requirements of a Pass 1 AND Research problem has been clearly and succinctly identified from coronial inquest. Presents a more detailed and advanced description of the nature and importance of the research problem from a qualitative perspective, supported by a variety of relevant literature. Research problem adequately identified from coronial inquest. Adequate description of the nature and importance of the research problem from a qualitative perspective, which is supported by relevant literature. Correct UniSA (2013) Harvard author-date system for in-text citation, paraphrasing & reference list. Coherent writing style with no grammatical or spelling errors. Adheres to word count. Research problem identified from coronial inquest but problem is somewhat unclear. Provides a limited description of the nature and importance of the research problem from a qualitative perspective, which is supported by minimal relevant literature. Mostly correct UniSA (2013) Harvard author-date system for in-text citation, paraphrasing & reference list. Coherent writing style with no grammatical or spelling errors. Adheres to word count Research problem identified from coronial inquest but problem is unclear and/or inadequately stated. Inadequate description of the nature and importance of the research problem from a qualitative perspective, supported by minimal and/or irrelevant literature. Incoherent writing style. Some grammatical &/or spelling errors. Minor incorrect in text citation, paraphrasing OR reference list. Below or above word count. Research problem not identified from coronial inquest. Minimal to no description of the nature and importance of the research problem from a qualitative perspective. Use of irrelevant literature OR section not referenced. Incoherent writing style. Significant grammatical &/or spelling errors. Major incorrect in text citation, paraphrasing OR reference list. Well below/above word count. Research Question Includes all requirements of a Distinction AND demonstrates critical and original thinking in relation to the question AND study population. Includes all requirements of a Credit AND demonstrates high level critical thinking in relation to the question, AND/OR study population Clearly and succinctly states a qualitative research question that is directly related to the research problem described and includes a clear study population. Adequately states a qualitative research question that is directly related to the research problem described and which includes a study population. No grammatical or spelling errors. States a basic qualitative research question that is directly related to the research problem described and which includes a study population. Question OR study population are somewhat unclear. No grammatical or spelling errors. Qualitative research question is stated but only partially related to research problem described.The question and/or study population are unclear and/or inadequately stated. Some grammatical &/or spelling errors. Qualitative research question not stated. OR a qualitative research question is stated but NOT related to research problem described. Question and population not clearly stated AND/OR are inappropriate. Significant grammatical &/or spelling errors. Critical Appraisal of the QL Literature (1,600 words) Includes all requirements of a Distinction AND demonstrates an exemplary critical appraisal & original thought which is supported by a more extensive range of relevant literature. Includes all requirements of a Credit AND demonstrates a high level, comprehensive critical appraisal and synthesis supported by a wider range of relevant literature. Includes all requirements of a Pass 1 AND provides a more detailed and advanced critical appraisal and synthesis supported by a variety of relevant literature. Critical appraisal demonstrates adequate comparing and contrasting and assessment of the quality and trustworthiness of existing literature in relation to research problem and population with the use of 1-2 additional relevant references. Correct UniSA (2013) Harvard author-date system for in-text citation, paraphrasing & reference list. Coherent writing style with no grammatical or spelling errors. Adheres to word count. Critical appraisal demonstrates limited, basic comparing and contrasting and assessment of the quality and trustworthiness of the existing literature in relation to the research problem and population with the use of the minimum 10 references. Mostly correct UniSA (2013) Harvard author-date system for in-text citation, paraphrasing & reference list Coherent writing style with no grammatical or spelling errors Adheres to word count. Critical appraisal demonstrates inadequate AND/OR unclear comparing and contrasting AND/OR assessment of the quality and trustworthiness of the existing literature in relation to research problem and population with the use of less than 10 references AND/OR literature was irrelevant. Incoherent writing style. Some grammatical /spelling errors. Minor incorrect in text citation, paraphrasing OR reference list. Below or above word count. Did not undertake a critical appraisal OR critical appraisal did not compare and contrast AND/OR did not assess the quality and trustworthiness of existing literature in relation to research problem and population. Use of irrelevant literature Incoherent writing style. Significant grammatical &/or spelling errors. Major incorrect in text citation, paraphrasing OR reference list. Well below/above word count. Conclusion (400 words) Includes all requirements of a Distinction AND presents an exceptional description of the research aim and rationale as to why the proposed study design would be appropriate for gathering data that would address the research question and aim. Includes all requirements of a Credit AND demonstrates a high level, in-depth, comprehensive thinking and description in relation to the research aim and rationale as to why the proposed study design would be appropriate for gathering data that would address the research question and aim. Includes all requirements of a Pass 1 AND provides a more detailed and advanced research aim and rationale as to why the proposed study design would be appropriate for gathering data that would address the research question and aim. Adequately states a research aim that is based upon stated research question and critical appraisal of existing research. Adequately proposes one appropriate research study design that could be used to answer the research question and aim. Adequate rationale why the 1 proposed study design would be appropriate for gathering data to address the research question and aim. Correct UniSA (2013) Harvard author-date system for in-text citation, paraphrasing & reference list. Coherent writing style with no grammatical or spelling errors. Adheres to word count. States a research aim that is based upon stated research question and critical appraisal of the existing research but aim is basic, limited. Proposes one research study design that could be used to answer the research question and aim but is basic, limited. Provides a limited, basic description of why proposed research design would be appropriate for gathering data to address question and aim. Mostly correct UniSA (2013) Harvard author-date system for in-text citation, paraphrasing & reference list Coherent writing style with no grammatical or spelling errors. Adheres to word count. States a research aim that is based upon stated research question and critical appraisal of research but aim is unclear or inadequate. Proposes irrelevant or incorrect research study design for answering the research question and aim Provides inadequate description of why research design would be appropriate for gathering data to address research question aim. Incoherent writing style. Some grammatical &/or spelling errors. Minor incorrect in text citation, paraphrasing OR reference list. Below or above word count. Did not state research aim OR stated research aim is not based upon stated research question AND/OR critical appraisal of the existing research. Does not propose one study design OR design is inaccurate. Provides incorrect OR no description of why proposed study design would be appropriate to address research question/aim. Significant grammatical &/or spelling errors. incorrect in text citation, paraphrasing OR reference list. Well below/above word count. STUDENT: MARKER: DR ANNE HOFMEYER MARK/GRADE: Comments: Read More