Immobility Causes Early Death among the Elderly Women in Australia - Literature review Example

Critical Appraisal of Published Research Name Institution Date Immobility Causes Early Death among the Elderly Women in Australia Introduction Immobility is a common cause of death among the old women in Australia. Old people and especially women are prone injuries that result from falling. One of these injuries is a hip fracture. Hip fractures affect the patient movement and reduces the frequency of movement. This causes immobility of the patient that leads to more complications on the patient’s health. If they remain unattended, old people with hip fracture or any other injury are usually prone to the risk of dying due to immobility. Failure of providing the necessary medical attention to these patients is also a risk factor that contributes to their immobility and other health complications that lead to their death. According to Coughlan & Dockery (2014), the elderly women have poor health and having a hip fracture worsens their health status. If they do not seek the necessary medical care, the risk of dying in a time less than one year is high. Hip fracture tends to increase chances of dying early in elderly women who are eighty years and above. When a woman aged eighty, in good health, experiences a hip fracture and does not seek treatment, her risk of early death of less than a year is high. as described by Leblanc, Hillier, Pedula, Rizzo, Cawthon, Fink, Cauley, Bauer, Black, Cummings & Browner, (2011), old women have limited movements and are usually immobile. Any injury that is exposed to them increases their immobility that increases their poor health. Considering Mrs. Piro’s case, she was ninety one years when she died. Her death was caused by immobility that led to the complications of thrombosis. These complications resulted to her early death. Mrs Piro had experienced a fracture on her thigh after she had fallen in the house. This fracture led to the dislocation of her right ankle. She did not receive treatment for the fracture and a permanent deformity was formed after healing. She had an ulcerated skin above the medical malleolus of the lower tibia that was displaced. When the leg was examined further, results showed muscle disuse atrophy on the right calf. It was also noted that, the subcutaneous oedema on the right calf as well as the foot had diffused. An antemortem thrombus was also noted on the right iliac vein. Mrs. Piro was reported to have had pressure sores for several weeks before her death. As described by the doctor, due to the weight bearing that was precluded by the fracture, the right calf muscles were not active for a period of weeks or months. Permanente (2011) argued that, women who experience hip fracture must be given a lot of attention especially within the first year to minimise their chances of early death. It is important to discuss the problem of immobility as the main cause of death among the elderly women in South Australia in quantitative perspective. The reason is that, there are increasing numbers of mortality rates among the aging population due to immobility (Cameron, et al 2010, p.870). This is alarming and discussing this problem quantitatively will provide information which is of great help to health care providers, care givers as well as family members who have the responsibility of looking after the elderly people and especially those with health complications. The aim of this assignment is to establish whether immobility causes early death among old women in South Australia. Research Question To what extend does immobility cause early death among the old women in Australia? Critical Appraisal of the Literature According to Permanente (2011), old women with a fracture on their hip are found to die in a three to six months period after experiencing the hip fracture. Osteoporosis is one of the greatest dangers of hip fractures. Osteoporosis is a condition among the elderly people whereby their bones are weakened and can break easily (Coughlan & Dockery, 2014). The International Osteoporosis (2014) describe that, 27% of elderly women aged 60 years and above are osteoporotic while 51% are osteopenic. Women above the age of fifty years have a 42% life time risk of osteoporotic fracture. The number of hip fractures within a year in Australia is 20,000 and is expected to increase by 40% every decade. Old women who are exposed to smoking, extended use of alcohol and a low body weight are advised to get their bone density scanned. This helps them in establishing their vulnerability to osteoporosis development. If diagnosed with osteoporosis, old women should start the intake of medication to strengthen their bones as well as decrease their risks to experiencing fractures. Mrs. Piro loved alcohol and continues its intake even at her old age. She slipped on the couch when she was drunk and injured her foot. Susan confirmed this incidence and described that Mrs. Piro’s foot was swollen. Since Mrs. Piro was old, she had a risk of osteoporosis and her bone density needed to be scanned. Old people are advised to have a high intake of calcium and vitamin D nutrients. The Center of Excellence for Fall Prevention (2014) denotes that, to build and strengthen their bones, old women should be encouraged to do a weigh bearing as well as exercise balancing. They should avoid cigarette smoking and their homes should be thoroughly assessed to ensure it is fall proof. Mrs. Piro was taken care of by Susan Piro who ensured that her blood pressure was frequently checked. As described by Susan Piro, Mrs. Piro liked alcohol and could not stop drinking even after being discouraged by her daughter and warned by the doctor. To ensure that her mother was safe and could move with ease, Susan Piro purchased a commode for the bedroom, a telephone at the side of her mother’s bed, shower chair, a walker, a walking frame, a wheel chair and a toilet raiser. According to statistics a third of old people in Australia experience falls each year. The falls results to fractures of different types (Yale Study on Falls Risk, 2012). Most of the family members do not recognize many of these falls. Therefore, a big number of falls among the old people go unreported. The Center of Excellence for Fall Prevention (2014) describe that, when an old person falls, he or she has a high possibility of falling again. Information depicts that, after being discharged from a treatment of hip fractures, the chances of old people falling again within a period of six months is high at (53%). 87% of hip fractures among old people in Australia that result from falling lead to death. Whether they are taken care of at the hospital or at home, old women with hip fractures die in a time less than one year. It is not necessarily that old people who fall experience injuries. However, 47% of them are seen not to have the capability of getting up without assistance. After falling, there was no visible injury on Mrs. Piro’s skin or leg. The only suspicion by Susan Piro was that, her mother’s foot was broken. For those who get the capability of getting up after experiencing a fall, the outcome of their hip fractures is affected greatly by their immobility. Falling causes compression that leads to the collapsing of the muscle cell in short time of thirty to sixty minutes. Complications such as dehydrations, pneumonia, pressure sores as well as hypothermia are experienced by the patient (Moyer, 2012). The doctor in Mrs. Piro case said that, she had complications of pressure sores that were present for some weeks. The weight bearing that was precluded by the hip fracture led to the inactivity of the right calf muscles for months. Hip fractures that occur as a result of falling cause immobility of older women. They are not able to move around without help or live independently. This immobility increases the chances of old women dying early. Since their activities are limited, their mobility is reduced. This makes them physically unfit and exposed to greater risk of falling again. According to Coughlan, (2014), women in their old age have a greater frequency of falling than men in their old age. As describe by Fox News (2014), patients nursing their hip fractures at residential places usually die or experience walking incapacity in a period of six months after experiencing the fracture. Patients with age above ninety and have hip fractures are advised to perform a reparative surgery. This will reduce their risk of completely becoming disabled and early death on their hip. Mrs’ Piro never sought any medication for her hip fracture and this increased her risk of dying early. Performing a reparative surgery was necessary to treat the hip fracture and extend her life span. As described by Fox News (2014), patient who nurses a hip fracture at home has high chances of experiencing surviving outcomes that are worse or functionality status which is bad. Old women and experiencing hip fractures are mostly bed ridden; their immobility decreases their hygiene since they cannot use their toilet. Poor hygiene increases the infection of pressure sores among other complications that increase their chances of dying early. Therefore, it is important to take care of these patients and stop their early death. After Mrs’ Piro was left by Susan Piro, she could do anything by herself. This decreased her hygiene status which affected her health and ended up dying. Getting help after experiencing an immobilizing fall by an old woman is important. This serves the purpose of improving their survival chances by 80%. They are also able to return back to their independent living. Mrs. Piro was reluctant to seek medical help and even refused to undertake any when Susan Piro sought for a doctor’s help. Because she refused to get help, Mrs. Piro died. 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. According to the International Osteoporosis Foundation (2014) the total costs that relates to treating osteoporosis in Australia are $7.4 billion within a year with which $1.9 billion are usually direct costs. Passing an Act for the preventing falls among the elderly is important. This will work towards educating caregivers on best practices of preventing falls among the elderly people. Hip fracture among the elderly women prevention and treatment needs to be addressed. This will play a big role in minimising early deaths of this vulnerable group. The doctor in Mrs. Piro confirmed that, although she was ninety one years old and very old, Mrs. Piro should not have died in the manner she did. She only required medical care to treat her ankle as well as the pressure sores. Cameron, Chen, March, Simpson, Cumming, Seibel & Sambrook (2010, p.870) describe that, hip fractures pose great danger of early death among old women. However, their risk of dying early does not result from the hip fracture but from the health conditions that are exposed by immobility. Immobility present in old women who have hip fractures increases their complications of thromboembolism that leads to early death. Elderly women aged eighty years and above are at great risk of death because they are found to be sick with other health conditions. Fractures on their hips tend to increase their death risk thrice. The reason is that, many of these elderly women never recover from hip fractures (Leblanc et al, 2011). According to the Yale Study of Falls Risk (2012), some of the factors such as age as well as previous falls experience that increase falls cannot be removed. However, factors that lead to falls such as mobility problems can be removed. Caregives and family members should take action and ensure that the elderly get help to walk, they can move around and their sitting or standing position is carefully transferred. To cater for Mrs’ Piro’s mobility problems, Susan Piro provided her mother with shower chair, a walking frame, a toilet raiser and a walker. Susan Piro also bought a wheelchair for Mrs. Piro to assist her in going for outings and also access the garden. For full treatment of hip fractures, the family members of the old women are advised to encourage the patient to perform a reparative hip fracture surgery (National Institute for Health and Care Excellence, 2012). Undergoing this surgery helps in improving the patient’s health and increasing their years of life. Old patients are found to decline treatment and most time they will not approve of a reparative surgery (Fox News, 2014). What family members are advised is that, such treatments must be undertaken and it’s not mandatory for the patient to approve. Susan Piro should have suggested a reparative surgery for Mrs. Piro to help in extending her life span and improve her mobility. Conclusion This assignment aimed at establishing the extent to which immobility causes early death among older women in Australia. The discussion provides evidence that, immobility increases complications of health condition among old women and this leads to their early death. To answer the research question and the aim or hypothesis of the assignment, various research designs can be used. Some of these research designs include; search methodology and focus groups and in depth case interviews (James, Gouldbourne, Morris & Shearer, 2010, p.7). The most appropriate research design that I would choose to gather data about the population would be the use of a search methodology. A search methodology would provide enough information about deaths among the elderly women that have occurred in Australia. Carrying out a comprehensive literature search of relevant public studies as well as unpublished studies that were carried out before is essential. This will provide records that are pertinent to deaths as a result of immobility among the elderly women. According to Jansen (2009, p.99), it is also important to carry out searches on multiple electronic databases such as internet searches and manual checks of different sections of references of review articles as well as studies published in the past at least five years back. Selection of the identified documents should be done based on how appropriate they are to the research problem. The documents and records that meet the relevant criteria should be retained for the purpose of extracting data during the review process. After selecting the relevant materials, reviewing of patients or clients records is done to obtain data based on clinic or hospitals regarding deaths among the elderly that occurred due to immobility. References Cameron, I., Chen, J., March, L., Simpson, J., Cumming, R., Seibel , M & Sambrook, P, (2010), Hip Fracture Causes Excess Mortality Owing to Cardiovascular and Infectious Disease in Institutionalized Older People: A Prospective 5-Year Study, Journal of Bone and Mineral Research, Vol. 25, No. 4, April 2010, pp 866–872. Centers for Disease Control and Prevention, (2013), National Center for Health Statistics, Health Data Interactive, Retrieved from www.cdc.gov/nchs/hdi.htm. Accessed: [09-10-2014] Center of Excellence for Fall Prevention, (2014), Information for Individuals & Families, Retrieved from http://stopfalls.org/individuals-families/ Accessed: [09-10-2014] 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 Accessed: [09-10-2014] 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: [09-10-2014] International Osteoporosis Foundation, (2014), Women over 50 Will Experience Osteoporotic Fractures, Retrieved from http://www.iofbonehealth.org/facts-statistics James, K., Gouldbourne, J., Morris, C & Shearer, D, (2010), Falls and Fall Prevention in the Elderly: Insights from Jamaica, Department of Community Health and Psychiatry, Mona Ageing and Wellness Centre, Retrieved from http://www.who.int/ageing/projects/AMRO-Jamaica.pdf Accessed: [09-10-2014] Jansen, B, (2009), The Methodology of Search Log Analysis. Pennsylvania State University, USA, Retrieved from http://faculty.ist.psu.edu/jjansen/academic/jansen_search_log_analysis.pdf Accessed: [09-10-2014] 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: [09-10-2014] 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: [09-10-2014] 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: [09-10-2014] Read More