Prevention of Falls in Elderly Rehabilitation Patients - Essay Example

INTRODUCTION Before the advent of Care Homes, the elderly did not die uncared for. Families, Servants and Nurses took great care of the elderly andtoday, care has been transferred into professional hands of physicians and nurses and other care providers. It is acknowledged that care should be a mixture of affection and concern, common sense and practical knowledge backed by professional skills. Mere professionalism without understanding the social and psychological trauma and circumstances of a patient would only lead to further complications and distress. Professional skills have to combine with genuine affection, practical knowledge, understanding and common sense and only then care for elderly would be effective. Research on the elderly has attained ethnographic cross-cultural comparative proportions of investigation, being one of the most necessary requirements of society. Professional acute care, community care with their circumstantial inadequacies and the situational hopelessness of the elderly in those last sad years motivate Sociologists to invest more time on finding alternatives and innovations. One point all the care facilities and Governments usually forget is that the care is necessity-dependent and not just age-dependent. For critical appraisal, I have chosen: 1. Exercise Training for Rehabilitation and Secondary Prevention of Falls in Geriatric Patients with a History of Injurious Falls, by Hauer et al. 2. Patient Falls in Stroke Rehabilitation A Challenge to Rehabilitation Strategies, Lars Nyberg, BSc Yngve Gustafson, MD, DMSc Stroke. 1995;26:838-842 AIM OF THE ASSESSMENT These articles belong to the researched data connected to this field. As the falling of elderly has become a main problem especially so in the western society, because it delays rehabilitation and healing, it is necessary to have as much information as possible on the given area. Critical assessment and comparison of two or more research pieces can give more insight to care workers like me who have to focus on the problem. This is a very pertinent area for a care giving professional and it is better to analyze the research available than simply scanning through it. METHODOLOGY: I would like to appraise both the works, analyse them and compare them. I would also like to critically go through them and point out the areas of deficiency and shortcomings. I have tried to find similarities, glaring dissimilarities and various points that the researches have touched in the process. I feel it is important because of the seriousness of the problem that can make the last days of the elderly very painful, lonely and ailing. It is important to welcome as much research as possible in this region. LIMITATIONS: Both the research work show very limited perspectives of the problem. They do not envelop the entire relevant issue. Instead, they focus on certain practical advice and connected research without concentrating much on day-to-day activities of the care homes that are trying hard for a successful rehabilitation. As these researches are not highly extensive, their field strength is rather limited. Even though they represent two highly important sides of the problem, one approaching from physical angle and another from mental, it is difficult to conclude that both the papers have achieved anything absolutely conclusive. LITERATURE REVIEW: Aging touches different parameters in the Western and Eastern World because in Eastern countries, families take care of the elders under normal circumstances. Problems facing the elderly in European Countries, Australia, USA or Eastern Countries are identical. Caring for the frail elderly does not limit itself to one region or country. "Older people in European society are therefore not to be regarded as a homogeneous mass but as a diverse group of people who may have only one characteristic in common - their age" says Hugman (1994, p.7). Restorative care is distinctively different from usual care because they have to be matched with the particular individualistic needs and health factors. "The matching factors included age, sex, race, baseline self-care function, cognitive status, whether hospitalization preceded the home care episode, and date of the home care episode" Tinetti et al, The Journal of the American Medical Association. The carers have to be well equipped with all possible knowledge of the old and recent researches in the field. "Our primary focus is on factors affecting the quality of life of categories of vulnerable older people and their carers in the context of care delivery in a range of environments. We believe that services will not improve until care, as opposed to cure, is accorded greater value and status and more attention is given to those factors promoting job satisfaction and morale among practitioners" argue Nolan et al (2001). Research is conducted from many angles and some of the researchers have been successful in providing valuable insights for the caregivers and patients alike. "In 1977, Exton-Smith examined the incidence of falls in 963 people over the age of 65 years. He found that in women the proportion who fell increased with the age from about 30% in the 65-69 age group to over 50% in those over the age of 85 years. In men the proportion who fell increased from 13% in the 65-69 year age group to levels of approximately 30% in those aged 80 years and over," Lord et al (2000). There had been a few arguments that collaborative training with combination of care giving sectors could be necessary to control the problem. "It may be that the pre-conditions for more collaborative working include joint training, shared budgets and non-hierarchical ways of working; but more than all these, its achievement requires issues of power and control in the professions to be addressed," Warnes (2000 p.182). Utmost tact is required as today's helpless elderly were yesterday's achievers and they do not like to be questioned or being treated as imbeciles. Care workers should tread carefully. "Autonomy and self-determination, the freedoms to make decisions and to act on them are two of the most sacrosanct values in our society. For the frail elderly, issues of autonomy centre around interactions with formal services and with informal caregivers, relatives and friends, who provide the support and assistance necessary for functioning in the community. This dependence can, however, pose a threat to their autonomy as agencies and others seek to provide what they perceive to be in the frail individual's best interest," Cox (1993, p.43). DISCUSSION: Uncontrollable, incurable and unpredictable falling could be a major set back in the healing process that could deprive self confidence and mobility. It could break bones that could remain painfully unhealed. In case of fire, falling patient could burn or inhale smoke. Risk factors for functional decline include acute illness, exacerbation of chronic illness, injuries, medication side effects, depression, malnutrition, decreased mobility and use of physical restraints. Functional status could be a sensitive indicator of health or illness in nursing assessment. Further decline could be prevented to some extent with effective nursing intervention including medication, regular dosages, adaptive equipments, ambulation and enhanced communication, the last one being the most important to avoid loneliness and mental deterioration and degeneration. Aging and ailing induce psychological changes along with environmental difficulties such as losing freedom, house, neighbours, surroundings and individuality. The first article is more about prevention of a secondary fall during the rehabilitation under all possibly foreseeable surroundings. It depends on a randomised three month intervention trial in the outpatient setting, focussing on 57 female geriatric patients between 75 and 90. Main focus was on training of strength, functional performance, balance training, physiotherapeutic treatment while strength, functional ability, motor function, psychological parameters and fall rates were continuously measured and the profit by intervention was assessed. Patients were split into two groups namely: study and intervention. Both groups received identical physiotherapeutic treatment and training related medical problems did not occur in the study group. Fall-related behavioural and emotional restrictions were reduced significantly. In the control group, change was minimal. In a way, this is a better study than the second one and gives way to further research, and is able to conclude that progressive resistance and functional training to reduce falls are safe and effective. But it does not give any attention to the psychological state of the patients. Psychological condition of the patients is as important or sometimes more important than the physical condition and could be a major reason for the frequent falls. It is difficult to draw blithe conclusions from studies that are conducted on very limited numbers of patients. But it is an encouraging study. The second article focuses mainly on the stroke patients to investigate their fall characteristics and consequences during inpatient rehabilitation care. 161 patients of the rehabilitation unit were studied and results were analysed. While total falls were 153, it was concluded that falls in stroke victims are a major dangerous phenomena. But research found that the frequency of falls in the first few weeks is not higher, while some patients are more fall-prone and some of them suffer from confusion and cognitive impairments that is understandable in right hemisphere stroke. It also concluded that it is a challenging task to reduce the falls without discouraging or minimising the activities of the patients. This is an extensive study where the focus is only on the stroke patients; but the results could be applicable to other elderly patients too. The study is conducted on only the falls without any interventional strategies. Perhaps the study would have been richer if intervention had been conducted on one group and the result would have been compared with the group without intervention. Still the risk was studied along with the fall tendency and this is beneficial to all elderly rehabilitating patients. The study does not offer any solution, but leaves the problem midway saying that more research is needed on prevention of falls, because stroke victims face the gravest danger of falling that cannot be reduced without more major research work and the here the current research remains inconclusive. Both the studies are concentrating only on one culture and one region, whereas they should have taken a vaster area for the study. Aging and connected care are a universal problem, not located only in one culture or region. In spite of the universality of the problem a certain amount of national variations do exist in homes and other alternative caring institutions. "To explain these national differences in the use of and developing social policies towards, institutional care for older people, it is necessary to refer both to the history of welfare in each country as well as to the prevailing cultural expectations in the present," (ibid, p.129). It is difficult to see great similarity between the two as they deal with different areas of the problem. Both articles are silent about psychological point of view, though the first article lays stress on physical interventions to gain control over the falling habit. They hardly gives any structural and environmental reasons for the fall and focus mainly on the physical process of the elderly, which is definitely right, but could be painfully restricted. Various researches have shown that mental and physical impediments could lead to the fall and it is necessary to judge both. The first article lays down very important suggestions for further research. Both show very limited perspectives of the problem even though there exists no doubt that both are strongly pertinent. The suggestions made by the first article and the reasons shown for the falls are derived from sensitive observation and knowledge of physical drawbacks that could be experienced by the elderly. The second research definitely shows the way for potential field work that could give better opportunity to further research and enquiry. Both the researches have fallen short of suggesting complete care methods and further information in prevention and supervision. CONCLUSION: Talking about prevention and supervision, complete knowledge of the patient's condition should be available to all care staff. Medical routines, check-ups, medicines on prescriptions and dosages are the responsibility of medical staff involved. Medical requirements like physio-therapy, psychological counselling etc. should be done as a routine. Visits from family members and friends should be encouraged with liberal timings and communication from all possible angles should be encouraged. It is necessary to conduct further research from various angles to understand more about the problem. Professional research could be conducted even by observing the elderly without inconveniencing them. The above mentioned papers are steps towards right direction and many such steps and strides are needed to arrive at a possibly perfect research based formula. It is not enough if social policies stem out of creditable intentions. It is necessary for the social policies to be commendably research based with professional help and opinions from diverse sources. Social policies that are grounded upon very diverse views are the most successful of all. In an aging society like ours, where family care is unavailable, care giving institutions assume the greatest responsibility and they could be guided by extensive research to help the elderly. BIBLIOGRAPHY: 1. Cameron, Ian D., and Kurrle, Susan E. (2002), 'Rehabilitation and Older People', the Medical Journal of Australia, 2002 177 (7): 387-391. 2. Cox, Carole (1993), The Frail Elderly, Auburn House, London. 3. Hugman, Richard (1994), Ageing and the Care of Older People in Europe, St. Martin's Press, London. 4. Kayser-Jones, Jeanie Schmit (1981), Old, Alone, and Neglected, University of California Press, Berkeley. 5. Lord, Stephen, Catherine Sherrington and Hilton B. Menz (2000), Falls in Older People, Risk Factors and Strategies for Prevention, Cambridge University Press. 6. Nolan, Mike, Sue Davies and Gordon Grant (2001), Working with Older People and their families, Open University Press, Buckingham. 7. Pinner, Frank A. and Jacobs, Paul (1959), Old Age and Political Behaviour, University of California Press. 8. Phillips, David R. ed., Ageing in East and South-East Asia, Edward Arnold, London. 9. Shanas, Ethel (1962), the Health of Older People, Harvard University Press. 10. Tinetti, Mary E. et al (2002), 'Evaluation of Restorative Care vs Usual Care for Older Adults Receiving an Acute Episode of Home Care' The Journal of the American Medical Association, Vol. 287, No. 16. 2098 - 2105. 11. Tracy, Martin B. (1991), Social Policies for the Elderly in the Third World, Greenwood Press, New York. 12. Wicks, Malcolm (1978), Old and Cold, Heinemann, London. 13. Warnes, Anthony M., Lorna Warren and Michael Nolan (2000), Care Services for Later Life, Jessica Kingsley Publishers, London. ARTICLES ANALYSED: 1. Hauer, Klaus, "Exercise Training for Rehabilitation and Secondary Prevention of Falls in Geriatric Patients with a History of Injurious Falls", Journal of the American Geriatrics Society, Volume 49 Issue 1 Page 10-20, January 2001 http://www.blackwell-synergy.com/doi/abs/10.1046/j.1532-5415.2001.49004.x 2. Nyberg, Lars and Gustafson, Yngve, "Patient Falls in Stroke Rehabilitation; A Challenge to Rehabilitation Strategies", Stroke. 1995;26:838-842 http://stroke.ahajournals.org/cgi/content/full/26/5/838 Read More