Strategic Plan to Reduce Falls and all Related Injuries in Alzheimer Disease Unit - Essay Example

Strategic Plan to Reduce Falls and all Related Injuries in Alzheimer Disease Unit Strategic Plan to Reduce Falls and all Related Injuries in Alzheimer Disease Unit Introduction Alzheimer’s disease (AD) is the most common form for dementia that is not curable. Alzheimer’s disease worsens as it progresses and severely affects the normal life of victims. This disease eventually leads to death although proper medication and observation can improve the condition of the patient. It has early, moderate, and advanced stages. In the early phase of the disease, the victim experiences increasing impairment of learning and memory. The moderate stage is characterized with progressive memory deterioration which limits the victim’s independence significantly and he/she fails to perform most of the common daily living activities. As the AD progresses, complex motor sequences become disorder, and this issue increases the victims’ risk of falling. In the advanced stage, AD patients will be completely dependent on their caregivers. According to the Center for Disease Control and Prevention (2014), falls and fall related injuries constituted the leading cause of both fatal and nonfatal injuries among older adults in 2010 (CDC). This paper will introduce a strategic plan to reduce falls and all related injuries in Alzheimer Disease Unit. Falls and other related injuries in Alzheimer Disease Unit The occurrence of falls in AD victims is very frequent and this problem results in dreadful consequences like fractures, cognitive decline, and lack of independence. Many studies have identified the fatal consequences of falls among AD patients with intend to develop potential prevention/intervention strategies. Statistical data from an Alzheimer’s disease unit in a nursing home in Chicago indicate that there have been 6-7 hips surgeries and one death resulting from fall over the last two months. According to Alzheimer’s Association (2013), 26% of the AD related hospitalizations in 2013 could be attributed to syncope, fall, and trauma. Orcioli-Silva, Simieli, Barbieri, Stella, & Gobbi1 (2012) reflect that as compared to healthy elders, elderly people with AD are highly vulnerable to falls, falling nearly 4-5 times a year. Referring to various studies, the authors add that ‘touched or stumbled on the obstacles’ constitute one of the leading causes of falls in AD patients. High cognitive load in AD patients causes motor changes, which in turn leads to decreased automated motor of gait and increased risk of falling. Kato-Narita and Radanovic (2009) clearly state that “elderly with dementia have a doubled to threefold risk for the occurrence of falls, probably due to motor impairment, attentional deficits, use of psychotropic medication, and behavioral symptoms.” So as to obtain a detailed knowledge of the occurrence of falls, Kato-Narita and Radanovic recruited 45 AD patients from an out-patient service at a university hospital. They used the Clinical Dementia Rating (CDR) to determine the severity of AD in those patients and thereby classified the disease into mild (CDR 1) and moderate (CDR2) AD. , Kato-Narita and Radanovic observed that the number of falls was 1.16/person for the CDR 1 whereas it was 0.75/person for the CDR 2 group. The authors did not find any significant difference between these groups. For the CDR 1, majority of the falls (79.3%) occurred indoors and only 20.7% happened outdoors. Similarly, 80% falls occurred indoors and the remaining 20% occurred outdoors in case of the CDR 2 group (Kato-Narita and Radanovic, 2009). Hence, it can be concluded that the occurrence of indoor falls among AD patients is frequent regardless of the severity of the disease. Risk of falls Falls among the AD patients constitute a great threat to efficiency of the Alzheimer care unit because it may often lead to life threatening complications or even instant death. Studies indicate that nursing home residents with AD are nearly twice likely to fall when compared to those without this disease even though other major risk factors are strictly controlled under a nursing home setting. Statistical data point that residents with AD have higher injurious fall rates as they experience more falls. Falls among AD patients residing in nursing homes may lead to life threatening complications because minor injuries often go unnoticed as self-reports by these individuals is unlikely. For the same reason, the fall rates of AD patients in an Alzheimer disease unit would be higher than actually reported. Obviously, elderly people are the major victims of Alzheimer’s disease, and therefore they are less likely to regain their health soon even if they sustain fractures or other serious injuries from a fall. Consequences of falls in dementia and the growing social cost and burden of caregivers have gained greater attention over the last few decades. Hence, researchers are striving to explore the risk factors for falls and thereby develop fall prevention policies. However, the major weakness of those studies was that they did not consider the stage of dementia, which could notably affect the occurrence of falls. Strategic plan As noted already, patients with AD have personalized needs and hence it is essential to give particular attention to the needs of those individuals to improve their health. Therefore, it is better to develop a strategic plan that gives specific focus to a special care like S.S Nursing Home and Rehabilitation Center in Chicago that has a large elderly patient population between the ages of 65 and 90. This facility mainly serves African Americans with unique health problems such as osteoporosis, osteoarthritis, Alzheimer’s disease, and other age related problems. Almost 100% of this facility’s clients are elderly people, and hence there is high risk for falls and fall related injuries. The organization has identified falls and related injuries as the biggest concern, and implemented a number of policies and programs to reduce the risk of fall related injuries. The proposed strategic plan will outline a six-month program specifically designed to identify the weaknesses of the current fall prevention measures and to develop new measures by resolving the issues identified with the existing programs. A risk assessment program is particularly important to evaluate the potentiality of measures designed and to ensure enhanced patient safety on a continuous basis. Since various environmental factors can have great influence on fall related injuries among AD patients, continuous assessment and evaluation of environmental factors is crucial. Similarly, staff intervention is inevitably important to reduce injurious fall rates among AD patients. Poor nurse patient ratio is a major challenge faced by Alzheimer disease units today because of staff shortage problems. Physically and mentally demanding working patterns and schedules persuade nurses to abstain from working in an AD rehabilitation facility despite higher remuneration. Furthermore, most of the experienced nursing practitioners are females and many of them do not like to continue in this profession for a long time due to family obligations. However, qualified and experienced caregivers are extremely necessary to look after AD patients effectively and to reduce their injurious fall rates. Here, recruiting qualified nurses from population rich but educationally leading countries like India, China, or Brazil is advisable to meet staff shortage issues. Evidently, there is an increased need for employment in those developing countries, and hence candidates from such regions may be willing to work for comparatively cheaper rates. This recruitment strategy may also improve staff retention rate and thereby improve nurse-patient ratio. When the nurse-patient ratio is better, there will be more number of nurses to take care of the whole AD patients, and prevent falls and related injuries. In the view of Doorn, Gruber-Baldini and Zimmerman et al (2003), the long-term care setting is a fruitful strategy that would facilitate prevention and intervention of falls and all related injuries. To justify, a long term care setting can assist caregivers to identify AD patients who are at high risk of falling at the time of admission. This will also help care givers to monitor patients’ risk factors continuously to determine who requires specific fall prevention measures. In other words, taking long-term care is beneficial to frame personalized intervention strategies that would match the specific needs of AD victims. The authors clearly state that “use of community-developed fall prevention methods such as strength training and exercise programs may be difficult with some residents who have dementia, and many such interventions have not been tested on persons with dementia” (Doorn, Gruber-Baldini & Zimmerman, 2003). People with AD need closer supervision to deal with fundamental fall prevention strategies. For instance, proper and close supervision may assist AD victims to identify weakness or dizziness, and help caregivers assure that patients are wearing proper footwear to prevent falls. In addition, assessment of health conditions besides dementia could be a better strategy to prevent falls. For instance, obesity is a health condition that increases the risk of fall. Experts in AD management say that close monitoring of high risk patients and continuous reduction of environmental hazards can play a significant role in mitigating the occurrence of injurious falls among AD patients. Since elderly people are likely to get fracture from a fall, strategies like the use of hip protectors and the supply of bone active medication, vitamins, and calcium supplements are advisable. At the same time, caregivers must manage the use of psychotropic medications. They should discourage the intake of excessive or inappropriate medications because those practices can significantly impair the physical as well as mental health of patients and increase their probability of injurious falls. Moving AD patients who are at high risk of falling to fully equipped nursing stations is also a potential strategy to reduce falls or fall related injuries. Similarly, AD victims should be monitored with superior care after a fall not to miss post-fall injuries that are less likely to be self-reported by patients. Conclusion From the above discussion, it is clear that falls and fall related injuries among AD patients appear to be a great threat to effective AD care. The number of AD patients injured from falls has been growing over the years mainly due to poor monitoring caused by staff shortage issues. In order to resolve this problem, it is advisable to recruit nurses from developing countries because they would be willing to work for relatively cheaper rates for longer periods. Long term care setting can be an effective policy to identify the unique risk factors of AD victims and to promote their health care in the long term. Better administration of medications, vitamins, and calcium supplements are also advisable to strengthen those patients’ bones and prevent fall-related fractures to some extent. The action plan will involve continuous assessment and evaluation of environmental factors as well as staff interventions, patients and family knowledge to enable everyone to be active participants in these practices. In short, a comprehensive action plan can play a significant role in reducing the occurrence of falls and fall related injuries among AD patients. References Alzheimer’s Association. (2013). Alzheimer’s disease: Facts and figures. Alzheimer’s & Dementia, 9 (2). Retrieved from http://www.alz.org/downloads/facts_figures_2013.pdf Cdc.gov. (2014). National center for injury prevention and control - home page|injury center|cdc. [online] Retrieved from: http://www.cdc.gov/injury/index.html [Accessed: 19 Jan 2014]. Doorn, C. V., Gruber-Baldini, A. L., Zimmerman, S., Hebel, R., Port, C. L., Baumgarten, M., Quinn, C. C., et al. (2003). Dementia as a Risk Factor for Falls and Fall Injuries Among Nursing Home Residents. Journal of the American Geriatrics Society, 51 (9). Retrieved from http://www.medscape.com/viewarticle/460913_5 Kato-Narita, E. M & Radanovic, M. (2009). Characteristics of falls in mild and moderate Alzheimer’s disease. Dement Neuropsychol, 3(4):337-343. Orcioli-Silva,D., Simieli, L., Barbieri,F. A., Stella, F & Gobbi1, L. T. B. (2012). Adaptive Walking in Alzheimers Disease. International Journal of Alzheimers Disease. ID 674589, 6. Retrieved from http://www.hindawi.com/journals/ijad/2012/674589/ Read More