Fall Prevention in Greece - Essay Example

Fall Prevention in Greece Falls and injuries resulting from falls are common injuries and health risks for the elderly. Epidemiological studies looking into the rates of falls among the elderly in their homes, in outpatient settings and in institutions reveal that among 65 year-old women, about 30% will suffer from falls; and over the age of 85, about 50% are expected to suffer from falls. For men, about 13% in the 65-69 age range have the risk of suffering from falls; this risk will increase to 31% in the 80-84 age range group. Those who are at greatest risk of suffering from falls are those who are living alone, who are single, more aged, divorced or widowed. Falls among the elderly is of great concern because they often lead to deaths. In fact, "among older adults, injuries cause more deaths than either pneumonia or diabetes" (Warshaw, 2006). And falls account for about half of these deaths due to injuries in the elderly. Falls often cause a decline in the quality of life of the elderly patient who will have decreased independence due to his injuries. And this decreased quality of lifestyle can ultimately lead to their early death. Fractures that often result from falls are usually of the hips, forearm, ankle, pelvis, upper arm, and hand (Scott, 1990, as cited by Centers for Disease Control, 2009). Falls are defined in different ways by different authors. The World Health Organization defines a fall as "an event, which results in a person coming to rest inadvertently on the ground or other lower level" (as quoted by Victorian Government health Association, 2008). Other authors think this definition is incomplete and include possible causes of falls like violent blows, loss of consciousness, sudden onset of paralysis as in stroke or an epileptic seizure (Gibson, et.al., 1987, as quoted by Victorian Government Health Association, 2008). But regardless of the number of definitions given to falls, the common trend in these definitions is that falls cause injuries; falls are also attributed to a number of factors. Many patients who have suffered from falls often develop fear of falling again, and as a result they tend to limit their activities. Their limited activities affect their health and physical fitness; and consequently because of poor health, their actual risk of falling is actually increased (Vellas, et.al., 1997, as cited by Centers for Disease Control, 2009). Prevention Measures There are various ways of preventing falls among the elderly population. These measures are not mutually exclusive; they can all be used for the patient in order to reduce the risk of falls to the lowest possible percentage. Environmental factors One of these measures may be categorized as environmental precautions. Environmental factors such as loose rugs or mats, electric leads and wires, and wet surfaces are factors which increase the risk of falls. Simple prevention measures can be adapted around the house in order to reduce or even eliminate the risk of falls from loose rugs and electrical wires. By simply eliminating these rugs and electric wires, falls can be prevented. Carpet edges should also be firmly tacked or taped down in order to prevent tripping. In order to prevent slips from slippery and wet surfaces, "bathrooms should have sturdy grab rails near the tub and toilet" (Loue, et.al., p. 260). Lighting should also be made bright in all rooms of the house in order to ensure that possible tripping hazards are seen by the elderly. Stairs should have handrails on both sides. Footwear should also be those of the non-slip or non-skid variety. These should provide adequate support, fit snugly and not easily fall off. By adapting these precautions, risks of falls can be prevented among the elderly. These precautions and prevention measures are simple and easy to adapt. And they do not cost much to apply. Strength and Balance Factors The factors of power and balance contribute to the risk of falls and injuries. When a person rises from his chair or when he walks around the room, muscle power and balance is required in order to ensure that no injuries befall him. The elderly often have limited mobility because of osteoarthritis, muscle and bone weakness, or possible surgeries. In order to address these possible fall risks, patients can be encouraged to exercise and to remain active. "This strengthens muscles and maintains joint position sense and balance" (Draper, 2008). These activities can best be implemented and applied in a group or a community of elderly patients in order to increase compliance and participation among the elderly. Community participation is important in instances where the elderly has already previously experienced falls. An elderly adult with a history of falls is less confident about staying and keeping active because of the risk that he might again be injured. Therefore, it is important for the elderly to be among other elderly people in the community in order to improve their confidence. It is especially important to encourage activity and exercise after retirement. Activities to be encouraged for these elderly persons must suit their needs and the level of their fitness. Care must be taken in order to ensure that the activities being undertaken by the elderly fit their age, their endurance and their strength (Draper, 2008). Trying to fit them into activities that are not appropriate for their body and their health may further endanger their overall physical make-up. Coming up with an exercise or an activity regimen that fit their needs and their preferences would help increase their participation and compliance with the activity regimen. Activities which develop and improve balance and strength among the elderly help minimize the risk of falls. Weight-bearing exercises for the elderly are more appropriate than non-weight bearing activities. "Walking, dancing, stair-climbing, gentle jogging, and weight training are some exercises of weight-bearing" (Lewis, p. 253). These activities should start out slowly and increase gradually based on the patient's tolerance. Some authors and occupational therapists suggest that these activities be undertaken about 3 to 4 times in a week for an estimated 45 minutes per session. These activities, however, should be undertaken while applying proper posture and body mechanics in order to prevent injuries. It is recommended for elderly clients to consult occupational or physical therapists and even their physicians before undertaking these activities in order to gain insight into appropriate activities based on their health and tolerance. Aerobic activities that improve cardiac endurance are also recommended for elderly patients. However, experts emphasize that these aerobic activities should follow proper warm-up and cooling down procedures. "Intermediate exercise classes should consist of a warm-up of 10 minutes, a conditioning phase of 20 minutes, a pre-cool down phase of 5 minutes, a muscle-strengthening phase of 10 minutes, and a cool down period of 10 minutes" (Lewis, p. 253). Along with the above strengthening activities, a proper and healthy diet is recommended for elderly patients. It is imperative for elderly patients to maintain a healthy diet. First and foremost, it will help prevent diseases and help stabilize possible illnesses that already afflict the elderly. A healthy diet also helps build up muscle and bone strength. A healthy diet of protein and calcium helps keep bones strong especially when the client is diagnosed with osteoporosis. Vitamin D and Potassium also helps patients with osteoporosis. Bread with fibre, cereal and brown rice products, fruits, dark green vegetables, as well as those high in Vitamin C "provide a firm foundation for fuelling the body with the resources it needs" (Lewis, p. 254). The elderly may consult with clinicians and dieticians on appropriate foods and portions that they can take with each meal. Elderly patients can be instructed on how to read product labels in order to ensure that they are taking the proper nutrients they need while avoiding the unhealthy components in the food they purchase. Neurologic Factors Neurological diseases or affectations among the elderly patients are also crucial factors that affect the risk of falls and injuries. Neurological diseases like Parkinson's disease, history of stroke, diabetic neuropathy, proximal myopathy, conditions that affect coordination, cognitive impairment impairing coordination, and depression can cause or increase the risk of falls among the elderly patients (Draper, 2008). Preventing falls in stroke patients usually involves the entire rehabilitation team. The team can help guide the patient through his recovery in order to improve and increase his mobility. The family also has to be involved in the rehabilitation process in order to lend moral support and to be able to assist the patient upon discharge. Falls can be prevented by putting up bed rails; transfer of patients from the bed to the wheelchair must be done by properly trained health care professionals; balance and retraining activities must be conducted with appropriate and adequate medical equipment (Barnes, et.al., p. 369). Parkinson's disease patients need to undergo balance, resistance, transfer, and gait training in order to reduce their risk of falls. These methods are inexpensive interventions which can help improve their independence. Physical activity and mobility are simple measures that can help improve the elderly. "Daily aerobic exercise designed to improve mobility and range of motion through walking and flexibility exercises have been shown to prolong life--and most importantly improve its quality--in those with Parkinson's disease (Kuroda et al., 1992, as quoted by Hirsch, et.al., 1998). Other fall preventive measures are available for elderly clients depending on their neurologic affectation. But the common trend among these measures is the emphasis on proper consultation and assistance from health care professionals. The disease of the patient calls for particular preventive measures appropriate for his affectation. A patient with diabetic neuropathy is different from a stroke patient; therefore preventive measures for falls may be different for each patient depending on the physician's recommendation and depending on the particular patient involved. Preventive measures should be individualized and made appropriate to each patient's needs. Alcohol Some studies have revealed that there is a strong relationship between alcohol and falls among the elderly. These studies have come to establish that about 11% of injured elderly adults are considered at risk drinkers and majority of these patients are also taking medications "which may result in a moderate or severe adverse drug reaction with alcohol" (Aging in Canada, 2005). Among those who are considered at risk drinkers, 30% are taking medications that may cause severe drug interactions with alcohol. Many of these elderly adults do not freely admit to taking alcohol when queried by health professionals. This often makes it difficult to diagnose and assess these patients because they tend to be deceptive about important details pertinent to their condition. Actual treatment of the alcoholic problem in the elderly can also be very difficult to undertake. In order to prevent falls attributed to alcohol intake, the primary intervention that needs to be undertaken by the health professionals is to address the alcohol problem of the elderly patient. Patients must be prompted and encouraged to enter alcohol rehabilitation. Drugs like disulfiram are probable choices that may be used by health professionals to help the patient recover from alcoholism (Offsay, 2007). Elderly adults should also be cautioned well about mixing alcohol with any of their drugs and medications. Loss of consciousness Loss of consciousness often precedes a fall. Loss of consciousness may be caused by syncope, dizziness, arrhythmias, and convulsions (Draper, 2008). Syncope is a symptom for other diseases. It is characterized by the loss of postural control and unresponsiveness. In elderly adults, syncope may be caused by several disorders and in some instances, the cause may be unknown. Falls that result from syncope often lead to head traumas and other injuries. In order to prevent falls attributed to syncope, it is prudent to identify the triggering factors for the syncope. By identifying these triggering factors, it may be possible to avoid these factors. Some elderly adult males whose syncope can sometimes be triggered by their urination can learn to urinate while sitting down. Those who tend to experience syncope from their nitrate medications can be given other drugs for their angina; they may also be instructed to sit down while taking their nitrate medications. Elderly adults who often suffer from orthostatic hypotension should be advised and instructed not to rise from their beds too quickly especially at night. They should be instructed to sit first at the edge of their bed and flex their feet before they stand. Elderly adults can also be instructed to avoid too much straining (Valsalva maneuver) while defecating. The Valsava maneuver can cause temporary blockage of oxygen to the brain, resulting to syncope. Using stool softeners and changing the diet can help decrease straining during defecation, and consequently prevent syncope. For the healthcare professionals, they should avoid prescribing drugs that may cause hypotension to the elderly adult patients. Those who need hypotensive drugs should be monitored. "Physical therapists can help patients maintain sufficient muscle tone in the lower extremities to ensure adequate venous blood return to the heart (Beers, et.al., 2006). Muscles can also be strengthened in order to prevent muscle weakness and susceptibility to falls. Dizziness can also cause falls and injuries among the elderly adults. Otologic dizziness is one of the most common causes of falls among the elderly adult population. Benign paroxysmal positional vertigo causes dizziness in about 50% of patients aged 80 years old and above. These patients suffer brief bouts of vertigo triggered by changing the position of the head. Meniere's syndrome may also cause dizziness in older adults and is especially common in those who are 50 years old and above. This syndrome "usually presents as spells of rapid decline in hearing, a roaring tinnitus, vertigo, and monaural fullness" (Hain, 2008). This syndrome eventually results to falls in elderly patients. The management and prevention of falls associated with this syndrome is the administration of vestibular suppressants and antiemetics. By managing the syndrome itself, the possibility of falls may be managed and reduced, even eliminated. Vestibular neuritis can also cause falls among elderly adults. It is a "monophasic self-limited condition typified by vertigo, nausea, ataxia and nystagmus" (Hain, 2008). The vertigo that they experience associated with their condition can result to injuries and falls. And again, in order to reduce and prevent falls caused by the vertigo, anti-emetics can be given to patients. Dizziness may also be attributed to vascular events, such as strokes which involve the cerebellum and the brainstem. Dizziness may be an indication of another much more dangerous condition. In these instances, the vascular risk factors are often addressed in order to prevent the dizziness. As was previously mentioned, falls that may be caused by other underlying conditions can be prevented by addressing the problem or condition causing the dizzy spells and other symptoms to manifest. Convulsions or seizure disorders can often become increasingly common after the age of 60. And convulsive bouts can often cause elderly patients to fall and injure themselves. Some studies have revealed that disturbances to the central nervous system such as subdural hematoma, stroke, and CNS infection can cause convulsions. Metabolic conditions such as uremia, hyperglycemia, hypoglycemia, hyponatremia, and alcohol withdrawal can also cause convulsions or seizures (Velez & Selwa, 2003). Sudden convulsive attacks can lead to falls, regardless of the patient's age. However, falls from convulsive attacks are especially problematic for elderly adults because they have weak and brittle bones and they usually bruise easily. Healing of injuries and fractures also takes longer for these elderly adults. Prevention of falls caused by seizures and convulsions may be addressed by treating the underlying condition causing the seizures. Treatment using anticonvulsive medications can help prevent and control seizures, and consequently prevent falls attributed to seizures. Health professionals and caregivers can also help ensure that elderly patients with a history of and tendency for seizures are placed in a room with padded surfaces and without any sharp-edged furniture. Padded or carpeted floors are also advisable for these patients in their hospital rooms and in their homes (Epilepsy Foundation, 2006). These do not prevent falls, but they help reduce injuries and fractures from falls that may result from seizures. Drop Attacks Drop attacks cause elderly adults to fall and injure themselves. These drop attacks may in turn be caused by a possible cardiovascular ailment, carotid sinus hypersensitivity, transient ischemic attacks, and orthostatic hypotension (Draper, 2008). Cardiovascular syncope is a very common cause for drop attacks. Studies have revealed that "cardiovascular disorders are responsible for as many as 77% of patients presenting to Accident and Emergency Departments with unexplained or recurrent falls and falls associated with loss of consciousness" (Davies, et.al., 1991, as quoted by Carey & Potter, 2001). Prevention measures for falls once again are associated with the treatment of the underlying disease. Monitoring is also recommended for elderly adults who have a history of cardiovascular ailments. They are also obliged to undergo laboratory and diagnostic tests in order to properly assess their heart and their physical fitness in general (Beers, et.al., 2005). Visual Disturbance Visual disturbances are often related to the environment of the patient. A cluttered environment can contribute to falls among elderly adults. By the age of 65, one in three people are likely to experience some form of vision-impairing disease. And this vision loss is most likely caused by macular degeneration, glaucoma, cataract, and diabetic retinopathy (Quillen, 1999). These visual disturbances or problems often cause disorientation and confusion to the elderly adult, causing him to fall or to trip over furniture and other objects in his path. To put it simply, he cannot avoid what he cannot see. In order to prevent falls attributed to vision problems, there are various surgical procedures and remedies that may treat the disease causing the vision loss. Laser photocoagulation may treat age-related macular degeneration; medical therapy using beta-adrenergic antagonists, alpha-adrenergic antagonists, parasympathetic agents, and such other related medications can help treat glaucoma; cataract surgery can treat cataract; and laser photocoagulation and intense blood sugar control can help manage diabetic retinopathy (Quillen, 1999). And by removing unnecessary barriers and obstructions in the home of the patient, falls attributed to visual loss can be reduced and even prevented. Lenses that fit their optical needs are also recommended for elderly adults with visual problems (Beers, et.al., 2005). Medication Drugs and medication may also contribute to falls. Drugs that can sometimes lead to falls are: sedative medications, confusion from psychotropic medication, polypharmacy, diuretics (may cause dehydration), vasodilators, ACE inhibitors, tricyclic antidepressants, alpha blockers, beta blockers, and other medications that cause orthostatic hypotension or decreased high blood pressure (Draper, 2008). In order to prevent falls associated with drugs and medications, a switch to other medications which do not cause hypotension is recommended. The dosage of these drugs may also be adjusted based on the patient's tolerance. If there are no alternative drugs that may be used, the physicians and health personnel must remind the patient to take the medication while seated or lying down and they should remind the patient to remain seated after taking such medications. Patient with hip surgery For a patient who has recently undergone hip surgery, falls may be prevented by referring them to a physical therapist or any other health professional who can improve their balance and gait. These health professionals can work with the patient in his home. The physical therapist can come-up with an exercise regimen which is customized to the needs of the hip surgery patient. The therapist can also recommend proper canes and walkers appropriate to the patient's needs. The patient can also take vitamins that can help strengthen and improve his physical fitness and strength. Hip protectors can also be sewn into the undergarments of the patient (Beers, et.al., 2005). In general, falls can also be prevented by correcting environmental hazards; by using the proper footwear (preferably with flat heels and firm midsoles); placing wheelchair adaptations to facilitate transfer (removable foot plates, antitip bars); using removable belts; wedge seating to prevent falls in elderly adults with poor sitting balance or severe weakness; using compliant but not too compliant flooring; instructing patients on proper ways of getting up after falling. Monitoring elderly adults is also important. Through frequent contact with family, friends, and medical personnel, deaths and exacerbated injuries from falls can be prevented (Beers, et.al., 2005). Conclusion Falls in elderly patients can be prevented in a variety of ways. Removing environmental hazards is the primary method of preventing falls. Other ways of preventing falls are based on intrinsic factors which are often related to the patient's illness or disease. By addressing the illness, possible falls resulting from loss of consciousness, seizures, and drop attacks may be prevented. Also by following precautions and proper body mechanics, falls and injuries can be avoided. It is imperative for health professionals to guide the elderly patient, to assist him, and to teach him proper and safe techniques in going about his daily activities. Works Cited Alcohol and Falls (27 March 2005) Aging in Canada. 23 May 2009 http://www.agingincanada.ca/Seniors%20Alcohol/1e7.htm Barnes, M., et.al. (2005) Recovery after stroke. New York: Cambridge University Press Beers, M. et.al. (May 2005) Falls. Merck Manuals. 23 May 2009 http://www.merck.com/mrkshared/mm_geriatrics/sec2/ch20.jsp Beers, M., et.al. (February 2006) Syncope. Merck Manuals. 23 May 2009 http://www.merck.com/mkgr/mmg/sec2/ch18/ch18a.jsp Carey, B. & Potter, J. (2001) Cardiovascular Causes of falls. 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