Introduction
Older adults with dementia especially those in the ages of 65 years and above have been identified as a vulnerable population to falling cases in nursing homes. Falls often lead to serious injuries causing the patient’s disability. According to Miake-Lye, Hempel, Ganz, & Shekelle (2013), “the reported rate of falls in acute care hospitals ranges from 1.3 to 8.9 per 1000 bed-days” (p. 390). Hempel et al. (2013) clarify that many falls are not reported, which makes it difficult to provide the exact numbers to study the problem.
It is remarkable that Miake-Lye et al. (2013) believe that nursing homes remain in the number of the healthcare institutions with the highest falling rates in the patients aged from 65 and older. The falls statistics among the patient with dementia in nursing homes necessitates the establishment of initiatives to prevent the trend. As such, delving into a study that seeks to improve the health of the elderly population concerning fall prevention in Miami would also foster their independence in carrying out their daily life undertakings.
Problem Identification and Significance
The problem of falls in the older adults with dementia remains the complicated issue despite considerable efforts aiming to improve the situation (Karlsson, Vonschewelov, Karlsson, Cöster, & Rosengen, 2013). The complexity of this problem is the mental status of the patients affecting their ability to be aware of the risk of falling (Kelsey, Procter-Gray, Hannan, & Li, 2012). If the patient is not able to evaluate the risks of falling in particular situations, greater responsibility for the problem prevention lies on the staff members. The endpoints of falls for this vulnerable population are the disability and loss of independence (Kelsey et al., 2012).
According to Miake-Lye et al. (2013), “between 30% and 50% of in-facility falls result in injuries” (p. 390). The fall can also have the adverse psychological consequences such as “a fear of falling, anxiety, distress, depression, and reduced physical activity” (Miake-Lye et al., 2013, p. 390).
The issue of patients’ fall in nursing homes has significance for this population heath promotion, health problem related to injuries prevention, and healthcare costs optimization. In addition, the issue has its impact on the staff performance rates because patients’ falls can be stressful and time-consuming for the personnel (Chase, Mann, Wasek, & Arbesman, 2012).
Addressing the issue from the financial point of view, it is important to understand that the healthcare costs resulting from patients’ falls in the nursing homes will likely be uncovered by the insurers (Gschwind et al., 2013). Therefore, these costs will lie at the shoulders of the clients. If the guilt of the staff member assigned to care after the patient who injured oneself as a result of a fall is proved, the court can adopt the decision to charge this specialist with the healthcare costs for treating the consequences of this event.
Proposed Resolution
Prevention Plan Description
Falling Risks Assessments Tools
First of all, the prevention plan is focused on the efficacy of the assessments tools used currently before devising the preventive strategies that would manage the fall issue among the elderly. As such, the effectiveness of the assessment tools that include the Morse Fall Scale, Schmid, STRATIFY, Hendrich I & II, and Get Up and Go among other tools would be evaluated to bolster the preventive initiatives.
The Morse Fall Scale is an assessment tool for measuring the falling risks for the hospitalized patients. This tool is created with the staff nurses needs in mind to help assess the possible falling threats for each particular patient. Based on the acquired results, the nursing specialist can make the prognosis for the patient’s falling risk and create the patient care plan accordingly (Kelsey et al., 2012). However, this tool has its limitations because it is not specific to the needs of every particular care unit.
Schmid is another falling risks evaluation tool that can implement to help the nursing professionals who care after the older patients with dementia. The algorithm and effectiveness of its work are very similar to that one of the Morse Fall Scale.
STRATIFY is a fall risk measurement tool that considers multiple factors while making assessment of the specific threats for each particular patient including current medications and mental status. This tool features moderate degree of specification to the local needs. Therefore, it can implement quite effectively in some institutions, while in others, its efficacy can be low.
Hendrich I & II is a falling risk measurement tool with the high degree of specificity. It focuses on the patient’s mental status and physical capabilities. Since it provides quite precise results, it is popular among the majority of nursing specialists from different backgrounds. However, its negative point is being time-consuming.
Get Up and Go is a simple and concise fall risk test. Though it takes less than a minute to perform, it provides the results with the high degree of accuracy. This assessment tool is often used in Miami nursing homes.
The assessment tools overviewed above will contribute to the problem solution by providing the nursing specialists with the data to identify the most vulnerable patients. Kelsey et al. (2012) support this conclusion by stating that “knowing which people are likely to fall under what circumstances should help prevention efforts by enabling different recommendations to be emphasized to different people” (p. 2149). The data collected with their help will implement at the next stage of the prevention strategy.
Catering Hazardous Situations
The next stage of prevention plan amounts to catering for the standard- and high-risk situations affecting the elderly population as a way of promoting their safety. All members of the healthcare team need to be educated about these situations (Choi & Hector, 2012). They will also engage in regular training sessions organized by the nurse leaders with the objective to increase their falling prevention proficiency when working with the elderly clients having dementia (Merom et al., 2012).
Educational and training sessions will have the main objective to provide every member of the team with essential knowledge and skills to perform one’s role in preventing falls and injuries from falls (Miake-Lye et al., 2013). The staff members should be educated about the following major falling risks “patient age”, “history of a recent fall, mobility impairment, urinary incontinence or frequency, certain medications, and postural hypotension”, “poor lighting”, “uneven flooring or small objects on the floor; suboptimal chair heights; and limited staff availability or skills” (Miake-Lye et al., 2013, p. 390).
Fall Prevention Tips for the Patients
Moreover, besides agitating for the observance of measures that enhance the safety of the care environment, the prevention strategy would also focus on inculcating fall prevention tips among the elderly (Granacher, Gollhofer, Hortobágyi, Kressig, & Muehlbauer, 2013). The patient recommendations will include
- importance of exercise;
- importance of the healthy diet with sufficient vitamins and especially vitamin D;
- importance of regular outdoor walks to stay physically active and have the opportunity to develop vitamin D naturally;
- stick to the prescribed medications and follow the health provider’s recommendations closely to avoid the side effects (Uusi-Rasi et al., 2015).
Other recommendations include keeping the vision sharp and organizing the surrounding space with the potential risks in mind (Uusi-Rasi et al., 2015). Nurses can also make their contribution here by helping the client increase awareness of the possible threats (Uusi-Rasi et al., 2015). Repeated recommendations will be needed before the patient manages to memorize the information about potential dangers (Kelsey et al., 2012).
It is though understandable that the elderly patients having dementia are characterized by the decreased ability to stick to the recommendations due to the cognitive limitations their condition may impose on them. Still, the facts indicate that the prevention programs efficacy rates are higher when they incorporate the patient educational component (Merom et al., 2012). Patient education will also include the use of the printing materials in the areas with the large potential falling risks and the recreational areas often visited by the affected patient category representatives (Uusi-Rasi et al., 2015). Another aspect is educating the family members about the strategies that will help them assist their elderly relative in additional falling risk elimination (Granacher et al., 2013).
Benefits for the Target Population
The nursing homes population will benefit from the suggested prevention plan by the estimated decrease of falls by 20% within the first year of plan implementation. This improvement will in its turn lead to the improved health indicators due to the decrease of the fall-related injuries. Besides, this positive development will affect the overall quality of the patient’s life.
Healthcare System Benefits
The healthcare system benefits will include reduction of the number of serious health issues that result from patient falls and healthcare costs optimization. In addition, the healthcare staff will benefit from the implemented plan by reducing the stress rates due to the patients’ falls and decreasing the workloads by means of eliminating extra care procedures.
Conclusion
In conclusion, the problem of falls in the older patients with dementia in nursing homes is a serious healthcare issue in Miami, Florida. Tackling this issue will help improve the health outcomes for the vulnerable populations, reduce the healthcare costs, and optimize the working process in the healthcare institutions. This project has suggested the intervention that would to a considerable extent combat the factors that undermine the safety and independence of elderly patients and thereby improve their health.
Notably, since palliative and hospice medical services mainly focus on the elderly population, preventing the fall cases in the sector would enhance its efficiency towards attaining the set goals. The offered prevention plan has included the following components: falling risks assessment tools implementation for identification of the vulnerable population, nursing staff training in terms of the situations with the increased falling risk, and providing education to the patients to help them avoid the hazardous situations and strengthen their body to increase falling risks resistance. The estimated outcome of this prevention plan implementation is the decrease of falls by 20% within the first year of plan implementation.
References
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Choi, M., & Hector, M. (2012). Effectiveness of intervention programs in preventing falls: a systematic review of recent 10 years and meta-analysis. Journal of the American Medical Directors Association, 13(2), 188-213.
Granacher, U., Gollhofer, A., Hortobágyi, T., Kressig, R. W., & Muehlbauer, T. (2013). The importance of trunk muscle strength for balance, functional performance, and fall prevention in seniors: a systematic review. Sports medicine, 43(7), 627-641.
Gschwind, Y. J., Kressig, R. W., Lacroix, A., Muehlbauer, T., Pfenninger, B., & Granacher, U. (2013). A best practice fall prevention exercise program to improve balance, strength/power, and psychosocial health in older adults: study protocol for a randomized controlled trial. BMC geriatrics, 13(1), 1-13.
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Kelsey, J. L., Procter-Gray, E., Hannan, M. T., & Li, W. (2012). Heterogeneity of falls among older adults: implications for public health prevention. American Journal Of Public Health, 102(11), 2149-2156.
Merom, D., Pye, V., Macniven, R., van der Ploeg, H., Milat, A., Sherrington, C.,… & Bauman, A. (2012). Prevalence and correlates of participation in fall prevention exercise/physical activity by older adults. Preventive medicine, 55(6), 613-617.
Miake-Lye, I. M., Hempel, S., Ganz, D. A., & Shekelle, P. G. (2013). Inpatient fall prevention programs as a patient safety strategy: a systematic review. Annals Of Internal Medicine, 158(5), 390-396.
Uusi-Rasi, K., Patil, R., Karinkanta, S., Kannus, P., Tokola, K., Lamberg-Allardt, C., & Sievänen, H. (2015). Exercise and vitamin D in fall prevention among older women: a randomized clinical trial. JAMA Internal Medicine, 175(5), 703-711.