Introduction
As the population ages, people can experience an array of health issues that lead to adverse outcomes, both personal and environmental (cultural, financial, legal, ethical, etc.). Despite the large variety of such problems, this paper will analyze the topic of osteoporosis and falls among elderly patients because it affects almost forty-four million adults aged fifty and older (Skarnulis, 2006). The paper will focus on defining this issue, identifying the affected population, describing cultural, legal, financial, and ethical implications, identifying possible interventions, resources, and costs, and analyzing the sustainability of the interventions for the problem of falls and osteoporosis in elderly.
Problem Definition and Population Affected
It has been estimated that more than half of adults aged fifty and older can suffer from osteoporosis and a third of adults aged sixty-five and older can experience falls (Skarnulis, 2006). Twenty to thirty percent of those adults who fall are likely to experience injuries that will decrease their independence and mobility, thus making falls one of the leading causes of injuries within the elderly population (Skarnulis, 2006).
Osteoporosis is a condition that causes brittleness and weakness of bones, making individuals more susceptible to fractures due to falls, bending, or even severe coughing; as a rule, fractures that are related to osteoporosis affect the spine, hip, or wrists (Mayo Clinic Staff, 2016). It is important to mention that bone is living tissue, the cells of which break down and get replaced with new ones. Osteoporosis is a condition that takes place when the creation of new bone cells cannot follow the breaking down of old ones. In general, there are no specific symptoms that can point to the early stages of osteoporosis; however, as bones become more brittle, the following symptoms can appear:
- Issues with posture and loss of height;
- Fractures in bones can occur more easily and regularly than in the past;
- Pain in the back that has been caused by problems in the vertebra (Mayo Clinic Staff, 2016).
When analyzing risk factors that can lead to the development of osteoporosis, there are several categories that both patients and healthcare professionals should take into consideration. Among such categories are unchangeable risks (sex, age, race, etc.), hormone levels, poor diet, medications, accompanying medical conditions, and unhealthy life choices.
Falls are a problem that is more than likely to follow osteoporosis; it is a complex multifactorial issue that needs a careful understanding of the mechanisms involved in it (Al-Aama, 2011). Falls are at the top of the causes of deaths, injuries, and admissions to hospitals among the elderly. Also, seniors are not only prone to falling in general, but they are more likely to develop fall-related issues such as head trauma or broken hips, which are connected to osteoporosis. Most importantly, falls rarely occur due to only one of the mentioned risks; a combination of several factors can often lead to a serious and threatening problem that needs addressing (Sollitto, 2017). Risk factors that lead to the increased possibility of falls in the elderly include the deterioration of physical health and fitness, impaired vision, side effects of medications, chronic diseases (e.g., arthritis, Parkinson’s, Alzheimer’s), surgical interventions, as well as environmental and behavioral hazards.
The population affected by osteoporosis and falls includes older patients aged 50 and over (osteoporosis) and 65 and over (falls). The frequency of falls due to bone weakness can increase with age and the level of frailty (World Health Organization, 2007). It has also been identified that the majority of patients affected by osteoporosis and subsequent complications are women and that older people are more likely to suffer from the condition when they are white or of Asian descent (Mayo Clinic Staff, 2016). Most importantly, the population that lives in nursing homes is far more prone to fall compared to those individuals that live at home.
Financial, Legal, Cultural, and Ethical Implications
The financial impact of osteoporosis and falls is critical to understand. Globally, the adverse effect of falls and their costs increase around the majority of healthcare systems around the world. In the US only, the average cost per instance of a fall in the elderly is $1049 (World Health Organization, 2007). The estimated mean financial impact of fractured bones is $8600, implying the total costs of $14 billion for the US healthcare system (Blume & Curtis, 2011). Approximately half of the patients with osteoporosis receive additional medication treatment, which averages to $500 per one individual ($2 billion across the country) (Blume & Curtis, 2011). Legal implications of osteoporosis and subsequent falls in the elderly are hard to identify due to the prevailing uncertainty regarding appropriate fall prevention standards, the variation of case-specific characteristics that lead to falls, and the attention to preserving the rights of patients regarding the decision-making on their treatment (Balzer, Bremer, Schramm, Luhmann, & Raspe, 2012).
As to the cultural and ethical implications of osteoporosis and subsequent falls in the elderly population, they are hard to identify because factors involved in the issue cannot be quantified. Cultural implications of this problem are yet to be identified. To some extent, there is a social responsibility of younger adults to care for the elderly; however, it can differ from one case to another. Ethical implications of osteoporosis and falls in the elderly relate to the issue of patient safety. If an older patient falls in a hospital or a nursing home, an ethical issue arises regarding the responsibility of healthcare providers because of the requirement to not harm. However, when an older individual falls at his or her home, ethical implications are nearly impossible to formulate because of the overall health status of the individual and whether his or her relatives should be held accountable for failing to prevent the fall from occurring.
Interventions to Address Osteoporosis and Falls in the Elderly
While there are a variety of factors contributing to the development of osteoporosis, interventions targeted at the improvement of physical well-being can be the most effective. To prevent bone fractures that result from falls and osteoporosis, it is recommended to encourage regular exercise. Physical activities are highly likely to increase the strength of bones, their density, and mass, thus making older individuals less prone to developing osteoporosis and avoiding fractures in cases of accidents. Importantly, exercise-focused interventions should not only be introduced to patients with osteoporosis but also adults aged younger than 50 for early prevention and the maintenance of bone strength.
According to the National Institute of Aging (2017), appropriate consumption of vitamins, minerals, and nutrients play a fundamental role in strengthening the bone tissue. For example, calcium has been proven to strengthen bones and teeth; therefore, it is recommended to introduce diet interventions to include foods that contain calcium (e.g., low-fat dairy products, tofu, dark leafy greens, fish, etc.). Importantly, diet interventions should be developed based on patients’ needs due to possible intolerances. In any case, prescribing calcium supplements can be a viable solution; although, it is recommended to get the benefits of this mineral from food.
Available Resources and Associated Costs
Resources available for addressing the issue of falls and osteoporosis among the elderly can be divided into the community and governmental resources. Regarding governmental resources, financial incentives can be introduced to fund campaigns to educate the elderly on the importance of physical activity and dietary interventions to prevent the development of osteoporosis and avoid falls. However, the problem has more potential to be resolved within communities rather than on the national level. Community resources can include volunteers, charity programs, and the overall support of older members of communities in their journeys to achieve better physical health and thus avoid possible accidents. Educational resources with regards to community support are the most important because they can act as tools for disseminating available information to the public to encourage the implementation of diet and exercise-based interventions.
As has been identified previously, one case of a fall of an older adult costs more than $1000. It is possible to reduce the identified sum if the mentioned interventions are implemented successfully. Associated costs related to interventions can range from federal funding to support healthcare facilities (including nursing homes) to charitable donations from stakeholders to community-based organizations that will promote the message of support for older individuals and assist them in overcoming the problem of falls that lead to injuries.
Sustainability of Interventions
Both diet and exercise-oriented interventions can be easily sustained when they are developed by the individual needs of each patient. For example, some patients can be underweight and thus have more chances to experience fractures and bone loss (Mayo Clinic Staff, 2016). This means that interventions targeted at preventing falls and osteoporosis for those patients should be focused on building weight and making them stronger. Some patients, on the other hand, maybe overweight and have an unhealthy diet. This means that interventions for avoiding falls and the destruction of bone matter should be targeted at losing weight and the development of a balanced diet.
It is important to mention that adults aged 65 and older cannot be held entirely accountable for sustaining lifestyle changes associated with the identified interventions. Family nurses, geriatric nurses, healthcare professionals at nursing homes, and family members should combine efforts to support the sustainability of interventions and help the elderly overcome the challenges that come with aging.
Concluding Remarks
The issue of osteoporosis and falls has been persistent and subsequently transformed into one of the most common contributors to deaths and injuries within the elderly population. Key resources for dealing with the problem include community support and government funding to educate older adults and their families on the importance of introducing lifestyle interventions. Diet and exercise-based interventions can become instrumental in reducing the occurrence of falls and osteoporosis. It is important to mention that each patient requires an individualized approach towards such interventions because different factors that are pertinent to each patient can contribute to the problem.
References
Al-Aama, T. (2011). Falls in the elderly: Spectrum and prevention. Canadian Family Physician, 57(7), 771-776.
Balzer, K., Bremer, M., Schramm, S., Luhmann, D., & Raspe, H. (2012). Falls prevention for the elderly. GMS Health Technology Assessment, 8, 1-13.
Blume, S. W., & Curtis, J. (2011). Medical costs of osteoporosis in the elderly Medicare population. Osteoporosis International : A Journal Established as Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 22(6), 1835-1844.
Mayo Clinic Staff. (2016). Osteoporosis: Overview.
National Institute of Aging. (2017). Vitamins and minerals.
Skarnulis, L. (2006). 7 health challenges of aging. Web.
Sollitto, M. (2017). 7 things that cause the elderly to fall.
World Health Organization. (2007). WHO global report on falls prevention in older age. Web.