Care Of The Elderly

Published Date: 02 Nov 2017

FACULTY OF HEALTH SCIENCES

B.Sc (HONOURS) NURSING

2011 INTAKE

NUR 2216 CARE OF THE ELDERLY

ASSIGNMENT

JAMIE CARUANA

ID: 391593M

Assignment Title

‘Immobility and Falls are Two Geriatric Giants that are associated with Serious Consequences in Old Age.’

In Light of Relevant Literature Discuss the above Statement.

The human body passes through different stages throughout its lifetime. One process which people pass through continuously is ‘aging’; whereby changes in the musculoskeletal normally occur and unfortunately there is a gradual loss of strength. This, together with other factors, contributes to the increase of immobility and falls in geriatric individuals, and unfortunately may have several consequences and affect the person’s lifestyle (Newman, 1995).

In my assignment I will be discussing the reasons contributing behind the likelihood of falls and immobility in geriatric patients, how the consequences hinder a person’s lifestyle and the management and education nurses should be applying to prevent rigidity and tumbles.

Falls

The World Health Organisation (as cited in Victorian Government Health, 2011) states that a fall may be described as an incident whereby a person involuntary comes to the ground. Balance and movement are controlled through input from sensory systems which send signals to permit adequate musculoskeletal function. In elderly, due to aging, certain medications and illnesses, such systems are affected, thus increasing the risk of a person falling (Ham & Sloane, 1997).

Polypharmacy

This term is generally applied to the use of multiple concurrent medications. Thus the risk of drug interactions increases and may have several undesirable effects. Mechanisms by which drugs could contribute to falling include fluctuations in blood pressure, deficiency in mechanisms responsible for postural reflexes and metabolic changes producing muscular weakness (Ham & Sloane, 1997).

Wooten and Galavis (2005) state that the elderly are more likely to have a combination of chronic disorders, and each condition generally requires a minimum of one medication. Furthermore the individual may have more than one doctor and each health professional may prescribe a different medication to treat the similar symptoms. Nonetheless, drugs are available over the counter and in addition, the older person may also opt to take herbal remedies along with their prescribed drugs.

An elderly person is more sensitive to drugs that affect the central nervous system and long-acting benzodiazepines such as diazepam, can cause several adverse side-effects including confusion and sustained sedation, which in turn increases the risk of falls (Wooten & Galavis, 2005). Newman (1995) also states that certain antidepressants, diuretics and beta-blockers also have the tendency to have confusion as their main side-effect and thus continues to put the elder at risk of falling.

Therefore as nurses it is important that we prevent the possibility of injuries and complications by instructing the patient to use one pharmacy and visit only one physician, where possible and let their doctor know if they are taking any herbal remedies. Moreover, nurses must ensure that medications are taken at the correct time and at the prescribed dosage. Keeping a detailed drug history chart would further ensure accuracy and less reduce the likelihood of prescribing multiple drugs for the same symptoms or conditions (Pervin, 2008).

Vision Impairment

With age, changes in a person’s vision occur, making it more difficult to balance and maintain their centre of gravity. There is a gradual reduction in depth perception, glare tolerance, peripheral vision and acuity. These are commonly affected by cataracts, glaucoma and age-related macular degeneration (Tremblay & Barber, 2005).

Encourage patients to have visit the Ophthalmology clinic regularly in-order to treat and manage certain diseases such as glaucoma and cataracts. Furthermore educate elders and their relatives to use contrast colours to identify objects such as handrails in their area of residence and use safe coloured strips on the first and last steps of staircases to identify an increase or decrease in the ground level (Tremblay & Barber, 2005).

Parkinson’s Disease

It is a chronic progressive disease that most often occurs in people above fifty years old. Its classic symptoms include tremors, postural abnormalities, dyskinesia (inability to control movements) and stiffness (Ham & Sloane, 1997).

Elderly suffering from Parkinson’s disease often have problems with their centre of gravity as it often shits from his or her base of support. Therefore it is very common for such individuals to lose balance whilst standing up from a chair or turning their head whilst talking. Moreover such persons also experience low blood pressure when arising from a supine position which leads to light headedness and contributes to a fall (Loftus, 2009). Studies also show that dyskinesias associated with Parkinson’s diseases inexorably also result in immobility (Ham & Sloane, 1997).

Alzheimer’s Disease

Fillit, Rockwood and Woodhouse (2010) state that Alzheimer’s disease is the most common form of dementia in the elderly. Its symptoms include difficulty in memorizing freshly learnt information, confusion, behavioural changes and trouble with swallowing, speaking and walking. Consequently, such individuals are at a higher risk of falling. Heerema (2012) also adds that elderly suffering from Alzheimer’s disease are more probable to fracture their hip when collapsing, resulting in the need of surgery and immobility.

During the middle and advanced stages of the disease, there is continuity in the weakening of muscle strength, walking and balance. Furthermore, vision is also affected and the individual may misapprehend steps, or changes in floor texture and appearance.

Hemiparesis

The National Stroke Association (2012) describes hemiparesis as weakness on one side of the body. It usually occurs after a patient as suffered a stroke and if the cerebellum is injured, the body’s ability to coordinate movement is affected. Therefore the elderly person may encounter difficulty when carrying out daily life activities due to poor posture, balance and coordination. Moreover, if the person does not carry out the exercises, muscle strength will continue to decline and lead to immobility.

Cervical Spondylosis

The National Health Service (2012) refers to cervical spondylosis as age-related damage to the bones and tissues in the neck. The elder will usually complain of stiffness and headaches. However in some cases, the individual may also have nerve damage and consequently will suffer from pins and needles in the arms and legs, as well as loss of sensation in the hands and legs. As a result, such individuals will experience difficulty when walking and thus are at a higher risk of falling.

As nurses it is important that we educate patients on supporting their neck with an appropriate pillow whilst resting and participate in daily exercises. Furthermore, if their physician has prescribed NSAIDs (Non-steroidal Anti-inflammatory drugs) such as ibuprofen, ensure that they are complying with the correct times and dosage (National Health Service, 2012).

Osteoarthritis

Ham and Sloane (1997) explain that osteoarthritis is a chronic disorder commonly characterized by recurrent restraint of joint motion, distortion and pain. It becomes more common as a person gets older and it is likely that the symptoms are unrecognized by the elder as they are often accepted as typical consequences of aging.

Unfortunately there is no cure for osteoarthritis and it is vital that as health care professionals, one stresses this fact yet encourages the older person that the management offered is focused on the relief of pain and discomfort, and prevention of further regression, as well as maximizing their functional ability (Fillit et al., 2010).

Pharmacological methods include the prescription of NSAIDs and acetaminophen. Side effects of NSAIDs include nausea, dizziness and confusion, therefore it is important that there is continuous assessment to ensure the effectiveness of the treatment and consider whether such drugs may contribute to the incident of a person falling (Fillit et al., 2010).

Non-Pharmacological Management approaches include a range of motion and strengthening exercises, joint preservation techniques and adaptive mobility aids. It is important to ensure that the mobility aids are used correctly and are of the appropriate size because they can in turn precipitate a fall. Moreover, incorrect use may increase joint stress and pain (Fillit et al., 2010).

If the elder is overweight, one must advise weight loss to diminish the load on the joints. Referral to a nutritionist or dietician would help the individual lose weight in a healthy manner (Ham & Sloane, 1997).

When the symptoms of osteoarthritis are at their peak, advise the older person to rest during such periods, however avoid static body positions that exacerbate the discomfort and pain. Nonetheless, complete immobilization should be evaded because it causes deterioration in muscle strength, joint range motion and exercise capacity (Ham & Sloane, 1997).

Rheumatoid Arthritis

Ham and Sloane (1997) state that Rheumatoid Arthritis is a systemic disease characterised by morning stiffness. Different to Osteoarthritis, Rheumatoid Arthritis morning rigidity lasts longer than thirty minutes and is also accompanied by tenderness, swelling and joint distortion. Its management and treatment however, are similar to those in Osteoarthritis; use of mobility aids, motion exercises, rest, NSAIDs and corticosteroids (Fillit et al., 2010).

Post-fall Syndrome

“After the fall comes an equally dangerous syndrome: the fear of falling” (Ham & Sloane, 1997, p. 315). Another factor which may lead to immobility is known as the ‘Post-fall Syndrome’, whereby an older individual becomes fearful of the possibility that he or she may repeat a past fall. This thereby brings about restriction in movement which consequently creates poor stability and increased weakness. The cycle continues by increasing the risk of falling when the person is mobile.

Examination

As nurses it is important to work in collaboration with the interdisciplinary team. As a whole, a holistic assessment should be carried to evaluate why an elder is falling. First, one must take into account a physical examination; blood pressure when the patient is standing, muscle strength and balance, visual acuity, history of disorders and the condition of the feet, as well as appropriate footwear. A full evaluation will permit clear understanding of the causes of falling and thus suggest effective preventive measures (Ham & Sloane, 1997).

Nonetheless, besides a physical examination, the area of residence must also be assessed. Most often, older persons are likely to fall in their homes as the hazards are not recognized until the individual has collapsed (Newman, 1995).

Fillit et al. (2010) also state that it is important to examine the psychological and emotional aspect of the elder. Their study shows that older people living alone or are less sociable and need home repairs, are more likely to fall. On the other hand, married elders or those engaging in social activities and have lived in the same residence for more than five years, if an accident had occurred, they were less likely to become immobile and often complied to exercise treatment.

Having completed a proper examination, relative interventions may be taken into account. For example adequate home lighting, safe corridors, assistive devices, regular eye check-ups, proper shoes and clothing, regular foot care, exercise programmes, and adjustment and compliance to medications (Fillit et al., 2010).

Exercise for the Older Person

Exercise is very beneficial to older individuals with gait disorders such as Parkinson’s, Alzheimer’s and Arthritis. One does not have to run a marathon, however walking three to five times weekly helps the individual establish their ideal weight, as well as move their joints so as to prevent further rigidity (Ham & Sloane, 1997). It also gives them more independence in their care and preserves their dignity and self-esteem. Nonetheless it continues to prevent injury by reducing the risk of falling (Newman, 1995).

Resistance training is efficient to aid in upper body strength. This can be performed in water; the sea or a pool, as it provides an excellent medium for permitting movement with little impact on bones and joints (Ham & Sloane, 1997).

It is important that as nurses we coordinate with the physiotherapists to ensure that relevant information is being given to the patient and we clarify and encourage what the physiotherapists are teaching the patient. This will increase compliancy and the patient does not receive different instructions which would confuse him or her (Fillit et al., 2010).

Mobility Aids

Assistive devices are useful to decrease the load and exertion on the lower extremities, as well as provide support and reassurance to the individual. To some elders, walkers and canes symbolize fragility and ill-health. It is essential that nurses explain and encourage individuals that such aids enable them to be more independent. Such reinforcement would empower them and increase their confidence. However as explained previously, such aids may increase the possibility of a fall if not used correctly, therefore education is needed to ensure that the mobility utility does not become a hazard (Ham & Sloane, 1997).

Immobility

Ham and Sloane (1997) describe immobility as the result of gait disorders, falling and lack of self-confidence. Unfortunately, there are several consequences to immobility; some can be severe, permanent and life-threatening. Such consequences include stiffness, decrease in muscle strength, institutionalization, loss of confidence, depression, malnutrition, electrolyte imbalance, osteoporosis, hypothermia, pneumonia, pressure sores, deep vein thrombosis, urinary incontinence and constipation.

Malnutrition

Failure to meet the body’s requirements has undesirable side-effects but with an older, immobile person, the adverse effects are more serious and severe. Malnutrition increases the risk for pressure ulcers, constipation, infection, dehydration and electrolyte abnormalities (Ham & Sloane, 1997).

Deep Vein Thrombosis

Fillit et al. (2010) states that deep vein thrombosis is more common in immobile patients due to the slow momentum of the blood. Therefore it is common for a blood to clot in veins in the legs, however the clots may dislodge and create a further complication known as pulmonary embolism; whereby the thrombus becomes clogged in one of the blood vessels situated inside the lungs.

Hence it is beneficial that nurses encourage movement to prevent a thrombus from forming and if mobility cannot be fully achieved, physicians may prescribe an anti-thrombotic such as Clexane (Fillit et al., 2010).

Pressure Ulcers

Immobility is the greatest risk factor for bed sores. The immobilized elder will be unable to shift their position and so force will be created on the same areas for a long period of time (Fillit et al., 2010).

Examining high-risk skin areas daily such as the heels and sacrum would help increase early detection and prevent further damage to tissues. It is important to encourage frequent body repositioning and the use of anti-pressure devices. Instruct the patient and relatives to consume adequate nutrition to help prevent the presence of sores (Ham & Sloane, 1997).

Urinary Tract Infections

Urinary tract infections are common in immobile patients and may occur due to poor perineal hygiene, bladder retention, malnutrition and diabetes (Ham & Sloane, 1997). Therefore it is important such infections are prevented by encouraging fluids, ensure that relatives check on the elder and assist with a bedpan; to prevent retention. It is also beneficial to encourage the individual to get out of bed and use the bathroom or bedside commode when possible. Moreover, if the older immobile person has a catheter, ensure that the correct hygiene precautions are taken. If the person lives in their own residence, educate relatives how to empty the urine bag and how to clean the catheter and meatus (Schoen, 2000).

Depression

Remaining in the same room and not being able to carry out certain activities may be embarrassing and demoralizing. The immobile elderly individual will feel as if they are incapable to do anything and that there life is over. Furthermore depression creates headaches and intensifies any pain. Therefore it is important that health care professionals to only aim at comforting the patient and reducing the severity of the symptoms but also to restore the older person’s ability to lead to a productive life (Fillit et. al., 2010).

Orthostatic Hypotension

Immobility also increases the rate of orthostatic hypotension by reducing the heart rate, stroke volume and cardiac output. The best nursing intervention is to help the patient prop up to an upright sitting position (Ham & Sloane, 1997). Furthermore, the Cleveland Clinic (2009) suggests elderly to drink more fluids, wear compression stockings to aid with blood circulation and encourages individuals to perform isometric exercises such as squeezing a towel in their hands every so often.

Conclusion

Having researched about the consequences and causes of falls and immobility, I have understood the importance of preventing recurrent episodes of falls and the vitality to avoid complete immobility. As nurses we serve an important role to reinforce information given by other members of the multidisciplinary team, encourage and support individuals and their relatives in order to increase the willingness to comply and participate. As a result, the elderly may resume activities of daily living and feel more independent.

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