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Falls are defined as a situation when a person is inadvertently lying on the ground, floor, or any other place. Injuries related to falls could be fatal but most of these injuries are nonlethal in spite of the fact that they bring plenty of sufferings to the patient. This paper investigates falls among hospice patients in Miami, Florida and suggests some prevention solutions that are crucial for the current situation. According to the official statistics, nearly 40percent of older adults fall at least once a year (Yamashita, Noe, & Bailer, 2012).
Moreover, every fourth fall results in the injury. Five percent of falls end in fractures and the same percent in serious tissue injuries. Falls occupy a sixth place among the causes of death of older people in hospice (Avin et al., 2015). Among people aged 85 years, over 20 percent of deaths occur due to falls.
The consequences of falls such as a fracture of the femoral neck and the fear of falling could lead to loss of the ability of the self-service. Falls cannot be regarded as accidental and inevitable events. They should try to prevent it. The current measures that include engaging hospice patients in strengthening exercises and minimizing the use of dizziness-inducing medications offer no concrete solution to falling cases. Additionally, the weak status of the hospices makes the strengthening processes stressful thereby necessitating the introduction of more suitable strategies (Gray, 2007). Hospice patients safety system begins with the fact that high quality and realistic reporting explains the necessity of changes that should be done in order to reduce the incidence of falls.
Problem Identification and Significance
The majority of hospice patients are elderly people: eighty-five percent of all hospice patients admitted were age 65 or older (Report of Hospice Demographic and Outcome Measures, 2014, p. 18). Therefore, it seems appropriate to identify this group of patients. A person could maintain balance and move only in the case of the combined interaction of cognitive and sensory organs, the neuromuscular system, and the cardiovascular system.
They provide the ability to respond quickly to the changing environment. With age, this ability to maintain balance is weakening. The incidence of falls among the elderly living in hospices is much higher than among people living at home. It should be noted that the majority of falls end with minor injuries, bruises, minor bleeding, or mild pain.
However, there are cases of falling that might result in hip fracture, severe brain injury, and other severe consequences for elderly people over 65 years. Therefore, there is a need for mitigating the risks that lead to falls among hospice patients in Miami, Florida owing to the nature of their conditions. The plan for reducing the fall cases would embrace an evidence-based practice that would bolster the safety of patients in the hospice atmospheres. In this concern, the strategy would add value in the area due to the limited research in the fields of hospice especially regarding fall cases.
Risk Factors
It is also very important to point out the fact that risk factors of falling should be evaluated individually for each patient taking concrete measures suitable for the patients requirements to prevent falling. Moreover, it is significant to improve the management of patients taking into account all possible risks and developing personal recommendations for the prevention of falls. When it comes to terminally ill patients, the hospice should be the most protected and prepared place for the danger of that kind. In other words, the hospice staff should protect their patients, especially the elderly from falling.
First of all, among risk factors, there is the age of hospice patients. Age is one of the major risk factors of falls in the hospice as the majority of patients are elderly people. The risk of falls and incidences connected with it is increasing with age. For instance, in the United States, 20-30 percent of the elderly fall survivors suffer from moderate or severe injuries such as bruises, fractures of the femoral neck, or head trauma (Markey, 2007).
This risk might be partially connected with bodily, cognitive, and sensory changes occurring along with the aging process. The next risk factor is sex. In all age groups, both sexes are exposed to the risk of falling. In some cases, men are more likely to die from falls while women suffer more from non-fatal falls. As a matter of fact, women fall more often than men do, and they have a much higher likelihood of fractures as a result of falls. Other factors include the following aspects:
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concomitant medical conditions such as neurological, cardiac, or other restrictive state functions;
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adverse reactions to drugs, physical inactivity, and loss of balance, especially among the elderly;
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low level of mobility, cognitive, and vision abilities;
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unsafe environmental conditions, particularly for people with vestibular apparatus disorders and poor vision.
In addition, another high-risk group is children. Falls in childhood occur mainly because of the behavior of children, their inherent curiosity in relation to the world around them, and increasing levels of independence that accompanies intricate behavior often referred to as risky .
Proposed Resolution
Strategies for the prevention of falls should be widespread and diversified. They should emphasize the importance of various prevention strategies by means of assessing several types of falls risks that might appear in the hospice. What is more, they should eliminate potential hazards and raise awareness of individuals and communities of existing risk factors.
Efficient programs to prevent falls are directed at reducing the number of falls, and the rigorousness of trauma in the case of falls. With regard to the elderly, the falling prevention program might include a number of components to identify and mitigate risks such as the following:
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clinical interventions to identify risk factors such as checking and changing health regulations, treatment of low blood pressure, the additional appointment of vitamin D and calcium, and treatment of correctable visual impairment;
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appointment of appropriate assistive devices in the presence of physical and sensory impairments;
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muscle strengthening and restoration of vestibular function on the requirements of health professionals;
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group exercises at the level of individual communities, which may include the area of fall prevention training and exercises such as tai chi or training in the field of conservation and development of the dynamic equilibrium;
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the use of special protective devices for hip among people at risk of hip fracture as a result of falls (Yamashita, Noe, & Bailer, 2012).
In the framework of falls prevention and patients care, a staff training program could be initiated. In most cases, patients who could fall were considered elderly adult patients, but this is not always true. Sometimes, there are cases of children or young people falls. Therefore, it seems important and appropriate to develop a training program to assist patients of any age with incurable diseases. Besides fostering patients safety and reducing the cost of providing hospice services, the study would also improve the quality of life (QOL) among the patients (Schonwetter, Kim, Kirby, Martin, & Henderson, 2010).
In all likelihood, effective fall prevention measures should be carried out in the close connection with other activities as an integral component of general programs aimed at palliative measures among hospice patients. However, the effective integration is possible only in the case when the outset is taken into account with the impact of specific measures to prevent injuries on the overall performance health of the elderly (Schonwetter, Kim, Henderson, & Martin, 2009).
Fall prevention strategy should be developed in parallel with more common strategies. It is necessary to clearly define the functions of numerous health professionals and institutions providing care for hospice patients. Successful implementation of individualized fall prevention programs is impossible without the participation of geriatricians and physical therapists who specialize in the corresponding area (Vieira et al., 2012).
Moreover, exercise is an important part of comprehensive fall prevention programs (Dyer, 2007). However, engaging professional exercise instructors is one of the conditions of the successful implementation of programs and the achievement of the long-term prophylactic effect. As a consequence, specialized training of personnel working with hospice patients is the key to safe and good practice and patients well-being.
Consequences of Falls among Hospice Patients
It is also worth turning ones attention to the dissemination of information regarding the effects of falls among hospice patients. Fractures that occur because of falls are the result of the interaction of internal and external factors. It goes without saying that the majority of falls of the elderly hospice patients is not associated with loss of consciousness and is not the result of emergency external influence. In its turn, aging becomes the decisive component.
If at a younger age, people often fall in the anterior-posterior direction, the older groups most typically fall to one side. In the context of the age-related decline of the soft tissue, mass in buttocks and thighs with a dropkick to the direction of trochanter explain a significant acceleration of hip fractures of people over 75 years. If vertebral fractures could occur spontaneously and are true osteoporotic , then a combination of falling and reduction of bone strength cause the peripheral skeletal fractures (for example, proximal femur, humerus, and distal forearm).
This combination of mechanisms requires a comprehensive diagnostic and therapeutic approach taking into account both bone strength and the risk of falling (Sperling, Neal, Hales, Adams, & Frey, 2005). Besides, the consequences of falls for some individuals are cumulated. The basis for the successful prevention of fractures should be a strategy stratification of elderly people in terms of risk of falling.
Conclusion
In conclusion, it should be stressed that fall prevention among hospice patients in Miami, Florida is very important, as it would lead to better living conditions. In spite of the fact that exercising and review of medication do not resolve the situation, it is significant to develop falls prevention measures by means of special staff training or creating an individual plan.
References
Avin, K. G., Hanke, T. A., Kirk-Sanchez, N., Mcdonough, C. M., Shubert, T. E., Hardage, J., & Hartley, G. (2015). Management of Falls in Community-Dwelling Older Adults: Clinical Guidance Statement From the Academy of Geriatric Physical Therapy of the American Physical Therapy Association. Physical Therapy, 95(6), 815-834. Web.
Dyer, O. (2007). Simple precautionary measures can reduce numbers of falls in hospital. BMJ, 334(7591), 447-447. Web.
Gray, J. (2007). Protecting hospice patients: A new look at falls prevention. American Journal of Hospice and Palliative Medicine, 24(3), 242-247. Web.
Markey, C. (2007). Unacceptable Risks. Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional, 25(3), 224. Web.
Report of Hospice Demographic and Outcome Measures. (2014). Web.
Schonwetter, R., Kim, S., Henderson,, I., & Martin, B. (2009). Prospective Study of Falls Among Hospice Patients Using Logistic Regression Modeling Technique (415-C). Journal of Pain and Symptom Management, 37(3), 503-504. Web.
Schonwetter, R. S., Kim, S., Kirby, J., Martin, B., & Henderson, I. (2010). Etiology of falls among cognitively intact hospice patients. Journal of Palliative Medicine, 13(11), 1353-1363. Web.
Sperling, S., Neal, K., Hales, K., Adams, D., & Frey, D. (2005). A Quality Improvement Project to Reduce Falls and Improve Medication Management. Home Health Care Services Quarterly, 24(1-2), 13-28. Web.
Vieira, E. R., Berean, C., Paches, D., Caveny, P., Yuen, D., Ballash, L., & Freund-Heritage, R. (2012). Reducing falls among geriatric rehabilitation patients: A controlled clinical trial. Clinical Rehabilitation, 27(4), 325-335. Web.
Yamashita, T., Noe, D. A., & Bailer, A. J. (2012). Risk Factors of Falls in Community-Dwelling Older Adults: Logistic Regression Tree Analysis. The Gerontologist, 52(6), 822-832. Web.
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