ALL THE KING S MEN Falls Mitigation THE ULTIMATE FALLS REDUCTION BELIEF ANSWERS TO FALLS MITIGATION LIES IN YOUR ABILITY TO LOOK INSIDE OF THE PERSON S REALITY - - - - T SOLELY AT EXTERL THINGS THE GOAL MUST BE TO DETERMINE THE PERSON S GOAL FOR MOVING OR GETTING UP AND THEN HELPING THEM MEET IT. COGNITIVE FUNCTIOL AGE ASSESSMENT ALLEN-Levels www.allen-cognitivelevels.com RCCT www.clocktestrcct.com DEFINITION OF CHALLENGING BEHAVIOR Whose Problem Is it? What is Non-compliance? presented by Diana Waugh MOMENTS IN MIND 4/15/10 Page 1
PLAGUES OF THE ELDERLY Boredom Loneliness Helplessness STRENGTHS OF THE CONFUSED ELDERLY REPETITIVE, N-THINKING BEHAVIORS PHYSICAL ACTIVITY SENSE OF RHYTHM HOARDING LONG TERM MEMORY HUMOR PHYSICAL/EMOTIOL HEALTH CAUSES OF BEHAVIORS ENVIRONMENTAL TASK SPECIFIC COMMUNICATION presented by Diana Waugh MOMENTS IN MIND 4/15/10 Page 2
ASSESSMENT OF BEHAVIORS Eleven W s WHO has the challenge WHAT is the challenge WHY address it WHAT happens before WHERE does it happen WHAT does it mean WHEN does it occur WHAT is the pattern WHO is around when it happens WHAT is the usual outcome WHAT is the desired outcome ABCs Antecedents to Behavior Behavior Consequences presented by Diana Waugh MOMENTS IN MIND 4/15/10 Page 3
SOCIAL ASSESSMENT What does the person like to: See Smell Taste Touch Hear Three stories that make the person happy Three topics/issues that make the person unhappy What do they like to do What is their favorite chair Where do they like to sit Where are they sleeping How long do they sleep Why do they get up presented by Diana Waugh MOMENTS IN MIND 4/15/10 Page 4
MEDICATION REVIEW This form can be used with the health care professionals to review the role of medications in falls. The sections marked Pharmacy can be used for pharmacists input also. MEDICATIONS Person receives one or more of the following medications: Analgesic Antianxiety Agent Anticonvulsant Antidepressant Antihistamines Antihypertensive Antiparkinson Agent Antipsychotic Agent Diuretic Hypoglycemics Muscle Relaxant Nonsteroidal Anti-Inflammatory Sedative/Hypnotic MEDICATION CONSUMPTION ISSUES Has the dosage form changed? Is the person taking the med at different times each day? Is the med being crushed sometimes and not others? Is a non-crushable med being crushed? _ Is the med being given either with food or without food as directed? presented by Diana Waugh MOMENTS IN MIND 4/15/10 Page 5
TIME OF FALL RELATED TO MEDICATION ADMINISTRATION Was a potential causer PRN med taken within the last 12 hours? Are any bedtime meds interfering with sleep, and possibly causing bedtime sedation? Are multiple sedative mediations given at bedtime causing hangover effects at time of fall? What is the peak action time of a suspected med? (Pharmacist) What may be the cumulative effect of the peak action of several meds? (Pharmacist) What are the peak action times of antidiabetic meds? (Pharmacist) What are the blood glucose readings at these peak action times? DOSE CHECK OF NEW MEDS Is this a typical geriatric dose (Pharmacist) If dose is high, was dose gradually achieved? If higher, was size of person taken into consideration? (Pharmacist) _ POST WITHDRAWAL MED EFFECTS _ Was a recently discontinued med stopped abruptly? _ Should the recently discontinued med have been tapered? (Pharmacist) _ Is the side effect of the discontinued med similar to the side effects of a new overlapping med? (Pharmacist) _ presented by Diana Waugh MOMENTS IN MIND 4/15/10 Page 6
VITAL SIGNS Are the blood pressures noted during typical times of incidents? Does the blood pressures fluctuate at different times of the day? Does blood glucose fluctuate during the day? What were blood pressures within a week before fall? If diabetic, what were blood glucose readings one week before the fall? SIDE EFFECTS EVALUATION Is the description of the personʼs condition before the fall clear? Is a suspected med side affect a likely factor? RECOMMENDATIONS Recommend continuation of current med regime? (Pharmacy) Recommend changes to the current med regime as follows: (Pharmacy) _ presented by Diana Waugh MOMENTS IN MIND 4/15/10 Page 7