Workshop 8: Aging Safely: Environmental Modifications to Reduce Fall Risk- Liz Jensen, RN MSN, RN-BC Clinical Director, Direct Supply, Inc. Objectives Review how aging and illness impacts a resident s ability to safely navigate their environment Compare the similarities and differences of environmental safety in a skilled nursing center versus an assisted living residence Explore practical & affordable environmental modifications that have the greatest impact in reducing fall risk. 1
Falls & Older Adults Adults 75 years of age & older experience the highest number of falls Fall rates in long-term care are 3x higher than for residents living at home Frail adults who require increasing assistance with ADLs, have muscle weakness and gait and/or balance disorders are 3-4x more likely to fall. Increasingly fewer differences Skilled Nursing 82% are female More than half are 85 years or older 85% require help with 4-5 ADLs 50% have Alzheimer s or dementia National Care Planning Council Tuesday, April 09, 2013 and AARP Public Policy Institute 601 E St NW, Washington, DC 20049 202-434-3890; Assisted Living 70% are female More than half are 85 or older, just 10% are younger than 65 74% receive help with ADLs, 37% have 3 or more ADL limitations 42% have Alzheimer s or dementia Assisted Living & Residential Care in the United States in 2010; accessed on www.ahcancal.org 2/1/2013 2
A Healthy & Safe Environment Compensates for the normal changes that occur with aging Is adaptable to a resident s changing needs Serves the resident, staff and visitors 3
Unique Considerations Skilled Nursing Increased frailty due to recent hospitalization may impact cognition, safety awareness, strength and balance. Opportunity for frequent staff observation is higher. Navigating a new environment and furnishings Challenges with older physical plants Federal regulations drive more standardization of physical plants, practices Assisted Living Experiencing normal aging, with increasing, but varying need for additional care and services May live alone in an apartment with limited ability for staff to observe Navigating a newer environment, but may have own, familiar furnishings Wide variety of physical plants, limited standardization Normal Aging Aging alone does not equate to disease and illness Age-related changes cannot be reversed but it is possible to compensate for their effects so wellness outcomes are achieved by modifying or eliminating risk factors Miller, C. 2012. Nursing for Wellness in Older Adults, Sixth Ed. Lippincott Williams & Wilkins 4
Functional Consequences Theory Theory for promoting wellness in older adults Helps us understand what normal aging looks like, how to promote independence and wellness and address the negative aspects of aging. Changes with aging are inevitable, but most problems are caused by risk factors Miller, C. 2012. Nursing for Wellness in Older Adults, Sixth Ed. Lippincott Williams & Wilkins Outside Room she will eventually go to Room she is currently in Resident 5
A Place to Start Normal Aging + Risk Factors = Increased Risk for Falls Vision Strength, Balance & Mobility Sleep & Rest Age Related Change Decreased dark adaptation Pupils become smaller Decreased upward gaze Smaller visual field Vision Functional Outcome Increases safety risk w/ lighting changes Decreased ability to adjust to glare Decreases field of vision Increasessafety risk for driving and maneuvering environment Decreased sensitivity of cornea Delayed recognition of injury to eye Decrease in tears Presbyopia Dryness and irritation Decreasedability to focus on near objects and adapt to light 40-50% of older adults in long-term care have a visual impairment e.g., cataracts, macular degeneration, glaucoma, diabetic retinopathy Miller, C. 2012. Nursing for Wellness in Older Adults, Sixth Ed. Lippincott Williams & Wilkins 6
Strength, Balance & Mobility Age Related Change Decrease muscle mass Impact Loss of strength,instability when transferring, walking Degenerative changes in joints Pain, decrease interest in walking Slower response of centralnervous system Affects response time, shifts in balance to avoid falling Osteoporosis Increases risk of fracture Loss of Strength Causes Surgery Illness Obesity Muscle degeneration Osteoporosis Arthritis Injuries Lack of physical exercise Nutritional decline Impact Increased risk for falls Decreased mobility Decreased functional abilities Ability to perform ADLs Increased risk for illness On average, people lose about 30 percent of their strength between ages 50-70 and another 30 percent of what s left, per decade after that. After age 40, most people lose about 1 percent of their lean muscle mass every year. Agin, B., Perkins, S. (2008)Healthy Aging For Dummies. January 2008. 7
Sleep & Rest Age Related Change Decreased amount of time in deep sleep (Stage IV) Increased amount of time in light sleep (StageI & II) Decrease amount of time in REM Impact Loss of physical healing Wakens more easily, difficulty falling back to sleep Loss of psychologically restorative sleep Diminished sleep efficiency More time in bed, but feel less rested Improving sleep quality and quantity reduces the risk for falling Cooke, J., Ancoli-Israel, S. (2011) Normal and abnormal sleep in the elderly. Handbook of Clinical Neurology. Vol. 98 (3rd series) Sleep Disorders Part I Falls will happen Confusion Anticipated Physiologic Fall Stroke Unanticipated Physiologic Fall Unfamiliar surroundings Accidental Fall 8
Intervene to reduce risk Confusion Anticipated Physiologic Fall Stroke Unanticipated Physiologic Fall Unfamiliar surroundings Accidental Fall Outside Room she will eventually go to Room she is currently in Resident 9
Start with the Resident.. Low vision due to cataracts and glaucoma; trouble with bright lights and navigating in a new environment. Wears glasses Recently hospitalized with pneumonia. Weak from inactivity and illness. Using a walker; has shoes & slippers with tread Did not sleep well in the hospital, difficulty sleeping through the night in facility. In a private room, changed to a foam mattress & new pillow Resident focused interventions Shoes with appropriate tread Clothing that doesn t impede movement Support natural routines and navigation routes Walkers and canes set to the correct height Wheelchair size is appropriate, leg supports move for easy access in an out of chair 10
Then, the room she is currently in.. Bedroom, bathroom, kitchen start with the room she is currently in & assess the space based on her risk factors Location of personal items, glasses, walker etc. Furniture fits the resident right height for chairs, bed, toilet seat; grab bars & handrails Color contrast to call cords, floor vs wall, bathroom contrast A Good Night s Sleep Environmental Considerations Quiet hours Noise reduction or elimination Wider bed, softer mattress, quality pillow Temperature adjustments Promote darkness during sleep curtains, light dimmers, use of amber lighting 11
Lighting Considerations for Low Vision 3-4x more light or light sources may be needed Glare reduces brightness differences and impairs contrast sensitivity, making it more difficult to distinguish depth and location Eliminate glare by Controlling the light source o e.g. sunlight, full spectrum lamps; avoid incandescent and halogen Controlling the surface reflecting the glare o e.g. diffuse with curtains, or lampshades Filtering it before it reaches the eye o e.g. tinted glasses Then the rooms she will eventually to go to Bathroom, hallway, dining room, gym take a tour of your community with a fresh perspective Reduce noise with artwork, draperies & furniture Consider seating in natural resting places throughout the community Create clear walking paths and exercise areas to encourage activity, improve strength and balance Consider adding balance assessment equipment to the gym. 12
Flooring & Furniture Considerations with Strength & Balance Concerns Flooring Furniture Be aware of pile heights in carpeting Consider how patterns in tile or laminate are perceived Avoid wax buildup Check for raised thresholds, slippery surfaces, rugs, mats Beds adjusted to appropriate height Chairs with arm rests provide better support when sitting and standing; avoid soft arm rests Firmer seats and a supportive back avoid sitting too far back or low in chair Avoid castors on chairs and tables Outside safety considerations Security systems to monitor exit Doorways / navigating entrance & exit Sidewalks / buckling, edges Patio / navigating furniture Grassy areas / uneven areas Outside seating / benches, chairs, shade Parking lot / potholes, uneven areas 13
Industry Trends Upgrading nurse call and resident monitoring systems Provide more data on resident location, movement and patterns Sleep & Activity Monitoring Resident trends, identifying changes in condition earlier Upgrading gyms, adding fitness and wellness programs to promote physical activity and exercise to improve strength & balance Healthy & Safe Environment Normal Aging Adapting for Risk Factors Resident focused interventions Immediate environment Other environments within community Outside Planning ahead 14
Live Chat with presenters Thursday, September 25 4:00 PM ET This live chat session provides the opportunity to talk with presenters, ask question and share ideas with other participants.. Liz Jensen, RN, MSN, RN-BC Clinical Director Direct Supply ljensen@directs.com 15
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