Question

This week you will be creating an Implementation Plan that will be attached to your final EBP. For the discussion board this week—outline your implementation steps 1-2-3. PICOT: In the elderly population of those aged 65 years or older, how does a fall risk assessment compared to environment modification affect fall rates within seventy-two hours after admission?

Answer 1

Answer :

A fall is any unplanned descent to the floor with or with out injury .

Injury levels can range from  minor to major injuries.

Falls clinical guidelines :

• Ask older adult aboutfalls in the past year .
• Check For balance and gait disturbances .

Intrinsic risk factors :

• Older age
• Cognitive impairment
• Female gender
• Past history of fallfallleg weakness or gait problems
• Foot disorders
• Balance problems
• Hypovitaminosis D
• Pain
• Parkinson's disease
• Stroke
• Arthritis .

Evaluation after a fall:

• Evaluate For acute ,subacute illness with history ,general examination and labs .
• Do orthostatic Bp ,supine and standing .
• Perform DIX - hallhallpike maneuver if history suggests vestibular component .
• Visual acuity screen
• Examine neck ,back ,legs , feet of pain ,deformities ,decreased range of motion ,contractures ,let length discrepancy - measure the distance from the anterior superior iliac spine to the medial malleous
• Assess strength ,tone ,sensation ,co ordination ,station and gait .
• Use a gait assessment tool (For example timed get up and go ) to determine a comfortable gait speed.
• Perform the romberg test to assess postural control and whether the proprioceptive and vestibular systems are functional.
• Perform cognitive screen such as the conistar or MoCA .

Assessing fall risk :

• Determining best tool For hospital is specificity ,sensitivity .
• Evidence demonstrates patient variables that incrwase a patient 's risk For falling :

- age

- mentation

- weak or impaired mobolity

- assistance with toilet needs

- medications : anti convulsants, anti psychotics , benzodiazepins , opiates ,sedatives etc.

Evidence demonstrates environmental variables that increase a patient 's risk For falling :

• Equipment : IV pole , urinary catheter
• Physical hazards in room : poor lighting , lack of handrails in bathroom .
• Poorly anchored rugs
• Clutter .

Sensitivity and specificity of risk assessment tools :

Sensitivity is the ability of fall risk assessment tool to correctly identify a fall risk patient .

Tell you how well the tool can correctly identify patients truly at risk For falling .

Specificity is the ability of a fall risk assessment tool to sreen out patient who are not at risk For falling .