Question

(Implement falls prevention strategies)

Case study  

Sally is preparing a falls prevention strategy for Angelo, who she supports in an aged care facility. Angelo is 86, and had two mini strokes that caused him to fall in the past. One fall caused Angelo a minor head injury, and he was momentarily concussed. Both times, Angelo was unable to get up on his own. Angelo is frightened of falling again, so avoids walking around unnecessarily.

Sally wants to encourage Angelo to live independently and safely. Sally uses the facility’s risk assessment forms to assess Angelo’s risk of falling, and has organised Angelo’s carer (his son, Michael) to also be present for the assessment process.

During assessment, Sally interviews Angelo about his feelings about previous falls. Angelo is embarrassed, and doesn’t want to talk about it. When Sally talks to Angelo’s son, Michael, about the falls, Michael says Angelo feels his integrity as a strong man has been weakened by the falls.

Sally in concerned because the falls mean that Angelo refuses to walk unless he really has to. He is not going outside for exercise, and avoids stairs or any uneven surfaces, which limits the activities he can do.

Sally is also concerned that Angelo smokes heavily. She does not know if this increases Angelo’s risk of stroke, but she is worried about his health in general. Angelo also has a poor diet. He doesn't’ eat many vegetables or diary, but eats a lot of sweet food, like pastries.

Sally organises a meeting with Angelo, Michael, two other workers and her supervisor to discuss and plan the falls prevention strategy for Angelo. The meeting runs for an hour. Sally brings Angelo’s medical history, his medication and blood pressure chart. She also brings a letter of recommendation from Angelo’s GP, which recommends that Angelo decrease his cigarette consumption as it increases the risk of stroke.

Sally and Angelo’s care team decide to use the following strategies to monitor the success of the falls prevention strategy:

• Interviewing Angelo formally every week and informally daily about strategies
• Reviewing incident reports
• Calling a weekly meeting with the team to discuss
• Reviewing Angelo’s falls diary every day

After one month, the following had occurred:

• Angelo nearly slipped and fell when using stairs to access a new physical activity on the lawn.
• Angelo nearly fell when tripping over a fallen branch in the garden.
• Angelo did not decrease his cigarette intake.
• Angelo did not regularly take vitamin D supplements.

1) What  should Sally consider when completing, maintaining and storing all relevant documentation and reports about Angelo?

3) Identify when and why strategies are not having the desired result and any indicators of increased risk.

2) Why should Sally share and celebrate any positive results with Angelo, Michael, other workers, her supervisor or health professionals as appropriate?

4)Determine future strategies and actions, including referral to other services.

Answer 1

Answers:

1. Sally should consider all the aspects regarding Mr. Angelo's personal and medical history and other activites. Sally considered that Angelo is very depressed and embarrased about his previous falls. The previous falls make him frightened and cretes feelings of fall again when walking or doing physical activites. Documentation for Angelo's case history includes the anxiety and frightening of previous fall incident, he is refused to walk, going outside for exercise, avoid stairs and surfaces. Sally should also concerned about his heavy smoking. Sally should must noted that Angelo has had two mini strokes and this habit of smoking causes dangerous for Angelo's life. Sally also considered about Angelo's poor diet including avoiding of vegetables. Sally also concerned about his consuming of sweet foods and pastries, that can cause contraindications to his health.

2. The strategies that Sally planned has not come in desired result. This happens because of noncoperation and fear of Angelo about his previous falls. Mr. Angelo was not interested to talk with Sally regarding his previous falls. This creates lack of communication between Sally and Angelo. This makes negative feedback in strategies and results become not better. Regarding Angelo, indicators of risk is chance of multiple strokes. Smoking, avoid appropriate physical exercises and poor diet makes him high risk of strokes and cardiac attacks.

3. Sally organized an assessment interview with Angelo, but the effect become not good due to noncooperation from Angelo. Angelo is not interseted to talk his previous fall episodes because of his fear. According to his son's statements regarding the previous falls, that Angelo feels his integrity as a strong man has been weekened by the falls. Also Angelo was not ready to decrease smoking and not taking appropriate vitamins.

4. Future strategies and actions: Psychological counselling for Angelo is better step for reducing fear and anxiety from previous falls. Counselling provides mental strength and overcomes fear and anxiety. This will also help him walking and doing other physical exercises without fear. Cessasation of smoking is also planned by other counselling program. Support from all family members will help him healthy diet and happiness in mind. Also referral to Psychiatrist consultation and physiotherapy consultation help him better to clear his doubts. Arrange Angelon to participate various activities like playing simple games, cultural programs, music and other entertainment activities, etc. This gives him more enthusiastic, motivation, and free from fear and anxiety. This helps Angelon to turn back into strong man.