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.

1. How can Sally determine Angelo’s physical indicators of risk of falls using appropriate tools and methodologies within the scope of her role?
2. How can Sally determine Angelo’s risk factors based on findings in collaboration with a supervisor and/or a relevant health professional? Identify specific health professionals.
3. Identify Angelo’s needs, issues and concerns that may be outside sally’s scope of practice and explain how Sally would refer to an appropriate supervisor, health professional or agency in line with organisation procedures.
4. How can Sally decide how strategies can be tested in collaboration with Angelo?
5. Discuss how strategies can be tested and how success could be measured and communicated with Angelo and the support team.
6. Explain how falls prevention strategies can be implemented, monitored and evaluated in a collaborative, positive and respectful manner.

Answer 1

1. Sally can determine Angelo’s physical indicators of risk of falls using the facility’s risk assessment forms. She can also interview him about his feelings about previous falls, his ambulation, his habits etc. Other than this, she can also talk with his caregiver to determine his physical indicators of risk of falls. She can also determine Angelo’s risk factors based on findings in collaboration with a supervisor and/or other relevant health professionals. She can also assess his gait and balance as a physical indicator of risk of falls.

2. Sally can determine Angelo’s risk factors based on findings in collaboration with the supervisor and/or a relevant health professional by discussing Angelo's issues in their presence and reaching a conclusion with their help. She can also get his medical record copy and find indicators in the record. His medical history, medication, and blood pressure chart can be checked to get pertinent details. Specific health professionals include the patient's GP.

3. Angelo’s needs, issues, and concerns that may be outside Sally’s scope of practice are reducing all risks of falls, to bring back his integrity as a strong man that has been weakened by the falls and make him walk/exercise, prescribe a medication to stop smoking, etc. Sally can ask his son to take him for a health assessment or she can recommend a referral to an appropriate supervisor at the aged care facility in line with organisation procedures.

4. Sally can decide how strategies can be tested in collaboration with Angelo by asking him if he is okay with these strategies. She can also include her supervisor, Angelo's son, his GP etc in decision making. She can also adopt a test and assess policy.

5. Strategies can be tested and success could be measured and communicated with Angelo and the support team using proven methods. These results can be communicated with others through her report or oral communication.

6. Falls prevention strategies can be implemented, monitored, and evaluated in a collaborative, positive, and respectful manner by daily interviews and practice sessions as well as assessments with Angelo and communicating this with his son.