“DIGNITY. RESPECT.
INDEPENDENCE. These are the top priorities for older people living in Irish
nursing homes.” (Hennessey, 2017)

Over the past few
years nursing homes have become a norm in the aging population in Ireland. Many
people feel it is the only option for the elderly. In some cases, patients may
think they are going for rest bite but never get to see their homes again.
Although it may be hard for these patients it can sometimes be the best option
for their safety and wellbeing. New advances in medical technology have made
these places even safer with different tools to aid the care staff and nurses
on helping patients receive the best standard of care to meet the Health
Service Executive (HSE) guidelines.

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METHODS

Assessing risk
assessment strategies which contribute to the safety of elderly people in
nursing care home environments and how different the common assessment
F.R.A.S.E works.  

 

LITERATURE REVIEW

 “A patient presenting with a fall resulting in
a fracture receives both a falls risk assessment and a fracture risk assessment.” ((HSE), 2008)

“A nursing
home is a place for people who don’t need to be in a hospital but who require
more assistance or treatment than is available at home.” (Homes, 2015)  Majority of elderly people end up in nursing homes
because they may no longer need general hospital care, but still need nursing
and medical care. Others may be unable to look after themselves at home or can
no longer be looked after by their immediate family. “Ireland’s
population is ageing. Today 11% are aged 65 years or over (468,000). Within the
next 25 years this will increase to 18% (to over one million people). The risk
of falling increases with age. One in three older people fall every year and two-thirds
of them fall again within six months. Older people are most likely to suffer
serious injuries, disability, psychological consequences and death following a
fall.” ((HSE), 2008). “Figures made
available at the annual conference of the Irish Society of Chartered
Physiotherapists (ISCP) also revealed that 7,000 people over the age of 65 are
admitted to hospital for the treatment of fall-related injuries each year. This
costed an estimated €402 million” (Condon, 2010). Some of these falls
are due to age, impaired mobility, history of falls, balance issue, medication
and many more problems in elderly people.

What is a risk assessment?

“Risk screening
tools estimate a person’s likelihood of falling. They consider a variety of
clinical factors or domains associated with falling that are relevant to the target
population and the setting such as balance and mobility, functional status, continence,
cognitive status, history of falls, medications. These tools have a scoring
mechanism that can predict the individual’s level of risk at low, medium or
high risk of falling.” (V Welch, 2016). Preventing falls
from happening is a major priority within the health system in many countries.
Risk assessment is an essential part of the risk management process. Assessing
a patient’s risk assessment provides an insight to the type equipment and
prevention strategies needed to prevent as little accidents as possible.
Although, there may be actions implemented to prevent these incidents happening
the patient’s medical conditions and the environment in which surrounds them
can sometimes take effect. “Many methods and programmes to prevent such
injuries already exist, including regular exercise, vitamin D and calcium
supplementation, withdrawal of psychotropic medication, cataract surgery,
professional environment hazard assessment and modification, hip protectors,
and multifactorial preventive programmes for simultaneous assessment and
reduction of many of the predisposing and situational risk factors.” (Prof Pekka Kannus, 2005). While some patients
may be in their right mind within the nursing homes others may be suffering
from Alzheimer’s disease, Dementia, Parkinson’s disease, chronic pulmonary
disease, cancer among other illnesses. For the likes of patients with these
diseases and illnesses the environment in which they are living in at home may
not be safe enough or well-equipped enough for the person/persons to live alone
at home any longer. In these cases, they may end up in nursing homes as a safer
option made by the persons family or by the person themselves.

A common tool used
to assess falls risk is Falls Risk Assessment Score for the Elderly (F.R.A.S.E)
made by Cannard 1996.

Rehabilitation in the environment

“Rehabilitation is
a key concept in the government’s plans to modernise the NHS. Its aim is to
restore a person’s autonomy, although there are sometimes barriers to making
effective rehabilitation a reality, some of which are explored here, along with
ways of helping teams in nursing homes to undertake more effective
rehabilitation.” (Clay, 2001).

When the patient
enters the nursing home they are cared for any pervious illness in which they
will avail of services such as, physiotherapy, rehabilitation, risk assessments,
regular exercise etc. these services help patients to improve their ability to
walk, keep their balance and help to improve their overall physical and mental health.
“Physiotherapy programmes that improve balance and strength are the key
element in preventing and rehabilitating falls and thus ensuring large
healthcare cost savings. Unfortunately, we know that that when people stop
exercise they will return to their base-line mobility and balance within four
weeks. The bottom line here is that the risk of fall increases significantly
once people stop exercising,” (Shumway-Cook,
2010).

“Physical therapy
is treatment that focuses on improving a person’s function, whether it’s related
to bones, joints, muscles or nerves. Typically, a person’s function has been
impaired in some manner because of an injury, wear and tear, or as part of the
aging process. When treating geriatric patients, physical therapists most often
treat functional problems such as pain, balance issues, poor endurance, trouble
walking and poor muscle strength. They also provide patients with therapeutic
programs to retain strength. Occupational therapy is treatment that focuses on
helping a person achieve independence in his or her day-to-day life. Within the
geriatric population, occupational therapists typically focus on a person’s
bathing, dressing, and grooming abilities. Occupational therapists are trained
to identify problems in these areas and make recommendations for improvement.
At times, equipment recommendations are made including rolling walkers, tub
benches, commodes and adaptive eating utensils.” (Jacobs, 2017)

Medical Conditions

Medical conditions
can be a huge factor for risk assessments being produced, these can be in
different forms and each has a specific purpose for each medical condition/
illness. (See Appendices). As the focus of this is on elderly people the main medical
conditions for the elderly people are the focus, these include;

Parkinson’s disease- “Parkinson’s disease (PD) is a neurodegenerative
disorder that affects predominately dopamine-producing (“dopaminergic”) neurons
in a specific area of the brain called substantia nigra.” (Elkouzi, 2017). “As your
Parkinson’s progresses, your posture can change – you may become more stooped
and your muscles may become more rigid. Having muscles that are less flexible
can increase your risk of falling. It’s more difficult for your body to move
and for you to protect yourself if you lose your balance.” (Parkinsons.org.uk, 2013). “Falling and loss
of balance are common problems for people living with Parkinson’s. These
problems develop over time as the condition progresses. For some people falling
may be a daily occurrence and may even occur several times in one day.” (Austrailia, 2015)

Alzheimer’s/Dementia- “Alzheimer’s is the most common form of dementia, a
general term for memory loss and other cognitive abilities serious enough to
interfere with daily life. Alzheimer’s disease accounts for 60 to 80 percent of
dementia cases.” (Association, 2017). “Dementia is an
independent risk factor for falling. Although most falls do not result in
injury, the fact that residents with dementia fall more often than their
counterparts without dementia leaves them with a higher overall risk of sustaining
injurious falls over time. Nursing home residents with dementia should be
considered important candidates for fall-prevention and fall-injury-prevention
strategies.” (Carol van Doorn, 2003)

Arthritis

Arthritis affects
majority of elderly people throughout their lives and can be a huge risk factor
in falling as patient’s mobility is reduced immensely and usually results in
the patients needing walking aids, such as walking stick and frames. In some
cases, if physical therapy begins soon after the diagnosis the speed in which
the disease develops can be slowed. Arthritis is a disease which causes inflammation
of the joints, there are over 100 forms of Arthritis for most sufferers it can
be extremely painful and can impact on their daily lives.

 

Nursing home technology and prevention

Prevention
techniques are becoming more and more important in these environments as
technology is on the rise. Many different initiatives have become available to
prevent these falls happening.  

“Methods of
preventing falls in the elderly have improved greatly over the years, and
technology and fall management strategies in hospitals and nursing homes have
all contributed to improve care of patients, residents and family members at
risk of a fall. One of the main improvements in technology has been to give
carers and nurses “advanced warning” when there is a risk of a fall. This
is commonly when a person at risk of falling leaves their bed or chair. The
latest bed sensor mats and chair sensors are able to alert the carer or nursing
staff or indeed warn the person themselves to stay where they are until
assistance arrives.” (Technologies, 2015)

“Bed Sensors – a
sensor mat is placed under the bed occupant or under the mattress. Sensors
located within the mat identify when the occupant is about to leave the bed and
alerts the carer. The nurse or carer can be notified in a number of ways
including an audible alarm, a radio pager or by connecting to a nurse call
system.

Chair Sensors – as
with the bed sensor only the mat is placed below the chair occupant and are
also use-able in wheel chairs.

PIR Sensors – a
sensor is placed in a particular location, often at exit points of a room or
building. When the sensor beam is broken the carer or nurse is notified as
described under bed sensor.

Additionally,
sensors can be connected to a range of monitors including a friendly voice
reminder – e.g. “stay in bed John, I’m on my way” and can be
programmed to only send an alert when someone does not return to their bed
within a pre-determined time. This feature is particularly helpful for anyone
who regularly visits the bathroom during the night.” (Technologies, 2015)