Nursing management of falls

The management of falls is challenging to the nurse, especially when older individuals expreience
multiple or recurrent falls. In these cases, it is helpful to identify a pattern, if any, to the falling. Similarities
in antecendets that lead to filling or specific symptoms might help identify the underlying cause. The goal
of management are to identify the underlying cause, to reduce the incidence of recurrent falling, and to
prevent serious injury.

Several aids for monitoring and preventing fall are available. The fall diary helps to monitor fall
occurrences, injuries, and patterns. Community-dwelling older patients may use a fall diary to jot down
all the important information that led to the fall, occured during the fall, or folowed the fall. This
information is extremel useful in determining antecendents and consequences of falling. Fall diaries are
inexpensive or may be created by the nurse simply by using a pen, paper, and ruler (Box 12-8).

For institutionalizad older individuals at risk for serious injury frombed or chair falls, the use of
bed or chair alarms help alert the nurse when movement is initiated. A sensor is attached to apatient
attempts to get up, he wire falls f the sensor and signals an alarm. These alarms are noninvasive and do
not restict voluntary movement in any way. The alarm is fairly loud and may startle an older adult, so it is
important to alert the patient and family about the noise to beexpected when the alarm is triggered. In
the corridors of hospitals and nursing facilitias, video surveillance cameras help staff view ambulatory
patients around the corner or in distant areas. These cameras are prohibited, however, in private areas
such as patient rooms because of privacy laws. Other safety aids include safety belts in wheelchairs and
the lap buddy”, which is a soft foam cushion that fit on the patient’s lap and wraps underneath the
armrests f a wheelchair. However, if a patient is unable to remove these device voluntarily, they are
considered restraining devices. If the use of these aids fits the criteria for “restraint” for a particular
patient, then the clinical guidelines for restraint use must be instituted. Health care providers must ensure
that the use of these aids is the least restrictive alternative available for the patient purposeful activity.

Injury epidemiology is the study of the interaction of effects f injury on the host, the environment,
and the gent. The process of aging, along with the effect of disease, results in changes that affect the host.
One aim of injury prevention is to alter factors that impnge on the host by maximizing patient health and
functional status, reducing unnecessary medications, and altering risk-taking behaviors. These combined
efforts will reduce the ris of unintentional injuries. Alterations in environment through the elimination of
enviromental hazards will reduce accidental injuries that occur in older patients’ homes. Improved
technology through research seeks to alter the transfer of energy and thus modify those agent-related
factors contrbuting to injuries in older adults. One such example is the alteration in the transfer of energy
by use of supersoft mats and floor surfaces designed to absorb the impact of a falling body and
redistribute its mass. Thus, when an older patient falls on a special floor surface, the rate of injury is likely
to be lower than on a conveentionl surface.

For all older patients at risk for falls and those at risk for serious injury from a fall, it is advisable
to discuss with them the possibility that falling will result in serious injur and how to reduce the potential
for such injury and how to reduce the potential for such injury. Patients should be given the choice of
reducing moblity to prevent serious injury or continuing ambulation, knowing that the risk of serious injury
is present. Patient autonomy should be promoted and respected; it is the patient’s choice. In instance in
which patients are demented or unable to make informed choices, discussion with the families or
guardians is required. In any event, the goal of the gerontologic nurse is to promote safety.
 Fall and injuryprevention modalities have received much attention in recent years. Evidence
suggests that certain activities that improve flexibility and balace will prevent injury (Agostini, han, &
Tinetti, 2004). It is advisable to follow the recommendations for treating a patient who has fallen.