Issues in Healthy Aging: The role of the Nurse Falls have become very common with older adults living in the community and long-term care facilities. The purpose of this paper is to research an issue, in this case falls, that impacts the healthy aging of older adults living in the community. This paper will discuss why this topic is important to healthy aging, what the nurse’s role is and what some interventions are to try and lower the rate and risk of falls that the older adult experiences. Falls can have a devastating effect on the older adult and it is important to do everything possible to try and make sure this does not happen. As one ages, his/her bones and muscles may begin to atrophy and his/her gait changes which can all increase his/her risk for a fall. It is important because having a fall and possibly an injury could completely change how an older adult lives his/her life. There are many statistics on how prevalent falls are in the society of today’s older adult. According to the Canadian Institute of Health Research (2005), “among older adults, falls are the leading cause of injury deaths and the most common cause of nonfatal injuries and hospital admissions for trauma” (as cited in Theris, Kathleen, Veronique and Lynn, 2012, p. 188). Also, according to Manitoba Health (2005), older adults, those over the age of 65, have a nine times greater chance of a fall injury than those who are not (as cited in Butler-Jones, 2009). According to Cumming (2000), falls do not only have a physical effect on an older adult, they can also lead to a loss in confidence and decrease in his/her activities (as cited in Public Health Agency of Canada [PHAC], 2009). Hip fractures, according to Tinetti and Williams (1997), can also have a large effect on the older adult, and falls account for 90% of hip fractures (as cited in PHAC, 2009). According to PHAC (2005), Canadians older than 65 have approximately 180 000 falls every year that result in an injury (as cited in Theris, Kathleen, Veronique and Lynn, 2012). Falls affect many older Canadian adults and they need to be reduced to increase the quality of life of the older adult. Falls affect a large number of Canadians every year in many different ways. For one, falling can lead to many other health problems, such as a pressure ulcer if a fall causes someone to become immobile. Also if a fall compromises an older adults mobility, he/she may not be able to do the activities he/she enjoyed before and also may not be able to be as physically active. In addition, if someone has a fall and is unable to get up to reach a phone and lives alone, they may not be able to get help. A fall could also affect the spirituality of a person if they are no longer able to attend services due to their injury. A fall can affect an older adult in many different aspects of their life. My client is at a very high risk for falls and scored a 75 on the Morse Fall Scale. This has affected her physically, as she has fallen before doing physiotherapy and will no longer do any leg exercises while she is standing. Because of this, my client also very rarely leaves her room and does not go to the activities that are provided by the long-term care center and does not socialize with others, which is not good for her overall health as well as her mental and psychological health. My client is also Roman Catholic and likes to attend the services that are offered at her long-term care center, however, if her next fall causes more injury, she may not be able to attend these anymore which could affect her spiritual health. Falls are affecting my client as well as many other Canadians in many aspects of their lives. The nurse plays a very important role in reducing the rate of falls for his/her clients. The nurse’s number one focus should be the client; to support, listen and educate them. Referring specifically to falls, nurses need to assess clients homes to see if there are dangers in the homes that could cause a fall as well as educating the clients on what changes need to be made to their homes and resources that they could utilize to do so. They also need to look at the medications a client is taking, know the side effects of these medications, if there are any dangers in any of the medications being taken together, as well as ensuring the client is taking the lowest possible dosage that will be effective. The nurse must also research the best evidence of the most effective exercises in reducing the client’s rate of falls. There are a number of barriers and challenges that nurses face when dealing with the issue of falls. Some barriers and challenges that the nurse might have are, that the nurse most likely does not assess a client’s home until there has been a fall and the client may not want to leave his/her home but he/she may have to because it is unsafe. Also, the clients may not know what medications they may be, they are on medications that are causing them to fall and they are unwilling to participate in physical activity, possibly because they do not know what activities to do. There are many College of Nurses of Ontario (CNO) Standards and Guidelines that support the role of the nurse. One standard is on medication; it informs the nurse step by step how to administer medication to clients through assessment, planning, implementation and evaluation (CNO, 2011). Another standard is restraints; the nurse should not automatically place a client in a long-term care center because his/her home is unsafe, they should first try and make the home as safe as possible. Also, if a client is at risk for falls, the nurse should not put all the bed rails up and keep the client confined in his/her bed, they should place the bed at the lowest height possible or put a mattress on the floor in case they do fall (CNO, 2009). There is also a CNO Standard on decisions, which contains a decision tree to help nurses make the best decisions (CNO, 2011). Another standard is the therapeutic nurse-client relationship; it is important for nurses to have this relationship with clients so they trust the nurse’s decisions and recommendations regarding their home, medication and exercise changes (CNO, 2009). Lastly, the guideline on working with unregulated care providers also supports the nurse when they are working with others such as those who are helping clients with their exercises or those who are installing safety items in a client’s home (CNO, 2011). Nurses have a great deal of support within their profession. There are many changes that can be made to reduce the rate and risk of an older adult falling. Firstly, a client’s home can pose many dangers to the possibility of a fall. As many older adults are still living in the community, it is important to make changes in their homes to reduce their risk of a fall. A few of the many changes that can be made to a client’s home are installing grab bars in the bathroom, elevating the toilet seats, using curtains instead of doors, removing the wheels from beds, getting rid a scatter rugs, increasing the lighting with more brightness and night lights, moving commonly used items to more reachable areas, having no cords lying around the floor, having no moving chairs, installing a hand rail or stair lift on the stairs, and getting a remote controlled thermostat and door lock (Theris, Kathleen, Veronique and Lynn, 2012). Doing all this would address the barrier of clients not wanting to leave their home. If their home is not safe, they may need to move to a long-term care center, but if these changes are made, they can stay in their own home. Altering the home is one change that can be made to reduce a client’s risk of falling. Another change that can be made is to have a client participate in physical activity and balance training. According to Gillespie, “a systematic review found that exercise is an effective intervention to reduce the risk and rate of falls” (as cited in Molla and Sandeep, 2011, para. 8). Also, a variety of exercises such as, gait, balance, strength, endurance and resistance training, Thai Chi, square stepping and walking have been proven to decrease the rate and risk of falling in older adults (as cited in Moola and Sandeep, 2011). According to Campbell et al. (1997), there was an intervention that involved many of these forms of exercises that resulted in a 31% reduction of falls (as cited in Rose and Debra 2008). The barrier that this intervention would help with would be a client not knowing what exercises to do; the nurse can either show them the exercises or find a place that has these activities for older adults. Physical activity is vitally important to protect clients from falls. A third intervention to reduce the rate and risk of falls in older adults is reviewing the medications a client is on as well as administering him/her Vitamin D. The Registered Nurses’ Association of Ontario (RNAO) best practice guideline for Prevention of Falls and Fall Injuries in the Older Adult, states how reviewing medication can reduce falls in the older adult (RNAO, 2011). It also says, “tricyclic antidepressants, selective serotonin-reuptake inhibitors, and trazodone were found to double fall rates and this rate increase had a dose-response relationship” (RNAO, 2011, p. 26). Also, the amount of medications that are being taken by a client, if taking more than five, increases the rate of falls (RNAO, 2011). In addition, according to Bischoff et al. (2003) “there is evidence to suggest that Vitamin D supplementation can reduce a person’s risk for falls” (as cited in RNAO, 2011, .28). The barriers that this intervention addresses is the client being on medications that cause them to fall; they should be taken off theses medications if at all possible and the nurse not knowing the effects of these medications, which would be solved by them doing a medication review. It is important for the medications of older adults to be reviewed and for them to take vitamin D. See Appendix A for search terms.

It is imperative that nurses take action to reduce the rate and risk of falls for older adults, as it is common and can have a large impact. Nurses should be getting into the homes of older adults to assess what the dangers are and what should be modified in the house, not only after someone in the home has a fall, but before, so that they do not even have a first fall. Clients, especially those who are on a large number of medications, do not know always know what they are taking, what it is for and what the side effects are, particularly those who have dementia or memory loss. This is why it is important for nurses to have this knowledge for their clients, so that they can deal with it if there is a problem, such as it is causing them to fall, or they can educate their clients about their medication(s). Nurses should also be getting their clients involved in physical activity and exercise to help reduce their risk of falling. The nurse can first handedly assist the client with exercising, or he/she can find resources for the client on where he/she can go for group-exercise, transportation to get there or possibly even someone that comes to the home to assist the client with physical activity. Nurses are involved in many aspects of assisting a client with decreasing his/her rate and risk of falling. All these interventions on their own can make a difference in reducing a client’s risk of falling, but using all these interventions together can have a large impact.

This paper discussed multiple ways for nurses to intervene on reducing the amount and possibility of older adults having a fall or an injury related to a fall. The issue, falls in the older adult, is extremely prevalent in today’s society and it needs to be addressed and taken care of. One single fall can have a severe effect on the way that an older adult lives his/her life and can have a devastating effect on his/her health in many different aspects. Therefore, it is vitally important to have a reduction in falls with the older adult to better his/her quality of life and overall health.

References
College of Nurses of Ontario (CNO). (2011). Practice guideline: Working with unregulated care providers. Retrieved form http://www.cno.org/Global/docs/prac/41014_workingucp.pdf
College of Nurses of Ontario (CNO). (2011). Standards of practice: Decisions about procedures and authority. Retrieved from http://www.cno.org/Global/docs/prac/41071_Decisions.pdf
College of Nurses of Ontario (CNO). (2011). Standards of practice: Medications. Retrieved from http://www.cno.org/Global/docs/prac/41007_Medication.pdf
College of Nurses of Ontario (CNO). (2009). Standards of practice: Restraints. Retrieved from http://www.cno.org/Global/docs/prac/41043_Restraints.pdf
College of Nurses of Ontario (CNO). (2009). Standards of practice: Therapeutic nurse-client relationship. Retrieved from http://www.cno.org/Global/docs/prac/41033_Therapeutic.pdf
Moola & Sandeep (2011). Falls: assessment and Prevention (community setting). Joanna Briggs Institute. Retrieved from http://search.proquest.com/docview/921793019?accountid=14789
Public Health Agency of Canada. (2009). Report on seniors’ falls in Canada. Retrieved from http://www.phac-aspc.gc.ca/seniors-aines/publications/pro/injury-blessure/falls-chutes/foreword-dedicace-eng.php#statisticsseniorsfalls
Registered Nurses’ Association of Ontario (RNAO). (2011). Nursing Best Practice Guideline: Risk prevention of falls and fall injuries in the older adult. Retrieved from http://www.rnao.org/Storage/80/7444_BPG_Falls-and_SUPP.pdf

Rose & Debra, J. (2008). Preventing falls among older adults: no “one size suits all” intervention strategy. Journal of Rehabilitation Research and Development, 45(8), 1153-66. Retrieved from http://search.proquest.com/docview/215285958?accountid=14789
Touhy, T. A., Jett, K.F., Boscart, V., & McCleary L. (2012). Erersole and Hess’ gerontological nursing & healthy aging. Toronto, Canada: Elsevier Canada

Appendix

Search Strategy

Databases: ProQuest Nursing & Allied Health Source, The Cochrane Library, and RNAO Best Practice Guidelines

Key Words: activities to reduce falls, reduce falls, how exercise reduces falls,

Limits: Publication date (2007-2012), Peer Reviewed, Evidence-based