GERIA CHAPTER 9

• Safety is a major concern when working with or providing care to older adults.
• The Centers for Disease Control and Prevention (CDC) (2014b) reports that over 41,000 older adults died from unintentional injury in 2010
• Falls, choking, poisoning, burns, and automobile accidents are the most common safety problems among older adults.
• Internal factors are specific to the person and include normal physiologic changes with aging, incidence of chronic disease, use of medications, and cognitive or emotional changes.
• External factors are specific to the environment and include factors that present hazards to older adults, such as poor lighting or a slippery floor.
• Internal risk factors:

  • Vision and hearing are protective senses.
  • Changes in visual acuity make it more difficult to read labels with small print.
  • Decreased auditory acuity reduces an older person's ability to detect and respond appropriately.
  • Decreased sensitivity of these senses increases the risk for accidental food or chemical poisoning in the older adult population.
• Physiologic changes that affect safety:

  • Decreased mobility
  • Decreased flexibility
  • Decreased muscle strength
  • Slowed reaction time
  • Gait changes
  • Difficulty lifting the feet
  • Altered sense of balance
  • Postural changes
• Cardiovascular

  • Decreased cardiac output
  • Dizziness
  • Syncope (fainting)
  • Anemia
  • Cardiac Arrhythmias
  • Orthostatic Hypotension
• Neurologic

  • Parkinson disease
  • Weakness and alterations in gait and balance
  • Decrease the ability to sense painful stimuli
  • Increasing the risk for tissue injuries, burns, and frostbite.
• Musculoskeletal conditions, such as arthritis, further reduce joint mobility and flexibility, decreasing the ability of the older person to move and respond to hazards and intensifying the likelihood of accidents or injury.
• Injury risks for older adults

  • Impaired physical mobility
  • Sensory deficits
  • Lack of knowledge of health practices or safety precautions
  • Hazardous environment
  • History of accidents or injuries.
• Cognitive changes or emotional disturbance and depression may be overlooked as risk factors for falls or injury. These disturbances reduce the older person’s ability to recognize and process information. Distracted or preoccupied older adults are less likely to pay full attention to what is happening or what they are doing. This lack of attention and caution increases the risk for accidents and injury.
• Falls are the leading cause of both fatal and nonfatal injuries among older adults
• Falls are a leading death caused by injury in people older than age 65 and number one for men over 80 and women over 75.
• The older a person becomes, the more likely he or she is to suffer serious consequences, such as a hip fracture or traumatic brain injury, from a fall.
• Ninety-five percent of hip fractures are caused by falls.
• Any fall is the best predictor of future falls. Twothirds of those who have experienced one fall will fall again within six months. Fear contributes to this risk, as the person who has fallen may reduce their physical activity and physical fitness out of fear of falling.
• Older adults living independently in the community often do not recognize hazards in their home environment that place them at risk for falls because they are too accustomed to their surroundings to view them as potential hazards. Older adults and their family members need to be aware of things they can do to reduce the risk for falls.
• Reducing the Risk for Falls

  • Prepare safe surroundings
  • Reduce environmental hazards and risky practices
  • Encourage proper-fitting footwear
  • Encourage assistive devices when needed
  • Encourage the older adult to ask for help when necessary
  • Provide toileting assistance at regular intervals
• Prepare safe surroundings


  1. Ensure adequate lighting, particularly in stairwells

  2. Keep frequently needed items on a table near the chair or bedside

  3. Consider a low-rise bed (14 inches from the floor)

  4. Use personal alarms and pressure sensor alarms to alert nursing staff of patient movement
• Reduce environmental hazards and risky practices

  1. Ensure no throw rugs, uneven floors, electric wires, oxygen tubing, or other items that could cause tripping

  2. Mop up spills in the kitchen or bathroom immediately

  3. Avoid placing items on the floor

  4. Encourage the older adult to not climb on anything other than an approved step stool to reach high places

  5. Allow adequate time to complete an activity or task

  6. If the older adult feels dizzy or lightheaded, encourage sitting for a while before standing
• Encourage proper-fitting footwear


  1. Recommend shoes with nonslip soles and low heels

  2. Ensure shoes have closures that are easy to manipulate

  3. Check that laces do not come loose and cause tripping

  4. Avoid loose-fitting slippers or shoes that can drop off the foot and lead to a fall
• Encourage assistive devices when needed


  1. Prescription eyeglasses enable the older adult to clearly see their environment

  2. A cane or walker provides security with ambulation by enlarging the base of support

  3. Keep assistive devices close at hand to avoid leaning or reaching

  4. Ensure the tips of the cane or walker have solid rubber grips to prevent slipping and may need to be modified on icy surfaces to promote gripping
• Encourage the older adult to ask for help when necessary

  1. Failure to seek help can lead to serious injury

  2. Encourage older adults to recognize that good judgment is a sign of healthy aging, not a sign of weakness
• Provide toileting assistance at regular intervals

  Assisting the older adult every two hours can help reduce fall risk
• Assessment begins with identifying and documenting intrinsic risk factors that place an individual at high risk for falls.

  • Age 75 or older

  • Recent history of falling

  • Dementia, hip fracture, diabetes type 2, Parkinson disease, arthritis, depression Use of assistive devices

  • Cognitive impairment

  • Gait, balance, or visual impairment

  • Use of high-risk medications

  • Urge urinary incontinence

  • Physical restraint use

  • Bare feet or inappropriate shoe wear
• Safety is a major concern when working with or providing care to older adults
• The Centers for Disease Control and Prevention (CDC) (2014b) reports that over 41,000 older adults died from unintentional injury in 2010
• The largest number of accidental deaths in the older adult population, by a wide margin, is from falls, the risk of which peaks sharply in the ninth decade of life

  
• Most common safety problems among older adults

  • Falls
  • Choking
  • Poisoning
  • Burns
  • Automobile accidents
• Internal factors


  Specific to the person and include normal physiologic changes with aging, incidence of chronic disease, use of medications, and cognitive or emotional changes
• External factors


  Specific to the environment and include factors that present hazards to older adults, such as poor lighting or a slippery floor
• Vision and hearing


  • Protective senses
  • Changes in visual acuity make it more difficult to read labels with small print
  • Decreased auditory acuity reduces an older person's ability to detect and respond appropriately
  • Decreased sensitivity of these senses increases the risk for accidental food or chemical poisoning in the older adult population
• Physiologic changes that affect the older adult's safety

  • Decreased mobility
  • Decreased flexibility
  • Decreased muscle strength
  • Slowed reaction time
  • Gait changes
  • Difficulty lifting the feet
  • Altered sense of balance
  • Postural changes
  • Decreased cardiac output
  • Dizziness
  • Syncope (fainting)
  • Anemia
  • Cardiac Arrhythmias
  • Orthostatic Hypotension
  • Parkinson disease
  • Weakness and alterations in gait and balance
  • Decrease the ability to sense painful stimuli
• Arthritis


  • Musculoskeletal conditions that further reduce joint mobility and flexibility, decreasing the ability of the older person to move and respond to hazards and intensifying the likelihood of accidents or injury
• Cognitive changes or emotional disturbance and depression

  May be overlooked as risk factors for falls or injury, reduce the older person's ability to recognize and process information, and increase the risk for accidents and injury
• Falls are the most common safety problems in older adults
• Falls are the leading cause of both fatal and nonfatal injuries among older adults
• The older a person becomes, the more likely he or she is to suffer serious consequences, such as a hip fracture or traumatic brain injury, from a fall

  
• Ninety-five percent of hip fractures are caused by falls