Exam geria

• Geriatrics


  Meeting the needs of older adults
• Safety when working with older adults

  • Major concern
  • Older adults are at risk of unintentional injuries
• 41,000 older adults died from unintentional injuries in 2010 according to the Centers for Disease Control and Prevention (CDC)
• Common safety problems among older adults

  • Falls
  • Motor vehicle accidents
  • Choking
• Falls have a peak risk in the ninth decade of life
• Motor vehicle accidents and choking also claim many lives of older adults
• Vision and hearing changes in older adults can increase risk of accidents
• Vision changes


  Make it more difficult to read labels with small print
• Hearing changes


  Reduced auditory acuity in elders
• 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
• Older adults


  • More susceptible to accidents and injuries than are younger adults because of internal and external factors
• Internal factors


  • Normal physiologic changes with aging
  • Incidence of chronic disease
  • Use of medications
  • Cognitive or emotional changes
• External factors


  • 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 vision and hearing


  • 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
• Conditions affecting safety


  • 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, increasing the risk for tissue injuries, burns, and frostbite
  • Arthritis
• 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
  • 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
  • Cognitive changes or emotional disturbance and depression may be overlooked as risk factors for falls or injury
• 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
• 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
• Any fall is the best predictor of future falls. Two-thirds 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
• Reducing the risk for falls

  • Prepare safe surroundings
  • Allow adequate time to complete an activity or task
  • 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
• 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
• Assessment of fall risk factors

  • 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
• If the patient is found to be at risk for falls, more frequent assessments must be performed and documented
• Many tools have been developed to help assess one's fall risk. Some of these tools require no special equipment at all and can easily be used in a home or community setting in one to two minutes
• Preventing falls and injuries in the home


  • Ensure that all rugs are firmly fixed to the floor
  • Maintain electric safety
  • Decrease clutter and other hazards
  • Provide adequate lighting
  • Provide grip assistance wherever appropriate
  • Take measures to prevent burns
• It is very important to communicate fall risk to the patient, family, and staff
• Gradual withdrawal of some sleep medications, antianxiety agents, and antidepressants from the regimen of older adults has been shown to reduce falls
• Other individual risk factors can be medically or surgically corrected to lower the risk of falls, such as pacemaker placement, cataract surgery, and vitamin-D supplements
• Basic safety precautions in the home

  • Make sure smoke detectors are installed
  • Use caution with cigarettes or open flames
  • Make sure there are no open flames from cigarettes, matches, candles, etc., if oxygen is in use
  • Check extension cords for fraying or loose plugs. Do not pull cords out by tugging on the wire
  • Be sure to turn off the stove or oven if you are leaving the area
  • Never cook while wearing long, loose sleeves that could catch fire, causing serious burns. Secure your hair if it is long
• Older adults are among the highest risk groups for injury or death caused by fire