GERIA

• Safety is a major concern when working with or providing care to older adults
• 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 are more susceptible to accidents and injuries than are younger adults

  • Internal factors specific to the person including normal physiologic changes with aging, incidence of chronic disease, use of medications, and cognitive or emotional changes
  • External factors specific to the environment including factors that present hazards to older adults, such as poor lighting or a slippery floor
• Vision and hearing


  Protective senses
• Changes in visual acuity


  • Makes 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

  • Cardiovascular changes including decreased cardiac output, dizziness, syncope, anemia, cardiac arrhythmias, orthostatic hypotension
  • Neurologic changes including Parkinson's disease, weakness and alterations in gait and balance, decreased ability to sense painful stimuli
  • Musculoskeletal changes including arthritis, reduced joint mobility and flexibility

  
• 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
• Falls are the most common safety problems in older adults
• Falls are the leading cause of both fatal and non-fatal 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. Two-thirds of those who have experienced one fall will fall again within six months
• 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
• Reducing the risk for falls

  1. Prepare safe surroundings

  2. Reduce environmental hazards and risky practices

  3. Allow adequate time to complete an activity or task

  4. Encourage proper-fitting footwear

  5. Encourage assistive devices when needed

  6. Encourage the older adult to ask for help when necessary

  7. Provide toileting assistance at regular intervals
• Assessment to identify fall risk factors

  • Age 75 or older
  • Recent history of falling
  • Dementia, hip fracture, diabetes type 2, Parkinson's 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
• Many tools have been developed to help assess one's fall risk
• Specific strategies to prevent falls

  1. Communicate fall risk to patient, family, and staff

  2. Develop and implement an individualized strategy to reduce fall risk
• Preventing falls and injuries in the home

  1. Ensure rugs are firmly fixed to the floor

  2. Maintain electric safety

  3. Decrease clutter and other hazards

  4. Provide adequate lighting

  5. Provide grip assistance wherever appropriate

  6. Place frequently used items at shoulder height or lower

  7. Take measures to prevent burns

  8. Review medications that can increase fall risk

  9. Correct medical or surgical factors that increase fall risk
• Basic fire safety precautions in the home

  • Make sure smoke detectors are installed
  • Use caution with cigarettes or open flames
  • Check extension cords for fraying or loose plugs
  • Be sure to turn off the stove or oven if you are leaving the area
  • Never cook while wearing long, loose sleeves
  • Have an escape plan
  • Do not use elevators when there is a fire
• Home security guidelines

  • Think and plan ahead to reduce risks to personal safety
  • Identify ways an intruder could enter the home
  • Maintain regular contact with family, friends, or neighbors
• DO NOT use elevators when there is a fire
• Older adults


  • More vulnerable than younger persons to attack and injury from those who prey on weaker or more defenseless people
  • Need to be aware of the risks presented by strangers and learn to institute measures to reduce the likelihood of injury
• Home Security Guidelines

  1. Think and plan ahead to reduce risks to personal safety

  2. Identify ways an intruder could enter the home

  3. Maintain regular contact with friends and family

  4. Use the telephone safely

  5. Answer the door safely

  6. Bank safely

  7. Prepare for emergencies
• Probably the most dangerous hazards, because of their size and speed, are motor vehicles
• Older adults are often unwilling to stop driving in spite of the serious risks to themselves and others
• Factors contributing to motor vehicle accidents in older adults

  • Age-related vision changes
  • Hearing changes
  • Decreased muscle strength, reduced flexibility, and slower reflexes
  • Changes in cognitive functioning, particularly due to Alzheimer disease
• Safe Driving Practices for Older Adults

  • Plan ahead to know where you are going
  • Add extra time so that you do not feel rushed
  • Limit your driving to places close to home, familiar, and easy to get to
  • Avoid distractions such as talking, playing the radio, or using a cell phone
  • Wear your seat belt at all times
  • Wear appropriate eyeglasses and hearing aids
  • Pace trips to allow for frequent rest breaks
  • Use extra caution when approaching intersections
  • Drive at a safe distance behind other cars
• Avoid Driving

  • If taking medications that affect driving skills
  • During rush hour
  • At night, when lighting is limited, or during inclement weather
  • On busy streets and in congested traffic areas
  • On limited-access roads with high speed limits and complex intersections such as freeways
• Warning signs that indicate a person should stop driving

  • Nervousness or lack of comfort behind the wheel
  • Difficulty staying in one lane
  • More "near misses"
  • More dents or scrapes on the car (or hitting or scraping the garage, mailbox, etc.)
  • Other drivers "honking" at you more often
  • Friends or family not wanting to ride with you
  • Confusing the brake and gas pedals
  • Difficulty turning to look over your shoulder when making lane changes or reversing
  • Medical conditions or medications that affect your ability to maneuver the car
  • Being easily distracted or having difficulty concentrating while driving
  • Getting lost
  • Receiving more warnings or traffic tickets
• Thermoregulation Risks for Older Adults

  • Exposure to excessively cold or hot environments
  • Limited financial resources to pay for heat or clothing appropriate for environmental temperature
  • Neurologic, endocrine, or cardiovascular disease
  • Hypometabolic or hypermetabolic disorders (diabetes, cancer, hypothyroidism, hyperthyroidism, malnutrition, obesity)
  • Infection or other febrile illness
  • Dehydration or electrolyte imbalances
  • Inactivity or excessive activity
  • Temperature-altering medications (alcohol, antidepressants, barbiturates, reserpine, benzodiazepines, phenothiazines, anticholinergics)
• Signs of Hypothermia

  • Mental confusion
  • Decreased pulse and respiratory rate
  • Decreased body temperature
  • Cool/cold skin
  • Pallor or cyanosis
  • Swollen or puffy face
  • Muscle stiffness
  • Fine tremors
  • Altered coordination
  • Changes in gait and balance
  • Lethargy, apathy, irritability, hostility, or aggression
• Hyperthermia


  Higher than normal body temperature, occurs when the body is unable to get rid of excess heat
• Symptoms of Hyperthermia

  • Mild, early signs of heat stress include feeling hot, listless, or uncomfortable. Cramps in the legs, arms, and abdomen are early indicators of elevated body temperature.
  • Indications of a serious heat-related problem may include hot, dry skin without perspiration; tachycardia; chest pain; breathing problems; throbbing headache; dizziness; profound weakness; mental or perceptual changes; vomiting; abdominal cramps; nausea; and diarrhea.
• Heatstroke


  A condition in which the body temperature can climb as high as 104°F, is a life-threatening emergency
• Psychological trauma caused by

  • Falls
  • Assaults
  • Motor vehicle accidents
  • Fires
  • Thermal events
  • Other injuries