Fall Risk Assessment of Alzheimer’s Patient

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Mrs. Janclet is a 75-year-old widow living in an assisted living facility for the aged. She has Alzheimer’s disease, and the facilities’ assisting nurse, Joleen, has brought her to Labgreen Hospital for the aged. Joleen helps the old lady walking enter the emergency room. The assisting nurse requests the attending medical physician to examine the old lady’s risk of fall state. The old lady cannot clearly remember her history, and the accompanying personnel agrees to help on duty practitioner assess the patient. Patient falls are prevalent globally, especially for people above 65, and screening such individuals is necessary (Colmenero et al., 2021). The nurse answers questions about the old lady helps fill the Stay Independent brochure and assists the observing physician in carrying the various clinical tests on the patient.

The nurse helped to expound on the data collected from the Stay Independent brochure. Inquiry if the patient has fallen in the last six months indicated that she had fallen three times over the previous three months (Center for Disease Control and Prevention, 2021). The brochure and nurse revealed that they had advised the patient to walk on crutches within the assisting facility. The accompanying nurse indicated that the patient was always worried about falling while in the corridors of her residence. Joleen revealed an inquiry about her urinal incontinence and said that the patient frequently complained about urinal incontinence. The attending doctor asked the nurse if the Janclet complained of instability while walking, and Joleen reported that the patient regularly complained of feeling unsteady while walking. The nurse also insisted that the patient had a problem when stepping on the carb. An inquiry of the medications taken by the patient showed that Janclet was on antipsychotic and antidepressant medication. Najafpour et al. (2019) argue that using these medications in the elderly increases risk of falling. They obtained a score of nine from the Fall Risk brochure that was filled.

The thirty-second chair examination, four-stage balance test, and timed up and go test were conducted on the patient. They also measured the orthostatic pressure of the Janclet during the clinical examination. The thirty-second chair test is vital in assessing the strength of the lower muscles of an individual (Center for Disease Control and Prevention, 2021). Mrs. Janclet was just able to stand without using the armrest just four times in thirty seconds. With the support of the armrest, she only stood for six times, which shows a high risk of fall. The four-stage test examines the postural stability, and the patient could hold two positions for just three seconds and requested to sit. They subjected the patient to a timed and go test, proving a decreased step height, reduced stride length, and an abnormality in swinging arms. The pulse orthostatic pressure was measured and showed a drop in 25mmHg of blood pressure when changing from upright to supine. These clinical tests show that Mrs. Janclet is at considerable risk of falling and needs a close check.

Scientists associate osteoporosis with aging, as the bones become weak. The old also develop atherosclerosis, cardiac output decreases, and lungs show impaired gaseous exchange (Barrett & Barman, 2018). These factors all increase the chance of patient falls in the old. The degenerative changes that occur in joints intensify the risk of elderly falls. The United Kingdom recorded a 20% increase in mortality rates between 1990 to 2016 and a mortality rate of 2.4% in 2016 (Haagsma et al., 2016).

Diseases such as neuropathies, visual impairment, Parkinson’s disease, osteoarthritis, and cardiovascular diseases predispose the patient to falls. Close monitoring of the patients by the adult care personnel would help reduce falls. Handrails on both sides of the staircases, bed alarms, gait belts, and fall prevention mats can help reduce falls. Education of the surrounding environment falls risk to elderly would help create awareness. Baris et al. (2016) estimated the cost spent on fall-related injuries was estimated to be US$3,302.60. Slade et al. (2017) state that the USA incurred US$31 billion due to fall-associated injuries. Other economic sectors would have benefitted if they had diverted these funds to them.

Alzheimer’s disease has affected the patient’s cognitive process and memory. A follow-up plan needs to be developed to help Mrs. Janclet, who is at significant risk of falling. Nurses need to build a better relationship with fall-risk patients to help prevent some cases of falls (Radecki et al., 2018). The physician advised that vitamin D supplementation should be given to help improve the patient’s postural stability. If the medications she is taking increase the number of falls, they should be stopped, and they bring the patient back to the health facility for a change in the treatment plan. Mrs. Janclet needs close monitoring, and they should train staff at assisted living centers to manage individuals at increased risk of falls.

References

Baris, V. K., Intepeler, S. S., & Yeginboy, E. Y. (2016). The cost of serious patient fall-related injuries at hospitals in turkey: A matched case-control study. Clinical Nursing Research, 27(2), 162–179.

Center for Disease Control and Prevention. (2021). Clinical resources | STEADI – Older Adult Fall Prevention | CDC Injury Center. Www.cdc.gov.

Colmenero, E., Gibson, J., & Hadley, L. (2021). Fall risk screening in the elderly.

Barrett, K. E., & Barman, S. M. (2018). Ganong’s medical physiology examination & board review. Mcgraw-Hill Education.

Haagsma, J. A., Olij, B. F., Majdan, M., van Beeck, E. F., James, S., Vos, T., & Polinder, S. Falls in older aged adults in 22 European countries: incidence, mortality and burden of disease from 1990 to 2016. The Impact and Prevention of Fall-Related Injuries among Older Adults, 21. Web.

Najafpour, Z., Godarzi, Z., Arab, M., & Yaseri, M. (2019). Risk factors for falls in hospital in-patients: A prospective nested case control study.International Journal of Health Policy and Management, 8(5), 300–306.

Radecki, B., Reynolds, S., & Kara, A. (2018). Inpatient fall prevention from the patient’s perspective: A qualitative study.Applied Nursing Research, 43, 114–119.

Slade, S. C., Carey, D. L., Hill, A.-M., & Morris, M. E. (2017). Effects of falls prevention interventions on falls outcomes for hospitalised adults: protocol for a systematic review with meta-analysis. BMJ Open, 7(11), e017864.

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Fall Risk Assessment of Alzheimer’s Patient

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