Capstone Project
Julie A. Sickles
Sacred Heart University
Introduction
In a classic definition, falls are untoward events which result in the person coming to rest unintentionally on the ground or another lower surface (Bok, et al., 2015). Falls, can be a devastating source of morbidity and mortality for the older adult. According to a Center for Disease Control (CDC) Report, “Falls Among the Older Adult,” more than one third of adults aged 65 and older fall each year in the United States and falls are the leading cause of injury deaths. Falls are also the most common cause of nonfatal injuries and hospital admissions for trauma in the older adult population (CDC Report). Unfortunately, the rate of fall-related deaths
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Our population consists mostly males (98%) from the ages of 18 to 90 plus years with a median age of 76.4 and serve over 171,000 Veterans located in eight counties in Southern Arizona and one county in Western New Mexico. SAVAHCS is a 277-bed hospital providing primary care and sub-specialty health care in numerous medical areas for eligible Veterans. SAVAHCS has specialized and numerous unique treatment programs to better serve its patients such as: The South Western Blind Rehabilitation Center, The Community Living Center, which provides specialty care as Rehabilitation, Geropsychiatric, Interim, Long Term, Hospice/Palliative, and Respite Care (va.gov). Our vision at the VA is to continue to be the benchmark of excellence and value in health care and benefits by providing exemplary services that are both patient centered and evidence based. This care is delivered by engaged, collaborative teams in an integrated environment that supports learning, discovery and continuous improvement. This continuous improvement and patient-centered care falls in line with post fall huddles/algorithm to determine cause and prevention of future falls therefore reducing health care costs for the hospital. This project also falls in line with the VA’s Health Care Modernization Report which identifies ways to improve Veteran health and well-being, Veteran satisfaction, and cost-effectiveness of services. It includes a current state assessment of each area of study, best practices and emerging trends
During hospitalizations, falls are amongst the highest preventable consistent adverse events. Preventing such undesirable events, enhances patient overall experience, as well as increased trust in the health care professional team (Fragata, 2011). The importance of fall prevention lies with the many serious unfavorable health outcomes it can pose on the patient. Falls have the potential increase length of hospital stay, limit mobility, independence, but can ultimately lead to health deterioration, including death. Worldwide, falls are the second leading cause of accidental death. In addition to the life-threatening health and safety risks falls have to the patient, it also as a financial impact,
It is always a wise choice to research similar case studies that may provide beneficial information relating to similar scenarios. I have done as such building my understanding of these scenarios which has a given me some background to my clients concerns. Several user friendly applications have offered me assistance analyzing security loop holes. They are the Microsoft Baseline Security Analyzer (MBSA) and Windows Server Update Services (WSUS).
The Center for Disease Control (CDC) reported that more than one third of adults 65 and older fall each year. Half of the elderly people, who fall, do so repeatedly. Aside from the health problems related to falls, nearly $20 billion of direct medical costs are associated with fatal and non-fatal falls (Larson & Bergmann, 2008).
Every year, about one third of everyone over the age of 65 falls, and do not report it to their doctors. Falls are the leading cause of fatal and nonfatal injuries in older people (Falls Among Older Adults). Falls become more common as people age because their bones become more brittle and their muscle mass decreases. In society today, the baby boomers are aging, which means falls will continue to increase in frequency. When a person falls, it doesn’t just affect the victim; it affects everyone. In 2012, approximately $30 billion went towards medical costs that were associated with falls (Falls Among Older Adults). To prevent more people being injured and more money being spent, there has to be a change.
Falls among any individual can cause significant trauma, often leading to an increase in mortality. According to the Centers for Disease Control and Prevention (2012), one in every three adults over the age of 65 falls each year. Long-term care facilities account for many of these falls, with an average of 1.5 falls occurring per nursing home bed annually (Vu, Weintraub, & Rubenstein, 2004). In 2001, the American Geriatric Society, British Geriatric Society, and the American Academy of Orthopaedic Surgeons Panel on Falls Prevention published specific guidelines to prevent falls in long-term
The widespread falls among the geriatric population reduce their quality of life and take away their functional independence. Lee et al (2013) state that falls leads to the rise in mortality rates and morbidity complications such as fractures and disabilities,1 out of 3 elderly persons in a community setting falls in a year. About 87% of all fractures in the elderly are due to falls. Several of the risk factors that are associated with falls are visual impairments, cognitive impairments, and health-related problems: arthritis, orthostatic, back pains, lack of balance-weakening muscles, previous falls, polypharmacy or psychoactive drugs (Lee et al, 2013).
The incidence of fall-related injuries in the elderly U.S. population will continue to increase (Quigley, Neily, Watson, Wright, & Strobel, 2017).
Falls are a common and complex geriatric syndrome that cause considerable mortality, morbidity, reduced functioning, and premature nursing home admissions. Falls have multiple precipitating causes and predisposing risk factors, which make their diagnosis, treatment, and prevention a difficult clinical challenge. Identifying effective interventions to prevent falls and fall-related injuries among older adults is a major area of research and policy development in geriatrics. Several published clinical guidelines review the evidence for fall prevention strategies and provide recommendations for assessment and intervention (Rubenstein & Josephson, 2006).
In USA, one in three adults over age 65 suffer fall while 20% to 30% experience moderate to severe injuries (Centers for Disease Control and Prevention, 2010). In 2010, the cost of falls among elderly people for US health care system was over $30 billion (Centers for Disease Control and Prevention, 2010). Over the last few decades the rate of fall related deaths in USA has sharply been escalating. Many older adults have developed the fear of falling, limiting their social activity and forcing them to live in fear. Some adults suffer lacerations, fracture and trauma during fall, deteriorating their quality of life.
According to the reports published by the Centers for Disease Control and Prevention Injury Centre (2007), falls are the third most common cause of unintentional injury death across all age groups and the first leading cause among people 65 years and older. A hospital can be a dangerous and erratic place for inpatients because of its unfamiliar
“In the United Sates, unintentional falls are the most common cause of nonfatal injuries for people older than 65 years (Hughes, 2008).” This illustrates a problem that requires addressing. “Rates of falls vary across hospitals and units however, the highest rates are found in neuroscience (6.12-8.83/1000 patient days) and medical (3.48-6.12 falls/1000 patient days) units” (Mion, 2014). Older adults are usually those most affected and their falls are
Falls are considered a leading cause of mortality and injury among older adults and majority of the falls occurs while hospitalized. One would think being in the hospital would be one of the safest places for older adults as far as fall prevention is concern due to the fact that hospitals provide staffing around the clock for patients but more and more falls have been occurring in the hospital especially in the older adult population. Fall is an unintended descent to the ground. It raises public and family care liability; it also decreases patient’s functioning because it causes pain and suffering, and increases medical costs (Saverino et al, 2015). The Center for Disease Control
A fall is a lethal event that results from an amalgamation of both intrinsic and extrinsic factors which predispose an elderly person to the incident (Naqvi et al 2009). The frequency of hospital admission due to falls for older people in Australia, Canada, UK and Northern Ireland range from 1.6 to 3.0 per 10 000 population (WHO 2012). The prevalence of senior citizen’s falls in acute care settings varies widely and the danger of falling rises with escalating age or frailty. Falls of hospitalized older adults are one of the major patient safety issues in terms of morbidity, mortality, and decreased socialization
My Capstone Proposal Project will be about sleep disturbances associated with cardiac surgery patients. One of the major complaints from the cardiac surgery population is the inability to sleep at night. My proposed strategy consists of the idea that by increasing nursing knowledge, education, and intervention there will be a reduction in sleep disturbances for the cardiac surgery population.
Falling is inevitable at some point in life, and although most of the time falls are not serious, some can be life-threatening. Falls are a danger to both physical and psychological well-being because they may diminish a person’s ability to maintain an active and independent lifestyle.1 There are many factors that place individuals at risk for falls such as age, muscle weakness, difficulty with balance or walking, psychological diagnosis, and several medical conditions.1,2 Approximately one-third of people over the age of 65 fall at least once a year.3 Individuals that are status post stroke are at an increased risk of falls, making falls assessment and prevention a common priority for clinicians treating this population.1,2 Therefore, to direct the experimental methods and build on a basis of previous literature on this topic, the search began using OneSearch, CINAHL, PubMed, and