Injury and Violence

Organizational Culture and Readiness Assessment

The rate at which patients come to the hospital for treatment and care as a result of falls is alarming. The most susceptible group of people to falls are those aged over 65 years (Chan, Zagorski, Parsons, & Colantonio, 2013). Falls have an increased tendency to cause physical and psychological issues on the patient. Statistics indicate that the issue causes the United States government billions to treat problems relating to falls among senior citizens (Chan et al., 2013). Many health care institutions have developed a range of intervention mechanisms. For senior citizens susceptible to fall, is increased physical mobility, improved home and environmental safety, and reduction of the impact of medications as a falls risk factor, as effective as treatment and rehabilitation after falling, for reducing the rate of falls? (Riva, Malik, Burnie, Endicott, & Busse, 2012) Many people tend to think that reducing instances of older adults standing and moving around would, in essence, reduce their likelihood of falling. Senior citizens who have fallen in the past also tend to think that reduction in the rate of activity would reduce their chances of falling significantly. A growing number of senior citizens have come to fear to fall, thereby resulting in a rapid reduction in their physical activities (Chan et al., 2013). This reduction in physical engagement also extends to one’s social engagements. A reduction in the level of social engagement further decreases the rate of physical activities since the senior citizens have little to look forward to achieving (Chan et al., 2013). Many have consequently fallen into depression thereby impairing their cognitive sense. Others tend to become socially isolated, and every fall they experience makes them feel helpless. Despite healthcare practitioners wanting to intervene and be present for these older adults, the cannot be available to all. The best remedy is to develop an evidence-based intervention model that will assist seniors and their caregivers to reduce the chances of these senior citizens ever falling.

Problem Description

Senior citizens are some of the most vulnerable population in general (Albert, King, Boudreau, Prasad, Lin, & Newman, 2014). Senior citizens are faced with a myriad of challenges ranging from old age illnesses to falling. Of all the challenges that seniors face, falling is the leading cause of injuries among them. Investigation shows that one in every three senior Americans aged over 65 years falls each year (Chan et al., 2013). This figure, when translated in a different way, implies that for every 20 minutes, a senior citizen in the United States falls (Chan et al., 2013). This high rate of falling may or may not cause injury, but it has a detrimental effect on the senior citizen. Investigations have also indicated that there are well over 2.5 million injuries that are reported and treated in emergency departments annually involving senior citizens (Chan et al., 2013). In the year 2013 alone, there were over 734,000 senior citizens who were hospitalized throughout the United States for injuries resulting from falling (Chan et al., 2013). It is best conceptualized as a senior citizen being treated in an emergency room every 13 seconds of every day, irrespective of the hour. In the year 2013 alone, there were 21,700 senior citizens’ deaths that were as a direct result of falling (Chan et al., 2013). In financial terms, the amount of money that the United States government spent on injuries resulting from falls of senior citizens amounted to $ 34 billion in the year 2013 alone (Chan et al., 2013). This figure has been on the rise with the 2000 health financial burden resulting from seniors’ injuries being $ 19 billion (Chan et al., 2013). The rate of these injuries has been projected to be continue increasing on a year over year basis unless something is done. Currently, the United States is having a rapidly aging population, which means that the rate of falls is also bound to go up significantly. Estimates put the financial implication of injuries from falls of senior citizens to reach $ 64 billion by the year 2020 (Chan et al., 2013).

The purpose of this project is to evaluate the current intervention mechanisms that have so far shown little improvements. The evaluation of the current intervention mechanism will also highlight challenges that are currently faced and loopholes or shortcomings of these models towards the reduction in the number of senior citizens falling. More precisely, this project is aimed at developing an evidence-based intervention mechanism that considers multivariable aspects that have proven effective in the reduction of the rate of the propensity of falls within the senior citizen’s populace.

This project has a range of stakeholders. The first stakeholder in this project are the senior citizens (Albert et al., 2014). They are the affected population under consideration in this project, and thus, they play a central role in the development of the intervention model. The second set of stakeholders are the home-based caregivers. These caregivers include the family members that stay at home with these senior citizens or hired assistants whose work is to care for the senior citizens. This group of individuals may extend to caregivers in senior citizens nursing homes where seniors go to spend their days away from the hype of the populace. Here, the senior citizens have more social time with people of similar age, and they can share stories and experiences, exercise together, and share moments together in the passage of time. The third stakeholders in this project are nursing professionals developing this intervention approach. These nurses are responsible for assessing the needs and challenges that seniors continue to face in their day to day activities. These nursing professionals will have the mandate to evaluate the current intervention approaches that are used and provide a customized intervention approaches to improve the current trend of senior citizens’ falls. The fourth stakeholder in this project is the local community and the community leadership. The local community is well-versed with senior citizens in their midst who may be suffering from falls. The community will play a crucial role in identifying senior citizens and providing the much needed moral support to their seniors as they embark on an improvement journey. The fifth stakeholder in this project is the government in general. The government spends heftily on the treatment of senior citizens’ care after falling. The government needs to take a proactive role in educating the senior citizens and the general population at large on the best intervention mechanisms that will see a drastic reduction in the number of senior citizens fall. The government will have a supportive role in this project since the proposed evidence-based approach can be adopted in the development of policies affecting the care of senior citizens throughout the country.

This project has several members. The project has a chair who is responsible for coordinating different aspects of the project. The chair oversees the scheduling and review of deliverables based on the delivery time set for different aspects of the project. The project has a secretary whose responsibility is to document all the information about this project as reported by the team. Documentation of this information makes it possible for the team to identify different aspects of improved model development. The team will have three research assistants whose responsibilities are to go to the field and carry out a preliminary investigation on the implementation metric and the performance of the model in diverse neighborhoods. These research assistants will take an active role in assisting homes with senior citizens to adopt the new model and report back to the project team on the efficiency level of the approach. These research assistants will also have the mandate to identify challenges that caregivers or seniors have in implementing the proposed evidence-based approach. Any reported challenge shall be treated by the weight it deserves and assists in refining the implementation approach for improved outcomes.

The progress of this project is based on the approval from relevant authorities (Pai, Yang, Bhatt, & Wang, 2014). The first level of approval will be the administration. The health care center’s administration reserves the explicit right of either allowing or denying employees to conduct investigations. Nonetheless, a health facility is supposed to document different statistics and thus denying a research that can improve the process would be unrealistic. The second approval is from the unit leadership to ensure that the research has been approved at the unit level. The third approval for this investigation is from the ethics board. The board would be interested in ensuring that proper and ethical data collection and recommendations preserve the privacy of participants and that the proposed investigation and its recommendations therein are in line with the industry’s research framework as per the research guidelines acceptable throughout the industry.

Each of the stakeholders identified for this investigation is expected to have a stake in the overall process. The senior citizens are expected to have a reduced chance of falling thereby reduce the chance of injury and hospitalization or untimely deaths attributed to falls (Pai et al., 2014). Caregivers have the ability to reduce the chances of seniors falling. This measure is possible through implementation and modification of home settings and the general environment where seniors work and live for improved safety. The nursing professionals involved in the development of this project have a range of experiences in working with the elderly in diverse communities. Their conjoined experience coupled with evidence-based care practice they have continued to exercise over the years has provided them with a unique set of skills that is paramount to this investigation (Albert et al., 2014). The nursing professionals also rely on a strict set of rules that compel them to continue applying evidence-based practice in all fields of care for improved outcome rather than rely on baseless care practices that might be futile in the long run. These nursing professionals are also able to demystify to the local community and other stakeholders’ diverse notions like eliminating the elderly from social gatherings as a means of reducing their likelihood of falling. The community has a lot of influence in the reduction of the rate of falls of their senior citizens. The community is where the largest majority of senior citizens reside, and thus, their knowledge on evidence-based intervention mechanism will compel them to play an active role in reducing the rate of seniors’ falls. Accordingly, the focus is on the real potential of the local community to continuously engage the elderly in their midst, in exercises and socializing with them, to avoid the elderly falling into depression and social isolation (Albert et al., 2014; Li, Procter-Gray, Lipsitz, Leveille, Hackman, Biondolillo, & Hannan, 2014). Additionally, the government plays a crucial role in both educating the mass and formulating policies. With evidence-based results, the government will be in a better position to develop education programs and advertisements directed towards seniors and their caregivers to reduce instances of falls. The government will also be able to formulate intervention mechanisms founded on evidence-based practice, which will significantly reduce the financial burden imposed by caring for seniors who have fallen. The government can also institute a nationwide policy change based on this evidence-based proposal that will find seniors across the nation and beyond benefit from the proposal and the influence that the government has over the healthcare system. Nevertheless, the one question that needs to be answered is, for senior citizens susceptible to fall, is increased physical mobility, improved home and environmental safety, and reduction of the impact of medications as a falls risk factor, as effective as treatment and rehabilitation after falling, for reducing the rate of falls? (Riva et al., 2012)

Literature Support

As senior citizens age, their mobility function becomes impaired (Albert et al., 2014). The risk of falling increases as a person ages. Many people can attest to the fact that they have either a friend or a relative who falls within the seniors’ category who has fallen at least once, whether in their presence of absence (Albert et al., 2014). Many of the fallen seniors’ assert that they just slipped and were unable to maintain their balance after even a slight slip, and they found themselves having fallen. Some of the senior citizens attest to feeling dizzy and falling to the ground (Chan et al., 2013; Albert et al., 2014). Investigation shows that some medication has negative side effects that may include weakening of some skeletal muscles or create a sense of dizziness on the patient. Many patients are however not given advice on what to do or how to manage the negative impacts of medication. Consequently, many of these patients end up taking their medication and going about their businesses without knowing that they medication is bound to bring dizziness and other negative consequences for some time as the drug works its way through the system to address another problem that is being treated. In some cases, a senior citizen tries to wake up from a chair and falls because the legs have become numb (Chan et al., 2013; Albert et al., 2014). The problem with these falls is that it leads to some medical complications. Falls lead to fractures. Depending on the section of the body that lands on the floor first, an elderly person may have a fractured arm, skull, spinal cord, or even fractured hip bone. Within the senior citizens, falls are documented to be the leading causes of fractures, which results in hospital admissions (Chan et al., 2013; Albert et al., 2014). The more severe fractures have the potential of depriving the older adult of his or her independence. Some injuries are quite severe, especially injuries to the head and the spinal cord and quite a number result to the death of the senior citizen. Statistics indicate that one in three senior citizens aged over 65 years in the United States falls within a year. The level of impact, financial burden, and damage that is caused by falls needs an urgent intervention. Evidence shows that some fractures lead to partial to total disability (Chan et al., 2013; Albert et al., 2014). The rate of recovery for seniors is significantly lower than that of the youth and thus any injury that a senior citizen sustains will take years to heal if at all it will heal. A range of experts focuses their attention on the long-term treatment of seniors who have sustained some form of injuries. Some of these citizens have ended up being taken into senior citizens nursing homes where they can be taken care of with others who are either ailing or old enough to be dependent on nurses at the facility. Treatment may be a long shot when dealing with senior citizens particularly given that the propensity of similar incidences occurring is high. A lot of time is spent trying to rehabilitate a fallen senior citizen mainly because their frail bodies keep deteriorating. Nevertheless, no matter how much rehabilitation efforts are made to the senior citizens, especially after a major fall that has resulted in a fracture of sensitive parts like the ankle, spinal code, and the hip, the largest majority of senior citizens will never return to independent living (Chan et al., 2013; Albert et al., 2014). In this case, the focus is on the reality that such injuries are not only physical but also mental making the senior citizens mentally disabled.

Another problem with treatment and medication approach is the fact that many adults who have fallen fear falling again (Chan et al., 2013; Albert et al., 2014). This fear of falling again appears to take deeper roots as people progress in age. This problem is prominent to those who have fallen as much as it is to those who have not fallen at all. Consequently, many of these senior citizens will avoid activities that compel them to stand up and walk like taking a stroll, going shopping, or engaging in a social function that involves standing up and moving around. The treatment and rehabilitation model has proven time and again to be quite ineffective in managing falls among senior citizens.

Solution Description

The proposed solution to the menace is to take a proactive preventative approach to falls by senior citizens. The solution is meant to have a holistic overhaul of senior citizens’ lifestyle choices. First, senior citizens have to have a comprehensive understanding of their health and medications. Unlike in earlier years when people are young and their reflexes are active, seniors have significantly poor reflexes and their ability to react to fall incidences. As aging strikes, an elderly adult’s vision dwindles in strength. Consequently, senior citizens need to have their eye sights checked on an annual basis and where possible, use contact lenses to improve the accuracy of their eye sights (Li et al., 2014; Pai et al., 2014). Seniors should also have their blood pressure and cardiac system examined to capture problems early. Proper dieting with enough vitamin D and calcium is paramount for senior citizens. A reduction in smoking and alcohol consumption habits should be emphasized among senior citizens. A senior citizen should also be appraised on side effects of all medications they are under and provided with precautionary measures.

Of paramount significance is a senior citizen’s level of physical activity (Li et al., 2014; Pai et al., 2014). Senior citizens should have some level of physical activities, especially exercises to keep their bodies active. A structured exercise program would be the most appropriate and should be developed in conjunction with the senior citizen’s doctor. Exercises should focus on agility, balance, coordination, and strength. Some of the proposed exercises include climbing stairs, hiking, weight training, jogging, and dancing among others (Li et al., 2014; Pai et al., 2014). Each of these exercises will reduce the fear of falling while improving the senior citizen’s physical and mental health (Li et al., 2014; Pai et al., 2014). These activities have been found to assist in strengthening bones while slowing the rate at which osteoporosis progresses in senior citizens. During pastime, senior citizens should engage in other activities like gardening or cycling to keep their body and minds occupied for improving the quality of life. Senior citizens should also change their footwear and have shoes that are properly fitting with nonskid soles. Shoes that have laces should be properly tied to avoid unnecessary accidents brought about by stepping on the laces.

The second major lifestyle change will include radical changes to the home setting from the bedroom to the living and bathroom (Li et al., 2014; Pai et al., 2014). There should be a flashlight near the senior person’s bed. The bed should be low enough for ease of getting into and out of. Bedsheets should be made of a material that is less slippery like cotton and wool. Clothes should be arranged in easy to reach closets to avoid having to climb and increase the chances of falling. Night lamps should be in place, especially between the bedroom and the bathroom (Li et al., 2014). The bedroom floor should be clutter free. Along the sitting room, there should be clear paths leading to different destinations or rooms in the house. Light switches should be easy to access for senior citizens. All stairs and hallways should be well lit with no clutter along these hallways. Extension cords should never cross the path where senior citizens walk and this goes to telephone cords (Li et al., 2014). Loose rugs should be secured using double-faced tape. The sitting chair and sofa should be raised so that it becomes easier to rise from the chair. In the kitchen area, throw rugs need to be eliminated. Any liquid that spills need cleaning immediately. Food, dishes, and other cooking equipment should be kept in an easy to reach level. Seniors should never stand on a chair or boxes as they try to reach or open an upper cabinet to avoid falling. In the bathroom, a slip resistant rug should be placed or easier exit. Grab bars should be installed on bathroom walls, and the bathroom should have the nightlight on at night.

Change Model

Changing can be a challenge, especially when one is accustomed to living in a given area without interference or rapid changes in the arrangement. For change to be effective, the following steps need to be followed. First, the community needs to be educated. Particular interest will go to families that have senior citizens living with them. Secondly, the proposed changes should be passed on to these families. If possible, a notice should be pinned in different sections providing guidelines that need to be followed to keep seniors safe. Thirdly, a community-based training center for seniors can be established where senior citizens can go and engage in physical activities based on the schedules developed with the doctor and trainer(s). Thirdly, senior citizens should propose pastime activities they are willing to engage in for improved quality of life. Finally, the local government should establish a seniors’ program where they regularly engage one another in talking, dancing, and other physical competitions like running to maintain an upbeat health status. The heavily dependent seniors may shun this idea at first, but as the program is slowly rolled out, they will have moral support from their peers and the community at large. Two key indicators will be used on post-project assessment, and they include an evaluation of the rate of physical activities among seniors and the rate of falls reported by the participating seniors.

Implementation Plan

The baseline for this investigation will be secondary data on the number of falls within the area of study. The measure used will include the level and type of physical activity among seniors and the reported number of fall incidences and accidents within the target population. Secondary data will be drawn from the health care’s database. Primary data investigating the outcome will be done on the field. Secondary data collection will require administrative approval while primary data collection will require patients’ informed consent.

Evaluation of Process

Data will be collected using a questionnaire. The questionnaire will investigate the rate of improvement in physical activities, nutritional changes, home modifications, and number of falls recorded after the implementation of the changes.

Reference

Albert, S. M., King, J., Boudreau, R., Prasad, T., Lin, C. J., & Newman, A. B. (2014). Primary prevention of falls: Effectiveness of a statewide program. American Journal of Public Health, 104(5), e77-84. Retrieved from http://search.proquest.com/docview/1524713298?accountid=45049

Chan, V., Zagorski, B., Parsons, D., & Colantonio, A. (2013). Older adults with acquired brain injury: Outcomes after inpatient rehabilitation. Canadian Journal of Aging, 32(3), 278-86. doi:http://dx.doi.org/10.1017/S0714980813000317

Li, W., Procter-Gray, E., Lipsitz, L. A., Leveille, S. G., Hackman, H., Biondolillo, M., & Hannan, M. T. (2014). Utilitarian walking, neighborhood environment, and risk of outdoor falls among older adults. American Journal of Public Health, 104(9), e30-7. Retrieved from http://search.proquest.com/docview/1560670529?accountid=45049

Pai, Y., Yang, F., Bhatt, T., & Wang, E. (2014). Learning from laboratory-induced falling: Long-term motor retention among older adults. Age, 36(3), 1367-9640. doi:http://dx.doi.org/10.1007/s11357-014-9640-5

Riva, J. J. Malik, K. M. P., Burnie, S. J., Endicott, A. R., & Busse, J. W. (2012). What is your research question? An introduction to the PICOT format for clinicians. The Journal of the Canadian Chiropractic Association 56(3), 167-171. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3430448/pdf/jcca_v56_3_167_commentary.pdf

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