Falls in Elderly

One in every three adults age 65 and older has suffered from a fall. Many falls go unreported to their healthcare provider. Falls have become the leading cause of death from an injury. (CDC, 2010). It is the most common cause of hospital admission due to trauma. In California alone, 1.3 million older adults experience an injury due to falling each year. Many suffer from moderate to severe injuries such as lacerations, fractures, and traumatic brain injury. In 2008, 82% of fall deaths were among people 65 and older (CDC, 2010)

For those who have fallen, and suffered a minor injury, a post fall syndrome occurs in many, which results in a fear of falling, dependence, loss of autonomy, and depression develops which subsequently increases their risk of falling. (WHO Global report 2008)

Women have a higher rate of falls, however; the fatality rate among men exceeds that of women. The fall death rate in 2007 was 46% higher for men than for women. (CDC, 2010)

This is attributed to several factors such as men are less likely to seek medical attention, for a condition until it becomes severe, resulting in a considerable delay to access preventive care and management of the disease. Men suffer from more co-morbidities than women, increasing the amount of prescribed medications they are placed on. Males are also likely to engage in activities that are physical, such as climbing ladders, standing on unsteady chairs, rushing with minimal attention paid to their environment, wearing poorly fitted shoes, cleaning roofs and ignoring their own physical limitations. (WHO Global Report, 2010)

According to the World Health Organization, Caucasians living in the USA have a higher risk of falling. Older whites are 2.5 times more likely to die from falls as their black counterparts (CDC, 2010).

For both genders the rate of hospitalization for a fall related injuries is two to four times higher among Caucasians than Hispanics and Asian/Pacific Islanders and 20% higher than African-Americans. This paper discusses the need for a class on how to prevent home falls to 20 Caucasian elderly males between 60-75 years old, using the Health Promotion Model. The class will be presented to a home health agency, in West Los Angeles to form a partnership. One of the agency philosophies is to maintain and improve the home safety of their patients. Their quality of care outcomes are greatly affected when patient's sustaining an injury from falls results in a hospitalization. All home health agency outcomes are reported to CMS (Center for Medicare/Medical Services).

Participants

The group consists of Caucasian males with the following breakdown in age, six men are 66, three men are 60, two are 62, four are 72 and three are 75. Sixty percent are married for over twenty-five years, with two to four children and forty percent are divorced or widowed with one to two children. Eighty percent are grandfathers who are actively involved in their lives.

Fifteen of the men are Roman Catholic, two are Protestant and three declined to state their religious beliefs. Ten men in this group have been retired for 6 years, 6 retired for the last 4 years and 4 continue to work on a part- time basis. Only six men have retirement benefits from their employer. They all worked as engineers at an aerospace company and are college graduates. The rest of the men, have Medicare benefits and live with a fixed income, their occupations were janitorial, landscaping, plumbing and construction. These men completed high school, with attending some college classes. Forty percent in this group are lifelong smokers, forty percent admit to history of alcohol abuse and sixty percent are obese.

The developmental characteristics of this target population are broken into three categories: Primary, Cognitive and Emotional aging, Primary aging entails the physical changes such as balding or graying hair, wrinkles, visible blood vessels on the skin, and fat deposits on the chin/abdomen. Diminished eyesight and hearing, affects all older adults. A significant portion over age seventy will have a loss of their taste and smell senses. Unhealthy behaviors of smoking, obesity, and drug use will enhance major organs and body systems to slow down and affect function such as - cardiovascular, respiratory, digestive, and renal/urinary. (Late Adulthood Development, 2008-2011)

In cognitive aging, memory fades as the year's progress specifically short term memory loss, long term memory is not affected. The rate of dementia increases with age especially with Alzheimer's, Parkinson's, and vascular dementia caused by strokes. (Late Adulthood Development, 2008-2011)

Emotional aging is defined as the last stage of life: integrity vs despair as theorized by Erik Erikson. The individual either has accepted their life to have meaning and purpose or they feel unfulfilled and unproductive. (Late Adulthood Development, 2008-2011)

Twelve men have type two Diabetes, in which four have macular degeneration, eight men have high blood pressure and coronary artery disease, and five of the eight have had cardiac bypass surgery. Nine men have had a joint replacement due to osteoarthritis and three men have been recently diagnosed with osteoporosis. Eight men of the twelve men have had traumatic falls on the job and at home all requiring hospitalization. Four of these men suffer from chronic pain requiring narcotic pain management. Three men reported falling at home and having "near misses".

The men were very motivated when invited to participate in a falls education class due to personnel experience with a fall or has had a spouse with a fall. All the participants are able to read and write, eighty percent require eye glasses and fifty percent have hearing aids.

Nursing Diagnosis/Educational Goal

Potential for injury related to lack of knowledge with falls prevention.

The men in this group have multiple co- morbidities, effects of the aging process and have sustained a fall or come close to having one.

The Health Promotion Model entails actions a person can participate in to be as healthy as possible and enjoy all that life has to offer. (Rankin, Stallings, & London, 2005)

Through the Health Promotion model, the educational goal will be to educate on making the home environment safer, and for each man to become aware of how to minimize their personnel risk of falls.

Class room environment

The home health agency has provided their conference room to have the class. There is underground valet parking and validation will be provided for all participants. On the corner of the building, there are two bus lines that stop near the building and some participants