risk factors - behavioral
- hx of falls
- fear of falling
- lack of physical activity
- impaired safety awareness
- inappropriate use of adaptive equipment
- inappropriate footwear
- substance misuse
- poor nutrition/ hydration
- risk taking behavior
risk factors - socioeconomic
- communication / language barriers
- living alone
- lack of support network
- limited access to services/ transport
- costs
- income level
- education level
- housing condition
- cultural factors
risk factors - environmental
- weather
- clutter
- stairs
- tripping hazards
- slippery surfaces
- poor lighting / contrast
- use of restraints
- lack of railing/ safety equipment
- poor building design
risk factors - biological
- impaired balance, mobility, muscle strength, coordination
- cognition and mood
- syncope/ dizziness
- sleep disturbance/ fatigue
- vision/ hearing
- age and gender
- health conditions
universal falls risk (SAFE)
Safe environment
Assist with mobility
Fall & injury risk reduction
Engage pt & family/ caregiver
pathologic conditions affecting mobility
gait disorders
osteoporosis
arthritic conditions
Parkinson’s disease
ataxia gait
disorganized gait
staggering
side-stepping
Parkinson’s disease gait
stooped posture
short, rushing, shuffling steps
uncontrollable propulsion
body ahead of feet
‘frail senior’ gait
stooped posture
hip and knee flexion
diminished arm swing
stiffness in turning
hemiplegia gait
poor arm and leg swing
affected limb does not bend at knee
ankle fixed and inverted
leg swings in wide circles
foot drag
osteomalacia gait
softening of bones due to Vit D deficiency
skeletal pain on weight bearing
unable waddling gait
osteoporosis
- silent disease
- high risk of bone fracture
- result in significant pain, loss of function, suffering, mortality
- affects about 55% of people 50+
risk factors for osteoporosis
non-modifiable factors
- female
- Caucasian race (European)
- advanced age
- family hx
modifiable factors
- osteopenia
- low body weight
(<132 lbs, 60kg)
- low Ca intake
- vit D deficiency
- estrogen deficiency / early menopause
- low testosterone
- inadequate activity
- pathological conditions
- steroids or anticonvulsants
- excess coffee/alcohol intake
- current cigarette smoking
arthritic conditions
- osteoarthritis
wear and tear
symptoms: pain, swelling, stiffness
women > men affected
onset = gradual
- begins mid 40s
arthritic conditions
- rheumatoid arthritis
RA is chronic, progressive disease that is a systemic disease of the immune system
- auto-immune disorder
- most common arthritis
RA cont.
- damage to joints due to inflammation
- synovitis (congestion/ edema) of synovial joint capsules
- pannus formation (destroy the joint capsule)
- fibrous ankylosis (fibrous invasion of the pannus formation that occludes joint space)
- calcification of fibrous tissue
rheumatoid arthritis
- 2-3x more common in women
peak age: - 20-60 (W)
- 30-60 (M)
osteoarthritis vs. rheumatoid arthritis
OA:
Onset: Usually later in life
Speed of onset: Slow (yrs)
Distribution: Asymmetrical
Joint affected:
- Wt bearing (knees, hips)
Worst: pm ( < 1hr)
Systemic Symptoms
RA:
Onset: Any age
Speed of onset: Rapid (wks/months)
Distribution: Symmetrical
Joint affected:
- small joints hands & feet
Worst: In the am ( > 1hr)
Systemic Symptoms:
- fatigue, fever, night sweats
nursing assessment for arthritis
- assess pain, mobility, evidence of falls, psychosocial changes
- need for mobilization aids
- assess baseline psychological function within stages of the disease
- assess med management and side effects
OA vs RA
wear and tear vs systematic inflammation of joints
pharmacological interventions
anti-inflammatory drugs
- NSAIDS (non-steroidal anti-inflammatory drugs)
- steroids
anti-rheumatics and immunity suppressants
- DMARDs (Disease Modifying Anti-Rheumatic Drugs)
drug to protect the stomach from drugs above
(especially NSAIDS)
- antacid
antibiotic if a joint is septic
- ex. minocycline
non-pharmacological interventions
- local (ice/ heat to joints and/ or limbs)
- systemic (regular and sufficient sleep 8-10 hrs)
- psychologic (stress reduction)
- PT: exercise, gross motor assistance
- OT: aids to living (larger handled utensils, zipper
pulls, bath bars, etc.), fine motor assistance - Stress reduction
Parkinson’s disease
neurodegenerative disorder
- tremors
- rigidity, stooped posture
- bradykinesia (slow move)
- hypophonia (lowered voice volume)
- micrographia (small, cramped writing)
- pain
- depression and dementia are common comorbidities
effect of dopamine
communication between nerve cells
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Introduction to Gerontology and Diversity15
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Health Promotion and Assessment17
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Medications17
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Legal and Ethical Concerns/Abuse and Neglect22
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PSYCHOSOCIAL FUNCTION AND ASSESSMENT22
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Delirium and Dementia16
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Depression17
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Chronic Disease and Palliative Approach18
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Hearing15
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Vision14
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Digestion and Nutrition22
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CV30
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Respiratory19
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Mobility Issue30
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integumentary Function12
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sleep & rest7
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thermoregulation6
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sexual function6
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Cancer26
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Diabetes Mellitus8
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Heart Failure9
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Pain18
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End of Life / Palliative12
