NURS 6540: Advanced Practice Care of Frail Elders | Week 5

According to the Centers for Disease Control and Prevention (2013), falls are the leading cause of injury and death among those 65 and older. As patients age, basic activities that were once a routine part of daily life become increasingly difficult, posing health risks. This was the case for 79-year-old Claire Broome.

While simply putting on a pair of pants, she slipped on her hardwood floors. This unexpected fall caused her to fracture her hip (Cameron, 2011). For geriatric patients like Broome, fall prevention is an integral part of care, and many patient falls can be prevented. As an advanced practice nurse caring for this patient population, you must recognize factors that put patients at greater risk and provide the appropriate patient education.

This week you explore fall-risk assessment tools, practice guidelines, and strategies for preventing and reducing falls in geriatric patients. You also examine atypical presentations of disorders, including strategies to overcome the atypical presentations.

Learning Objectives – NURS 6540: Advanced Practice Care of Frail Elders | Week 5

By the end of this week, students will:

• Evaluate the effectiveness of fall- risk assessment tools
• Analyze strategies to reduce the risk of falls for geriatric patients
• Apply key terms, concepts, and principles related to the common geriatric syndrome of falls
• Analyze atypical presentations of disorders in geriatric patients*
• Analyze strategies used to overcome atypical presentations of disorders in geriatric patients*

*This Learning Objective supports assignments that are assigned this week, but due in Week 8.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Resnick, B. (Ed.). (2016). Geriatric nursing review syllabus: A core curriculum in advanced practice geriatric nursing (5th ed.). New York, NY: American Geriatrics Society.

• • Chapter 34, “Falls” (pp. 259-263)

This chapter examines the prevalence and causes of falls in the older adult population. It also presents clinical guidelines for assessing, managing, treating, and preventing falls in older adults.

Holroyd-Leduc, J., & Reddy, M. (Eds.). (2012). Evidence-based geriatric medicine: A practical clinical guide. Hoboken, NJ: Blackwell Publishing.

• • Chapter 9, “A Balancing Act: Preventing and Treating Falls” (pp. 105–123)

This chapter identifies risk factors associated with falls in older adults. It also examines interventions for treating and preventing falls in order to improve outcomes for older adults.

Don’t miss underlying reason for elder’s fall: Perform a functional assessment. (2010). ED Nursing, 13(5), 58–59.

This article examines causes of falls in older adult patients and identifies methods for treating falls in older adults.

Panel on Prevention of Falls in Older Persons, American Geriatrics Society, and British Geriatrics Society. (2011). Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. Journal of the American Geriatrics Society, 59(1), 148–157.

This article presents guidelines for preventing falls in older adults. It also identifies recommendations for screening and assessing falls in older adults.

Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. Journal of the American Geriatrics Society, 59(1), Panel on Prevention of Falls in Older Persons, American Geriatrics Society, and British Geriatrics Society. Copyright 2011 by John Wiley & Sons, Inc. Journals. Reprinted by permission John Wiley & Sons, Inc. Journals via the Copyright Clearance Center.

Kanis, J. (n.d.). WHO Fracture Risk Assessment Tool. Retrieved August 4, 2014, from http://www.shef.ac.uk/FRAX/

This website provides the calculation tool for the fracture risk assessment. It also identifies risk factors that increase a patient’s susceptibility to fractures.

NURS 6540 Discussion: Fall-Risk Assessment

Fall risks are very high for the geriatric population. According to the Centers for Disease Control and Prevention (2013), one out of every three adults aged 65 years and older falls each year. This can be attributed to factors such as changes in aging, other health issues, environment, and effects of prescribed drugs. When caring for geriatric patients, it is important to screen them for risks and perform fall-risk assessments. These assessment tools help to determine the level of risk for patients so that preventive measures can be taken. The implications of falls are very serious and range from fractures to mental health disorders and even death. In this Discussion, you explore risk assessment tools for use with patients at your practicum site.

To prepare:

• • Review the Kanis article in this week’s Learning Resources.
  • Consider a geriatric patient at your practicum site who is at risk for falls. Coordinate an opportunity to assess this patient with your Preceptor.

Note: When referring to your patient, make sure to use a pseudonym or other false form of identification. This is to ensure the privacy and protection of the patient.

• In addition to the Fracture Risk Assessment Tool (FRAX), select one of the following tools to assess this patient for falls:
  • Tinetti Performance Oriented Mobility Assessment (POMA)
  • Systems Approach
  • Berg Balance Scale
  • Elderly Mobility Scale
  • Timed Unsupported Stead Stand (TUSS)
  • Six-Minute Walk Test (6MWT)
  • Hendrich II Fall Risk Model
• Consider why you selected the assessment tool for this particular patient.
• Assess the patient using the tool you selected under Preceptor guidance. Reflect on the assessment, including any issues with the patient and/or the effectiveness of the tool.
• Think about strategies and interventions to reduce the risk of falls for frail elders.

By Day 3

Post a case study description of a geriatric patient from your practicum site who is at risk for falls. Describe this patient’s FRAX assessment. Then, describe the other assessment tool you used in the fall-risk assessment and explain why you selected the tool for this particular patient. Explain the patient assessment, including any issues with the patient and/or the effectiveness of the tool. Finally, explain strategies to reduce the risk of falls for your patient.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days in one or more of the ways listed below. Respond to colleagues who selected a different assessment tool than you did.

• Suggest alternative tools for assessing your colleagues’ patients.
• Recommend additional strategies to reduce the risk of falls for your colleagues’ patients.
• Share insights based on your own experience and additional literature search.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! NURS 6540: Advanced Practice Care of Frail Elders | Week 5.