Normal age-related changes contributing to falling

Numerous age-related changes predispose older adults to falling, especially when these
changers affect functional ability and give rise to sensory impairment or gait and balance insability. This
section highlights the salient age-related changes associated with falling, along with nursing
interventions directed at modifying the impact of these changes in organ function may contribute to an
intrinsic risk for falling (Tideiksaar,2009).

Vision

Structural changes in eye shape and crystalline lens flexibility accompany the aging of the eye. It
is the latter changes inflexibility of the lens that causes presbyopia, a reduction in the eye’s
accommodation for changes in depth, as when ascending or descending the stairs. If older individuals
are experiencing presbyopia, instruction must be given for them to carefully watch door edges, curbs,
and landing steps, which signal a change in height. Additionnally, because of the tendency for the
crystalline lens to become cloudy and form a cataract with advancing years, eye glare may occur and
cause temporary visual disturbances. This effect is particularly evidentoutdoors on sunny days or
indoors as bright light reflects off shiny floors. Instruction must be given to older individuals with this
problem to wear wide-brimmed hats or sunglasses to shield the eyes from the glare effect and to shade
indoor windows with drapes or blinds to minimize the effects of sun glare.

Hearing

An age-related change affecting the inner ear is atrophy of the ossicle in the inner ear, which
causes changes in sound conduction, including a loss of high-tone frequencies, called presbycusis. Other
age-related changes include an amplification of background noise and a decrease in directional hearing.
The vestibular system is in integral part of maintaining balance and to a large degree is dependent on
intact hearing. Therefore, older individuals with hearing impairments are more susceptible to falling
when feedback to the brain is altered.

Assassment of hearing difficulties begins during the initial interview. In some individuals with
significant hearing loss, it becomes necessary to use alternative forms of visual cues to signal where
their feet and bodies are in space so that they can maintain stability. For instance, when hearing loss
cannot be corrected, one aim of the management of hearing problems is to introduce vibratory or visual
cues to compensate for hearing loss. The use of bells on shoelaces causes a vibratory sense that can be
felt by older adults when a foot is placed on the ground. Nursing interventions include instructing older
patiens to observe foot placement on the floor by literally ‘’watching their step” and to be especially
cognizant of environmental conditions such as floor surfaces.

Cardiovascular factors

One of the most common problems facing older adults is the loss of tissue elasticity, which
affects the arteries. This lack of elasticity leads to a decrease in tissue recoil, resulting in changes in
blood pressure with position changes. Older adults who lie supine and then get up quickly are likely to
experience the effects of lack of tissue elasticity when the blood pressure drops and a feeling of
lightheadedness develops. It is important to educate older individual to changes position slowly and to
dangle the legs a few minutes when arising from a supine position. Older adults should be encouraged
to wait between position changes and to hold onto the side of the bed or other furniture should an
episode of lightheadedness occur. The use of a single bed rail specially manufactured for transferring
aids older adults in getting in and out of bed.

Musculoskeletal factors

The bones of aging individuals, particulary the weight bearing joints, undergo “wear and tear”,
which causes loss of supportive cartilage. As a result, joint may become unstable and “give way”.
Leading to a fall. In many instances, osteoarthritis occur in the weight-bearing joints, stability.
Interventions are directed at identifying such problems and correcting then trough the use of
antiinflammatory agents, or all of these measures. If joint pain develops and remains untreated, it may
cause older adults to become sedentary or immobile. This phenomenon of disuse and muscle atrophy
contributes to muscle weakness. This cycle of pain, reduced mobility, disuse, and atrophy may become a
vicious one unless interrupted by regular mobility and pain control through the use of topical or
systemic medication. Nursing interventions are directed at encouraging, supervising, or assisting with
regular ambulation; appropriate use of ambulation aids; joint range of motion; and modalities such as
ice, hot packs, and physical therapy.

Another normal age-related musculoskeletal change is the reduction in steppage height, which
may place older adults at risk for tripping, especially when door edges are not visible or carpeting is
frayed. The gerontologic nurse’s role is to identify these changes and offer suggestions for
improvement, depending on the cause. In some cases, an assistive device may have to be employed to
aid mobility and avoid further joint damage.