SAFETY

Many of the safety recommendations for older adults are similar to

those for younger people:
 Using lap and shoulder belts in motor vehicles.
 Avoiding driving while intoxicated.
 Using smoke detectors in the home, and maintaining hot
water heaters at or below 120 F.

Falls, however, are a safety risk that is relatively unique to the

elderly.
 Falls are the leading cause of unintentional injury death in
older adults in this country.
 Approximately one half of elderly adults living in institutions and one third of
community dwelling elders fall every year.
 Between 5% and 11% of these falls result in serious injuries, including fractures.
 Twelve thousand Americans die as a result of a fall each year.
 Elderly adults are susceptible to falls as a result of postural instability, decreased muscle
strength, gait disturbances and decreased proprioception, visual and/or cognitive
impairment, and polypharmacy.
 Environmental conditions that contribute to falls are slippery surfaces, stairs, irregular
surfaces, poor lighting, incorrect footwear, and obstacles in the pathway.
 Patients who fall more than twice in a 6 month period require fall risk assessment and
intervention.
An easy-to-administer fall risk assessment tool is one that uses the mnemonic “I HATE
FALLING.”
I Hate Falling
Inflammation of joints or joint deformity
Hypotension (orthostatic blood pressure change)
Auditory and visual abnormalities
Tremor
Equilibrium problems
Foot problems
Arrythmias, heart block, valvular disease
Leg-length discrepancy
Lack of conditioning (generalized weakness)
Illness
Nutrition (poor, weight loss)
Gait disturbance

Fall risk prevention strategies

 Balance and strengthening exercises
 Home safety modifications
 Elimination of high risk medications
 Physiologic and environmental risk factor reduction

Intensive approach approach is needed in:

 Community-dwelling elders aged 75 or older or in
clients 70–74 years of age.
 Who use antihypertensive or psychoactive
medications.
 Who use four or more prescription medications
 Who have cognitive impairment or impairment of gait,
strength, or balance.
 POLYPHARMACY AND MEDICATION ERRORS
 Elderly adults are at increased risk of adverse drug effects compared to younger adults,
because they take more medications, as well as due to the biologic effects of aging and
chronic diseases.
 Medication under- and overutilization by this population has been shown to increase the
number of hospitalizations and emergency room visits, to worsen cognitive functioning,
and to contribute to falls.
 AHRQ has appointed a Task Force on Aging to investigate important health issues
related to the elderly population.
 This task force has set enhanced patient safety through reduction of medication errors in
the elderly population as one of its priorities for clinical practice improvement.
 The United States Pharmacopeia (USP) has created a Personal Medication Organizer to
help seniors play an active role in keeping track of their medications.
 Adults over 65 years of age take an average of 4.5 prescription and 2 over-the-counter
medications at any one time.
 This number is markedly higher for hospitalized patients or those living in nursing homes
or assisted living facilities.
 Polypharmacy is not always inappropriate in this population of clients who have multiple
chronic illnesses, but increased numbers of medications carry increased risks.
 Frail elderly adults are more likely than healthier age-mates to suffer adverse drug
reactions.
 It is estimated that one fifth of community dwelling elderly clients are prescribed
medications that are not recommended for use in this population.
 These medications include:
 Long-acting benzodiazepines
 Sedative or hypnotic agents
 Long-acting oral hypoglycemic
 Analgesics
 Antiemetics
 Gastrointestinal antispasmodics
 Elderly clients who require home care services and are, therefore, among the more
disabled, are prescribed these medications even more often than the healthier members of
their cohort.
 The Beer’s List of medications to be avoided in the elderly has become a national
guideline for prescribers and pharmacists in the United States.
 GERON
REPORT

(SAFETY, POLYPHARMACY,
AND MEDICATION ERRORS)

Submitted by:
Millicent Faye Gelit BSN 3

Submitted to:
Mrs. Evelyn Rances, MAN, RN