ISSUES/ CONCERNS RELATED TO GAIT INSTABILITY

GERONTOLOGIC NURSING PRACTICE 1. Wear footwear with non-skid soles

2. Use mobility aids & assistive devices as prescribed
I. SAFETY
3. Make deliberate attempts to scan the environment while walking
• Security & prevention of accidents & injuries to look for possible hazards
4. Participate in an exercise program that includes muscle
II. FALLS strengthening &gait training
• Conditions associated with greatest risk for serious injury: 5.Make environmental modifications
1) Mental status changes
2) Osteoporosis
3) Gait or balance instability FALL & INJURY PREVENTION STRATEGIES
4) Concurrent fractures
5) Restraint use PHYSICAL MODIFICATION
▪ Cushion the landing surface
• Some Common Causes of Falls? ▪ Pad the floor
a) EXTRINSIC FALLS ▪ Cushion bony prominences
o Improper footwear ▪ Lower the distance to the floor surface
o loose or frayed carpeting ▪ Use low-rise beds
o poor lighting ▪ Use mattress on the floor
o cluttered environment with obstacles ▪ Sit during dressing & shaving
o difficult-to-see edging on sidewalks ▪ Sit on a shower chair instead of standing in a tub
o tripping over cords or walkers ▪ Avoid high heels, use flat shoes or wedge heels
o slips on the floor from spills or slippery substances
o sitting or leaning in a movable object BEHAVIORAL MODIFICATION
o glare on the floor ▪ Slow the pace of activities
o poorly repaired steps ▪ Avoid risk-taking behaviors such as climbing on ladders
o lack of grab rails or devices to lean on ▪ Rise slowly & dangle legs before changing position
o missing step on stairs ▪ Pay attention to environment, terrain, uneven or slippery
surfaces
b) PRODROMAL FALLS
o CHF
ENVIRONMENTAL SAFETY
o Infections
▪ Paint curbs and edges
o Functional decline with impairment in mobility &
▪ Remove IV tubings in the hospital setting
performance of ADLs
▪ Remove urinary catheter & drainage bag
▪ Install grab bars & rails
c) PREMONITORY FALLS
▪ Use the Lifeline for fall detection
o Seizure
▪ Set a pre-determined sched for “checking in” with neighbors or
o CVA
friends
o orthostatic hypotension
o syncope
o vertigo
• Lifeline Medical Alert System – detects more than 95% falls
d) MULTI-FACTORIAL FALLS o 24/7 access to the U.S.-based Response Center
o visual loss o most advanced fall-detection technology in USA
o orthostatic hypotension
o peripheral neuropathies
o lower extremity weakness
o poor balance
o gait abnormalities

BEHAVIORAL INTERVENTIONS TO PREVENT

SERIOUS INJURY FROM FALLING:

OSTEOPOROSIS
1. Take meds for increasing bone mineral density
2.Take Vitamin D & supplements • Lifeline with AutoAlert
3.Eat well-balanced nutritious meals high in calcium o the first pendant-style help button that can automatically place
4. Perform moderate weight-bearing exercises on a routine basis a call for help if it detects a fall and the elderly is unable to push
5.Avoid smoking the button himself/herself
6.Avoid excessive alcohol ingestion
7. Avoid strain on the spine (bending/heavy lifting) III. FIRE HAZARDS
NON-BURN INJURIES
BALANCE INSTABILITY a. Knife Injuries
1. Change positions slowly & carefully b. Carbon Monoxide Poisoning
2. Stabilize position before moving c. Cooling Fans
3. Use mobility aids & assistive devices as prescribed d. Foodborne Illnesses
4. Assume a seated position during high-risk activities such as
bathing & dressing 1) What is Carbon Monoxide?
▪ Carbon monoxide, or “CO,” is an odorless, colorless gas
that can kill

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2) Where is CO found?
▪ in fumes produced any time one burns fuel in cars or trucks, 5. ABANDONMENT
small engines, stoves, lanterns, grills, fireplaces, gas ranges, or ▪ the purposeful and permanent desertion
furnaces. of an elderly person.
▪ CO can build up indoors and poison people and animals who ▪ The victim may be left at a hospital, a
breathe it nursing home, or in a public location.
▪ The abandoning person feels
3) Symptoms of CO poisoning overburdened or believes he or she
▪ Headache lacks the resources to care for the victim
▪ Dizziness
▪ Weakness IX. FIREARMS
▪ upset stomach • In USA…..here are some F-A-C-T-S!
▪ vomiting o more than 17 million people aged 65 years or older own a
▪ chest pain firearm
▪ confusion o ELDERLY have the highest rate of suicide by a firearm
▪ often described as “flu-like.” o data suggest that a disproportionate number apply to carry a
- People who are sleeping or drunk can die from CO concealed weapon
poisoning before they have symptoms o At least one new handgun has been designed and marketed
- for older people
4) Who are at risk from CO poisoning?
▪ Infants • Safe operation of firearms for elderly?
▪ Elderly o Issues on memory, thinking, judgment as well as physical
▪ People with and behavioral competence
- chronic heart disease o Gun availability can pose a particular risk to those with
- anemia dementia and to their caretakers
- breathing problems
CHALLENGE FOR THE NURSE?
▪ Each year, more than 400 Americans die from unintentional
• Conduct individualized safety assessment
CO poisoning not linked to fires, more than 20,000 visit the
• Identify age-related risk factors that affect safety
emergency room, and more than 4,000 are hospitalized
• Develop interventions aimed at prevention of harm & injury
IV. SEASONAL SAFETY ISSUES
A. Hyperthermia
B. Hypothermia

V. UNSAFE STORAGE OF MEDS & HEALTH CARE SUPPLIES

IN THE HOME

VI. LIVING ALONE

VII. AUTOMOBILE SAFETY

VIII. ABUSE & NEGLECT

Five Areas of Abuse and Neglect
1. NEGLECT
▪ failure or refusal to fulfill one's duties
or obligations to an elderly person

2. EMOTIONAL ABUSE

3. EXPLOTATION OR FINANCIAL ABUSE

4. PHYSICAL ABUSE

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