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University of Notre Dame *

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Nursing

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Nov 24, 2024

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Case Study: Older Adult Question 1: list at least 4 common environmental hazards that may be found in an individual’s nvironmental hazards in the home can significantly increase the risk of falls, especially for older individuals like Mrs. Green. Here are four common environmental hazards to consider: 1. Poor Lighting : Inadequate lighting can make it difficult to see obstacles or changes in the walking surface. It's especially important in areas where there might be stairs or changes in floor level ( Introduction to Environmental Public Health Tracking , 2023). 2. Clutter : Objects left on the floor, such as loose papers, cords, rugs, or general clutter, can easily cause tripping, particularly if Mrs. Green has any visual or mobility impairments (Coşkun & Sarıışık, 2020). 3. Slippery or Uneven Surfaces : Wet floors, polished wooden floors, or uneven tiling can cause slips and falls. Bathrooms and kitchens are common places where such hazards can be found. 4. Lack of Safety Equipment : Absence of grab bars in the shower or near the toilet, handrails on both sides of stairways, or non-slip mats can make accidents more likely. These tools are essential for someone with a history of stroke and resulting weakness (Gawrońska & Lorkowski, 2021). Addressing these hazards is an essential part of fall prevention strategies. Additional measures like wearing suitable footwear, ensuring cords are safely tucked away, and using furniture that is stable and without wheels can also contribute to a safer living environment for Mrs. Green.

Question 2: Discuss how falls affect older adults and Name some interventions that can help the older adult recover after a fall. Falls can have significant effects on older adults, impacting their physical health, mental well- being, and overall quality of life. Here’s how falls affect older adults: Physical Impact : Falls can result in a range of injuries from minor bruises to more severe injuries such as fractures (hip fractures being particularly common and serious), head trauma, and soft tissue injuries (Vaishya & Vaish, 2020). Even without injury, a fall can lead to a fear of falling again, reducing an individual's willingness to be active. Psychological Impact : Fear of falling can cause older adults to limit their activities and social engagements. This can lead to further physical decline, depression, social isolation, and feelings of helplessness (Schoene et al., 2019). Quality of Life : Reduced mobility and independence can affect an older adult’s quality of life (Talarska et al., 2018). They may require assistance with daily activities or might have to move to a more supportive living environment if they are unable to manage independently. Economic Impact : Falls can be costly due to medical bills, rehabilitation, potential long-term care needs, and the possible need for supportive equipment or home modifications (Florence et al., 2018). Interventions that can help an older adult recover after a fall include:

 Medical Evaluation : After a fall, it's crucial to have a thorough medical evaluation to assess for injuries and underlying health issues that could increase the risk of future falls (Appeadu & Bordoni, 2023).  Physical Therapy : Engaging in physical therapy can help improve balance, strength, and gait. Therapists can tailor exercises to an individual’s specific weaknesses or deficits (Shahid et al., 2023).  Occupational Therapy : Occupational therapists can assist in recovering functional skills and suggest home modifications to make daily tasks easier and safer (Wellecke et al., 2022).  Home Modifications : Installing grab bars, ramps, improved lighting, and slip-resistant flooring can make a home safer and more navigable (Papadopoulou, 2020).  Assistive Devices : Canes, walkers, or wheelchairs might be needed to improve mobility and stability.  Medication Review : A healthcare provider should review all medications to identify any that may contribute to fall risk due to side effects like dizziness or hypotension.  Education : Educating the individual on how to get up safely after a fall and how to reduce fall risks can also be beneficial.  Nutritional Support : Adequate nutrition and hydration are important to maintain muscle mass and overall health, which can aid in recovery.  Psychological Support : Counseling or therapy to address the fear of falling and to help cope with the psychological aftermath of a fall is important.  Fall Prevention Programs : Participating in evidence-based community fall prevention programs can help reduce the risk of future falls.

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It is important to have a multifaceted approach that addresses both the physical injuries and the psychological impact of falls in older adults. Collaboration among healthcare providers, the individual, and their support system is key to a successful recovery. Question 3. Discuss at least 2 disorders that may alter an older adult’s cognition Cognitive function in older adults can be affected by a variety of disorders, many of which are more common in the elderly. Two major disorders that may alter an older adult's cognition are: 1. Alzheimer’s Disease : This is the most common form of dementia among older adults. It is a progressive neurodegenerative disorder that affects memory, thinking, and behavior (Bellenguez et al., 2022). Early signs include difficulty remembering recent conversations, names, or events. As Alzheimer's disease progresses, symptoms can include confusion, trouble speaking, difficulty with walking and swallowing, and changes in personality and behavior. 2. Vascular Dementia : This form of dementia is caused by conditions that block or reduce blood flow to the brain, depriving brain cells of vital oxygen and nutrients. Factors that increase the risk of heart disease or stroke can also increase the risk of vascular dementia. It often occurs after a stroke blocks an artery in the brain, but strokes may not always be obvious (Wolters & Ikram, 2019). Symptoms can vary but often include problems with concentration, organization, communication, and decision-making.

Both of these disorders can significantly impair an older adult's ability to function independently. It is important to differentiate between these and other potential causes of cognitive decline, such as medication side effects, chronic illness, depression, and delirium, as some of these conditions can be treated or reversed with appropriate intervention. References Appeadu, M. K., & Bordoni, B. (2023). Falls and Fall Prevention in the Elderly. In StatPearls . StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK560761/ Bellenguez, C., Küçükali, F., Jansen, I. E., Kleineidam, L., Moreno-Grau, S., Amin, N., Naj, A. C., Campos-Martin, R., Grenier-Boley, B., Andrade, V., Holmans, P. A., Boland, A., Damotte, V., van der Lee, S. J., Costa, M. R., Kuulasmaa, T., Yang, Q., de Rojas, I., Bis, J. C., … Lambert, J.-C. (2022). New insights into the genetic etiology of Alzheimer’s disease and related dementias. Nature Genetics , 54 (4), Article 4. https://doi.org/10.1038/s41588-022-01024-z Coşkun, G., & Sarıışık, G. (2020). Analysis of slip safety risk by portable floor slipperiness tester in state institutions. Journal of Building Engineering , 27 , 100953. https://doi.org/10.1016/j.jobe.2019.100953 Florence, C. S., Bergen, G., Atherly, A., Burns, E., Stevens, J., & Drake, C. (2018). The Medical Costs of Fatal Falls and Fall Injuries among Older Adults. Journal of the American Geriatrics Society , 66 (4), 693–698. https://doi.org/10.1111/jgs.15304 Gawrońska, K., & Lorkowski, J. (2021). Smart homes for the older population: Particularly important during the COVID-19 outbreak. Reumatologia , 59 (1), 41–46. https://doi.org/10.5114/reum.2021.103939

Introduction to Environmental Public Health Tracking . (2023, January 20). https://www.cdc.gov/nceh/tracking/tracking-intro.html Papadopoulou, S. K. (2020). Rehabilitation Nutrition for Injury Recovery of Athletes: The Role of Macronutrient Intake. Nutrients , 12 (8), 2449. https://doi.org/10.3390/nu12082449 Schoene, D., Heller, C., Aung, Y. N., Sieber, C. C., Kemmler, W., & Freiberger, E. (2019). A systematic review on the influence of fear of falling on quality of life in older people: Is there a role for falls? Clinical Interventions in Aging , 14 , 701–719. https://doi.org/10.2147/CIA.S197857 Shahid, J., Kashif, A., & Shahid, M. K. (2023). A Comprehensive Review of Physical Therapy Interventions for Stroke Rehabilitation: Impairment-Based Approaches and Functional Goals. Brain Sciences , 13 (5), 717. https://doi.org/10.3390/brainsci13050717 Talarska, D., Tobis, S., Kotkowiak, M., Strugała, M., Stanisławska, J., & Wieczorowska-Tobis, K. (2018). Determinants of Quality of Life and the Need for Support for the Elderly with Good Physical and Mental Functioning. Medical Science Monitor : International Medical Journal of Experimental and Clinical Research , 24 , 1604–1613. https://doi.org/10.12659/MSM.907032 Vaishya, R., & Vaish, A. (2020). Falls in Older Adults are Serious. Indian Journal of Orthopaedics , 54 (1), 69–74. https://doi.org/10.1007/s43465-019-00037-x Wellecke, C., D’Cruz, K., Winkler, D., Douglas, J., Goodwin, I., Davis, E., & Mulherin, P. (2022). Accessible design features and home modifications to improve physical housing accessibility: A mixed-methods survey of occupational therapists. Disability and Health Journal , 15 (3), 101281. https://doi.org/10.1016/j.dhjo.2022.101281

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Wolters, F. J., & Ikram, M. A. (2019). Epidemiology of Vascular Dementia. Arteriosclerosis, Thrombosis, and Vascular Biology , 39 (8), 1542–1549. https://doi.org/10.1161/ATVBAHA.119.311908

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