Introduction
There is a rapid increase in the number of people who are living into older age. This essay will discuss the incidence of fall that is attributed to a lack of physical activity by people who are 65 years and above. With the number of elderly people rising with each passing day, it is estimated that in the next two years around 16 percent of the population will comprise of elderly adults (Hua, Yoshida, Junling, & Hui, 2007). The lack of physical activity for these individuals will be evaluated with a focus on the number of falls that are experienced by both women and men. The impact of falls will be examined to establish the efficacy and the health care costs associated with the fall. It has been established that nurses do play a vital role in promoting physical activity amongst the elderly within the community. This essay will look into the strategies that can be used to promote physical activity for the elderly within the community. Strategies that can be used for fall prevention will also be covered.
Elderly Falls
Within the community, falls have been a major health issue. It is estimated that around 30% of elderly adults (65 years and above) experience a fall at least once a year. This is set to increase, especially as the Australian population continues to age. It has expected that the aging population will increase from 16% to 23% in the year 2050. A fall is described as an even where an individual will inadvertently come to rest on the ground. The World Health Organization (WHO) has indicated that falls do happen across the globe especially those involving elderly adults. Therefore, this phenomenon is not restricted to a particular country or region. Falls are the major causes of injury for the elderly. Some of the injuries might result in disability while others have resulted in death. This goes to show the severity of falls for elderly adults. Falls do account for numerous health care costs with the costs expected to rise to $1.4 billion by 2050. The incidence rate for falls in Australia indicates that women are more prone to falls than men.
The incidence of falls in the elderly
In Australia, it is estimated that one out of three elderly adults will fall at least once every year. The falls are mainly attributed to a decline in muscle function. This denotes the need to ensure that the elderly stay active. Without physical activity, the elderly will lose the functioning of most of their muscles and this works against them as they will not be able to prevent themselves from falling. Within the community, the number of elderly adults who prefer to sit at home and watch tv or read is increasing. While this is acceptable, there is need to ensure that the elderly within the community does have some sort of physical activity that will ensure that their muscle function does not decline and they do not get frail. With decreased muscle functionality a person becomes frail and performing daily activity becomes hard. A simple task like walking up a step of stairs becomes hard. For such a person, the risks of them falling increases with each passing day. Elderly adults are already at an increased risk of suffering from falls. This is further compounded by their lack of physical activity. One study carried out in Australia established that during a follow-up period of 12 months 49% of the subjects fell and 23% fell more than once. This goes to show how prevalent the incidence of falls is in Australia. Within the community, it has been found that the rates are almost similar to the study with a slight decrease in the number of falls. However, repeat falls are higher. This could be attributed to the continued decrease in physical activity amongst the elderly within the community.
The good news is that a majority of the reported falls are reported to occur outdoors and not indoors. This means that there could be other contributing factors. However, physical activity is still the number one factors that increase the rates of falls. The fall locations outside include steps, kerbs, streets, or parks. The falls inside the house also included tripping on steps. In order to avoid tripping while walking, one needs to lift their foot high enough. With aging, the lifting process is tiring and this could indicate why a majority of falls are recorded to occur on the steps or stairs.
Impact of Falls on The Elderly Individual
Elderly falls account for 40% of injury-related deaths (Vieira, Palmer, & Chaves, 2016). There are falls that will result in the total death of the individual. It is quite obvious that falls in the elderly will result in injury. The injury might not always be physical. Sometimes the injury can be psychological resulting in the individual fearing or avoiding certain areas or activities. Within the community, the commonly self-reported injuries include abrasions, superficial cuts, sprains, and bruises. It is also estimated that the number of elderly adults who suffer falls within the community about 20-60% will suffer injuries, 2-6% suffer fractures, 10-15% suffer serious injuries, and 1-1.5% suffer hip fractures (Hua et al., 2007). The common injuries that lead to hospitalization are femoral neck fractures leg fractures, fractures of the radius, ulna, and other bones in the arm. These fractures are costly for the individual and they result in them being hospitalized, which increases their health care costs. Hip fracture is the most serious and costly of these fall-related injuries. Recovery for the elderly is slow for hip fractures and this makes them vulnerable to post-operative and bed rest complications. About 20% of the cases of hip fractures result in death and those who survive about one-third of them do not regain complete mobility (Ding & Yang, 2016).
Falls do not just result in physical injuries. The elderly also suffer psychologically. This is because most of them do not understand how they could have fallen While others will not focus much on the fall, there are some who will think so much about the fall and start feeling bad about them self. This leads to mental torture and the individual suffers psychologically. Considering their age and the need for other medications, the individual’s health will continue to deteriorate and this might result in early death. Therefore, there is a need to encourage the elderly in the community to stay active and take part in some of the arranged group physical activities. For this particular age group falls account for 4% of all hospital admissions. The number increases with each passing year and this should be worrying for the community administrators. Falls do affect the quality of life of the elderly. They not only lead to fractures, but they also reduce the state of function for the individual, which leads to a loss of motor ability.
Contributing and Causative Factors
There are many contributing factors for falls in the elderly. Some of the factors are increasing age, medication use, lack of physical activity, cognitive impairment and sensory deficits. While a majority of the reported might have multiple causes, it is clear that the lack of physical activity is a major risk factor for falls. With the aging process, the individual will lose most of their muscle function and there is a need to maintain some physical activity to ensure that the individual will not become too frail (Ding & Yang, 2016). Although there are some medications that might lead to loss of energy as a side effect it is vital that individuals remain active even if for an hour a day. A physically inactive elderly individual is far likely to fall than an elderly adult who takes some sort of physical activity every day. According to the literature, there is a possibility of reducing and preventing falls in individuals. One of the recommended ways is to ensure that as one gets older, they should exercise frequently (Trombetti et al., 2016). This will ensure that there is no loss of muscle function. In Australia, it is estimated that with the continued increase in the number of elderlies, if nothing is done to increase their physical activity, then the country might have a huge problem. The rate of hospitalizations will increase and the number of elderlies in hospitals will rise. Therefore, there is a need to encourage the elderly within the communities to actively participate in physical activities.
Nurses Role in Physical Activity Promotion
Nurses should evaluate elderly patients and individuals in order to identify the ones who are at risk of suffering a fall. Within the hospital, all elderly patients are not encouraged to walk by them self and a nurse must be at and to assist them when they are walking. The elderly who visit the hospital and can be able to walk while they are undergoing treatment are encouraged to maintain physical activity (Chavez, Dwyer, & Ramelet, 2018). This ensures that they are not overly reliant on others and they do not lose their motor ability while in hospital. Elderly patients are monitored closely to ensure that they do not fall while in the hospital. Nurses are encouraged to keep a close watch over the elderly even when they are lying in bed (Clancy & Mahler, 2016). Bed guards should be available to ensure that one does not roll over from the bed. Elderly patients are encouraged to seek the assistance of a nurse every time they need to exit the bed.
A complete physical examination is a necessary part of the evaluation process. The nursing staff will conduct this examination to gauge the elderly patient’s range of motion and their physical activity level. According to Kwan and Straus (2014) proximal muscle weakness of the lower extremities, which is a common risk factor for falls can be examined by asking the patient to stand 5 times from a seated position without using their hands. If the patient takes more than 11 seconds to complete the task this might indicate muscle weakness. Balance assessment should also be done and this can be accomplished by using a progressive Romberg. Gait should be assessed to determine if the patient is at risk of falls related to them being distracted or having to turn. The nurse should also find out if there are any medications that the patient is taking. There are some over-the-counter medications that might play a role in increasing the risk factor for the patient.
Strategies to Promote Physical Activity
It has been posited by Vieira et al. (2016) that the use of cognitive-behavioral or behavioral strategies is more effective than using health education or exercise prescriptions. With cognitive-behavioral strategies, the elderly is using the power of their own self-talk and they can push them self to achieve what they set out to achieve (King, 2001). This is more powerful than having to continuously encourage a person to partake in some physical activity. Behavioral strategies are aimed at instilling exercise behaviors in the individual. Once a person forms a pattern and behavior, it becomes hard for them to break it. This way the individual will maintain their physical activities. We cannot rule out the impact that nurses and physicians can have on encouraging people to exercise or undertake physical activity. However, these interventions do not have a lasting effect. Therefore, there is a need to use them with other behavioral methods to ensure that the elderly patient will be consistent. Encouraging the elderly patient to set goals that are achievable will get them to start physical activity and once they achieve one goal another should be set. This way they will be working towards something while they maintain their physical activity.
Conclusion
Leading a sedentary lifestyle for the elderly can be costly. The lack of physical activity has been linked to increased risks of falls by the elderly. Falls can result in physical harm and sometimes even death. Although falls are preventable, a lot needs to be done to ensure that the elderly remain active and they do not lose their motor ability. Reducing the risk of falls will also reduce the hospitalization costs for the elderly since falls have been linked to the increased hospitalization rates for the elderly. With continued physical activity, an elderly person can reduce his or her risk of falling and the complications that come from falls.
References
Chavez, K. S., Dwyer, A. A., & Ramelet, A.-S. (2018). International practice settings, interventions and outcomes of nurse practitioners in geriatric care: A scoping review. International journal of nursing studies, 78, 61-75.
Clancy, A., & Mahler, M. (2016). Nursing staffs’ attentiveness to older adults falling in residential care–an interview study. Journal of clinical nursing, 25(9-10), 1405-1415.
Ding, L., & Yang, F. (2016). Muscle weakness is related to slip-initiated falls among community-dwelling older adults. Journal of biomechanics, 49(2), 238-243.
Hua, F., Yoshida, S., Junling, G., & Hui, P. (2007). Falls prevention in older age in Western Pacific Asia Region. WHO Background Paper to the Global Report on Falls among Older Persons.
King, A. C. (2001). Interventions to promote physical activity by older adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(suppl_2), 36-46.
Kwan, E., & Straus, S. E. (2014). Assessment and management of falls in older people. CMAJ, 186(16), E610-E621.
Trombetti, A., Reid, K., Hars, M., Herrmann, F., Pasha, E., Phillips, E., & Fielding, R. (2016). Age-associated declines in muscle mass, strength, power, and physical performance: impact on fear of falling and quality of life. Osteoporosis international, 27(2), 463-471.
Vieira, E. R., Palmer, R. C., & Chaves, P. H. (2016). Prevention of falls in older people living in the community. Bmj, 353, i1419.
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