Older Adult Health: Mental Aspect Essay

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Updated: Mar 1st, 2024

Introduction

My professional area of nursing is mental health, and I will focus on older adult health and the ongoing risk assessment. One of the key health problems that develop in this population is inpatient falls. This essay aims to analyze the scenario from my personal experience based on the reflective model by Driscoll. In particular, the model implies the discussion of three questions, such as what? so what? and now what? I consider that this tool is rather useful since it offers a simple yet comprehensive method for presenting personal scenarios and exploring them.

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The reflection on the various aspects of the scenario and its critical analysis allows for understanding the learning lessons and making relevant conclusions. For experienced nurses, Driscoll’s model serves to help them remain competitive in the rapidly changing healthcare environment, while student nurses benefit from the opportunity to link theories and practice (Edwards 2017; Smith 2016). In terms of the Trust Policy, no sensitive patient data will be disclosed. More to the point, I will also clarify the role of the Multidisciplinary Team (MDT) in my scenario evaluation.

Reflection

What?

When I was on the ward, Mrs. G, an 80-year-old woman, was hospitalized because of the fall that happened at her home. This patient seemed to have no cognitive disorders and was independent in spite of her age. After introducing me to this lady, my mentor stated that I would conduct her physical health observation and also assist her with her care needs. At the same time, I was given a health assistant who helped me with the observations. Upon the completion of the assessment, I found a bruise on her back that was the consequence of her previous fall in home settings. When I notified my mentor about the existence of the bruise, he asked me to document it. The MDT was also involved in the evaluation process to ensure that all the issues are taken into account and that the most suitable intervention would be chosen to offer this patient mobility aid.

To better understand the problem of falls, it seems to be important to refer to the academic literature. Falls in older adults are the dominant cause of mortality and morbidity with the development of complications. It is estimated that one out of three Americans who are aged 65 and over tends to fall at least once annually (Sherrington et al. 2017; Pfortmueller, Lindner & Exadaktylos 2014). Since the number of older adults increases rapidly, the need to explore this topic becomes evident.

Most importantly, falls lead to social and economic challenges that are faced by patients, their families, and communities. Inpatient falls are also widespread across the UK hospitals, which occur due to a lack of awareness, training, and early identification (Morilla-Herrera et al. 2016; Gopinath et al. 2016; Vieira, Palmer & Chaves 2016). I agree with the current studies that prioritize the role of timely assessments that help to recognize those patients who are at risk of falling. Therefore, this reflection utilizes the idea of preventing complications through the easy-to-implement assessment.

So What?

Nursing examination of patients with falls includes a physical examination, the study of the patient’s ability to move independently, and assessment of the patient’s environment. Ellis et al. (2017) state that the nurse should ask the patient and his or her relatives about cases of falls during the last year, clarifying their features, such as location, suddenness, provoking factors, shoes and clothes, and environment.

Accordingly, I asked Mrs. G about the mentioned issues and received her responses. Elderly patients with mental disorders and memory impairment may not remember episodes of their falls, and in these cases, information should be sought from relatives or caregivers (Callis, N 2016; Phelan et al. 2015). However, in the given case, the patient was alert and oriented as her answers were complete and conscious. As a nurse, I tried to find out not only the conditions in which the falls occurred but also the accompanying symptoms, time of day when the patient fell and behavior after it.

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I conceptualized my skills and knowledge in the field of applying the risk assessment for falls in elderly patients. There is a range of aspects that should be evaluated, and the complete risk of falls program should integrate the indicators such as the number of falls, the presence of imbalance, falls more than twice a year, and falling without seeking medical help (Gale, Cooper & Aihie Sayer 2016; Kehoe et al. 2016). To test the ability to perform basic functions, the patient was offered to perform several tasks.

First of all, I asked Mrs. G to place both hands behind the head to test her ability to comb hair and wash her back was evaluated. Then, she was offered to place both hands on the back at the waist level and proved her ability to dress, use the toilet and perform hygiene procedures of the lower body (Gawler et al. 2016; Thies et al. 2015). After that, I stated that the old lady is expected to touch the thumb on her opposite leg while seated, which is the evaluation of putting on one’s lower body and carrying hygiene procedures.

In the course of these tests, I found that the patient is relatively independent in her movements and daily needs. Nevertheless, balance assessment showed that Mrs. G is at risk of more falls in the future since her vestibular apparatus seemed to be impaired due to her age. During the “Stand Up and Go” test, the patient was asked to sit in a free position on a chair of standard height with armrests, get up from the chair without the help of hands, walk several meters forward, go up to the chair and sit without the help of hands (Kojima et al. 2015). The test was carried out in the usual way, without outside help, while this test was evaluated as a risk factor for falls.

Acting as a part of the MDT, I learned that teamwork is essential in risk assessment since all the members contributed to the process (Bruce et al. 2016; Hopewell et al. 2018). It was also important to me to complete the evaluation chart, while both my mentor and my assistant helped me with it.

I found that I acquired the ability if successfully connecting the theoretical guidelines with the practical actions. For example, I was aware of different tests that are useful to assess the physical well-being of the patient to prevent further incidents. Mrs. G was requested to squeeze my fingers with both hands to ensure that she can open doors and hold a sheet of paper between the thumb and forefinger, which tests selecting and holding items (Hill et al. 2015).

I considered the possibility of the lady’s free movement by asking her to lift from a chair without the help of hands. When determining stability, the duration of maintaining equilibrium was fixed when resting on one leg in a standing position with arms spread apart and the opposite leg allotted. The ability to maintain equilibrium for more than 10 seconds was considered a good result, from 5 to 10 seconds satisfactory. The inability to maintain balance on one leg was assessed as an unsatisfactory result. It should be stressed that testing was carried out alternately on each of the patient’s legs.

In the course of working with Mrs. G, I mastered my skills in finding relevant evidence-based guidelines and applying them to the specific needs of the patient. When my mentor suggested that I should refer to the National Institute for Health and Clinical Excellence (NICE) recommendations, I accessed this source and found more information about fall reasons. The frequent occurrence of fractures in the elderly and senile can be caused by osteoporosis, weight loss, pathology of the joints, especially the lower extremities as well as hearing and vision problems (Curl et al. 2016; Gopinath et al. 2016). However, it should be remembered that the risk of fractures due to falls is especially significant in patients with impaired motor function.

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In other words, this also shows that the patient is at risk of recurrent falls and complications. I contacted the MDT to share this finding and ask them to perform the vision assessment as well. I understood that risk management is a complex procedure that should integrate patient needs, preferences, environment, and, most importantly, the evaluation of balance. The results of tests should be properly documented and shared with the MDT so that they can make the most pertinent decision.

Now What?

The analysis of these data leads to the conclusion that it is necessary to take measures to prevent falls and fractures. The UN has determined the rights of elderly people from socio-political positions: independence, participation, care, and dignity (Kenny, Romero-Ortuno & Kumar 2017; Manthorpe & Moriarty 2017). The concept of active longevity and health promotion, as opposed to a long dependent life, provides for independence from material and physical assistance from relatives or social workers and diseases.

I understood that for nurses, it is necessary to set older people to be more attentive to their health, using possibilities of their training, diet, physical exercises, and a favorable environment (Burton et al. 2015; Hill et al. 2015; Kvelde et al. 2015). The importance of older people’s physical activity in preventing falls is also confirmed in the Global Recommendations on Physical Activity for Health that is formulated by the World Health Organisation (WHO). It states that older people should give the physical activity of medium intensity at least 150 minutes a week, or perform aerobics exercises of high intensity at least 75 minutes a week, or have an equivalent amount of physical activity of medium and high intensity.

Reviewing my assessment of Mrs. G, I can state that I became more confident in my actions, and the similar scenario would not cause any confusion. I learned the basics of physical evaluation since I was given the opportunity to conduct and document it. Considering that the overall number of older adults tends to increase, I consider that their care should be much more elaborated and structured (Clinical guidelines on falls and fractures 2017).

I would like to stress that before any examination, nurses should give informed consent and refrain from any intervention in case the patient denies them. In terms of ethical and legal considerations, as a nurse, I should act at the patient’s best. Working in the MDT team, I learned that interaction and mutual trust are essential in providing high-quality care services. Therefore, I think that my communication skills should be improved so that I can deliver messages properly and pay attention to others’ information. In addition, it is clear that I should always refer to the NMC Code (2019) and Trust Policy, which promote confidentiality to patients’ sensitive data.

My mentor played a great role in this assessment by guiding me through the patient’s physical examination and further documentation. Even though I made some mistakes, I consider that I will pay more attention to these issues during my further work to avoid them. It was useful to ask questions and receive detailed answers from my mentor (Babatunde & El-Gohary 2018). In my future practice, I plan to be responsive to older adults, especially those who are at risk of falls. I will act according to the national guidelines and local policies to ensure ethics, law, and care delivery appropriateness.

Summary / Conclusion

To conclude, this reflection allowed me to reveal my practice strengths and weaknesses in assessing older adults regarding the risk of falls. I identified the areas I need to improve on to become a competent professional nurse in my future career. The use of the model by Driscoll was also important since it provided the set structure of the reflection. In general, the key positive outcome of the examination is that I learned to connect theory and practice, which is one of the fundamentals of effective nursing services.

Reference List

Babatunde, S & El-Gohary, H 2018, ‘Necessity of mentoring in entrepreneurship education: reflection by practitioners’, Journal of Professional Issues in Engineering Education and Practice, vol. 145, no. 1, 25-38.

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Bruce, J, Lall, R, Withers, EJ, Finnegan, S, Underwood, M, Hulme, C & Lamb, SE 2016, ‘A cluster randomised controlled trial of advice, exercise or multifactorial assessment to prevent falls and fractures in community-dwelling older adults: protocol for the prevention of falls injury trial (PreFIT)’, BMJ Open, vol. 6, no. 1, pp. 1-28.

Burton, E, Cavalieri, V, Adams, R, Browne, CO, Bovery-Spencer, P, Fenton, A M & Hill, KD 2015, ‘Effectiveness of exercise programs to reduce falls in older people with dementia living in the community: a systematic review and meta-analysis, Clinical Interventions in Aging, vol. 10, pp. 421-423.

Callis, N 2016, ‘Falls prevention: identification of predictive fall risk factors’, Applied Nursing Research, vol. 29, pp. 53-58.

2017. Web.

Curl, A, Thompson, CW, Aspinall, P & Ormerod, M 2016, ‘Developing an audit checklist to assess outdoor falls risk’, Proceedings of the Institution of Civil Engineers. Urban design and planning, vol. 169, no. 3, pp. 138-152.

Edwards, S 2017, ‘Reflecting differently. New dimensions: reflection-before-action and reflection-beyond-action’, International Practice Development Journal, vol. 7, no. 1, pp. 1-14.

Ellis, G, Gardner, M, Tsiachristas, A, Langhorne, P, Burke, O, Harwood, RH & Wald, H 2017, ‘Comprehensive geriatric assessment for older adults admitted to hospital’, Cochrane Database of Systematic Reviews, vol. 1, no.9, pp. 1-100.

Gale, CR, Cooper, C & Aihie Sayer, A 2016, ‘Prevalence and risk factors for falls in older men and women: the English Longitudinal Study of Ageing’, Age and Ageing, vol. 45, no. 6, pp. 789-794.

Gawler, S, Skelton, DA, Dinan-Young, S, Masud, T, Morris, RW, Griffin, M & Iliffe, S 2016, ‘Reducing falls among older people in general practice: the ProAct65+ exercise intervention trial’, Archives of Gerontology and Geriatrics, vol. 67, pp.46-54.

Gopinath, B, McMahon, CM, Burlutsky, G & Mitchell, P 2016, ‘Hearing and vision impairment and the 5-year incidence of falls in older adults’, Age and Ageing, vol. 45, no. 3, pp. 409-414.

Hill, AM, McPhail, SM, Waldron, N, Etherton-Beer, C, Ingram, K, Flicker, L & Haines, TP 2015, ‘Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial’, The Lancet, vol. 385, no. 9987, pp. 2592-2599.

Hopewell, S, Adedire, O, Copsey, BJ, Boniface, GJ, Sherrington, C, Clemson, L & Lamb, SE 2018, ‘Multifactorial and multiple component interventions for preventing falls in older people living in the community’, Cochrane database of Systematic Reviews, vol. 1, no. 7, pp. 1-307.

Kehoe, A, Smith, JE, Edwards, A, Yates, D & Lecky, F 2015, ‘The changing face of major trauma in the UK’, Emergency Medicine Journal, vol. 32, no. 12, pp. 911-915.

Kenny, RA, Romero-Ortuno, R & Kumar, P 2017, ‘Falls in older adults’, Medicine, vol. 45, no. 1, pp. 28-33.

Kojima, G, Masud, T, Kendrick, D, Morris, R, Gawler, S, Treml, J & Iliffe, S 2015, ‘Does the timed up and go test predict future falls among British community-dwelling older people? Prospective cohort study nested within a randomised controlled trial’, BMC Geriatrics, vol. 15, no. 1, pp. 38-45.

Kvelde, T, Lord, SR, Close, JC, Reppermund, S, Kochan, NA, Sachdev, P & Delbaere, K 2015, ‘Depressive symptoms increase fall risk in older people, independent of antidepressant use, and reduced executive and physical functioning’, Archives of Gerontology and Geriatrics, vol. 60, no. 1, pp. 190-195.

Manthorpe, J & Moriarty, J 2017, ‘Falls prevention: access and acceptability to all?’, Working with Older People, vol. 21, no. 2, pp. 72-81.

Morilla-Herrera, JC, Garcia-Mayor, S, Martín-Santos, FJ, Uttumchandani, SK, Campos, ÁL, Bautista, JC & Morales-Asencio, JM 2016, ‘A systematic review of the effectiveness and roles of advanced practice nursing in older people’, International Journal of Nursing Studies, vol. 53, pp. 290-307.

Pfortmueller, CA, Lindner, G & Exadaktylos, AK 2014, ‘Reducing fall risk in the elderly: risk factors and fall prevention, a systematic review’, Minerva Med, vol. 105, no. 4, pp. 275-81.

Phelan, EA, Mahoney, JE, Voit, JC & Stevens, JA 2015, ‘Assessment and management of fall risk in primary care settings’, Medical Clinics, vol. 99, no. 2, pp. 281-293.

Sherrington, C, Michaleff, ZA, Fairhall, N, Paul, SS, Tiedemann, A, Whitney, J & Lord, SR 2017, ‘Exercise to prevent falls in older adults: an updated systematic review and meta-analysis’, British Journal of Sports Medicine, vol. 51, no. 24, pp. 1750-1758.

Smith, K 2016, ‘Reflection and person-centredness in practice development’, International Practice Development Journal, vol. 6, no. 1, pp. 1-6.

Thies, SB, Price, C, Kenney, LPJ & Baker, R 2015, ‘Effects of shoe sole geometry on toe clearance and walking stability in older adults’, Gait & Posture, vol. 42, no. 2, pp. 105-109.

Vieira, ER, Palmer, RC & Chaves, PH 2016, ‘Prevention of falls in older people living in the community’, BMJ, vol. 353, pp. 1-14.

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