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Professionals as Health Protectors

Twelve thousand older people die in America each year as a result of falls.1

Safety, a universal need people have at all stages of life, becomes increasingly important as we age because of natural changes that make people more vulnerable to injury. As we age, falls and untoward medication incidents are responsible for a significant number of serious and life-changing injuries and even deaths. Proactive planning by health care professionals to protect health, and address fall risks and safety problems stemming from medications can significantly reduce the risk of injury.

Ben Franklin’s saying, “an ounce of prevention is worth more than a pound of cure” is as true today as ever. Professional literature includes a plethora of health promotion, risk reduction, and injury prevention information related to falls and medications for older adults. Two easily remembered tools are included in this month’s edition of Gero Gems to assist in assessing falls and prescribing medications for professionals working with older adults.

Unintentional injuries are the ninth leading cause of death for people over 65 and falls are at the top of the list.2 We know that older people are increasingly vulnerable to falls as a result of physical and environmental factors. Because professionals in geriatrics indicate that older people who fall more than twice in a 6-month period need to be evaluated, it is essential to include fall risk assessment when working with older adults.3

The “I Hate Falling” Mnemonic

This mnemonic fall risk assessment tool is designed to be easy to administer and is intended as an adjunct to the professional “tool kit” in assessing fall risk.

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 disturbances4

Older people 65+ are inherently at risk for injury from medications because of aging changes and chronic illness and often take several prescriptions along with a number of over-the-counter medications at any one time.

About one-fifth of community-dwelling older people take medications that are prescribed but not recommended by the Beers Criteria (HCFA guidelines for prescribers and pharmacists).5

The Harvest Mnemonic

The HARVEST mnemonic below, useful in clinical decisionmaking about prescriptions, has the potential to assist professionals in providing a “harvest of health protection” for older people:

  • Have a list of commonly prescribed medications available
  • Assess patient health status that may predispose to medication adverse effects
  • Review Beers Criteria before initiating
  • Verify new and existing medications
  • Ensure the older person’s understanding of medication adverse effects
  • Safety through preventative and proactive monitoring of medications
  • Therapeutic goals established to minimize adverse effects 6

While The Beer’s Criteria 7 is considered an excellent reference useful in aiding professionals in medication prescription for older people, it is not intended for use in lieu of clinical judgment but as an adjunct to competent clinical decision making. We are reminded that professional competency is essential to enhancing the safety, protection, and promotion of health and well-being for older adults and the community.

Recommended Resources: Evelyn’s Picks

Resources:

  1. Roman, M. (2004). Falls in older adults. AACN ViewPoint, 26(2), 1-7.
  2. Department of Health and Human Services Centers for Disease Control and Prevention, 10 Leading Causes of Death by Age Group, Slides (2003), available online July, 2007.
  3. Sloan, J.P. (1997). Protocols in Primary Care Geriatrics. New York: Springer Publishers
  4. Mauk, K. (2006). Gerontological Nursing: Competencies for Care. Boston: Jones and Bartlett, p. 367.
  5. Ibid.
  6. Helton , T., McGrain, A., & Muliira, J. (2005). A case study: Inappropriate use of amitriptyline in the elderly. Geriatric Nursing, 26(5), 317-320.
  7. Archives of Internal Medicine. Updating the Beers Criteria for Potentially Inappropriate Medication use in Older Adults, December 2003.

GERO GEMS are a monthly publication of the Center for Aging with Dignity. Compiled by Evelyn Fitzwater, Gero Gems is designed to raise awareness of aging and related issues impacting health care professionals and our society as a whole.

For more information:

Go to the Senior Health health topic.

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