1. Safety measures for elderly and geriatrics

2. OUT LINE introduction safety risk factor - why the elderly ?
Most common hazards
assessment methods
prevention

3. Objectives
After completing this seminar the students will be able to :
1.Discuss factors that affects people's ability to protect themselves from injury
2. Describe methods to assess a client's risk for injury
3. Identify common potential hazards through the life span
4.Give examples of Nursing diagnosis,interventions,outcomes for a client at risk for accidental injury
5.Explain interventions to prevent falls

4. Safety why its important
introduction
Safety why its important
Safety: The condition of being safe; freedom from danger, risk, or injury.
Safety : a contrivance or device designed to prevent injury
- its important to take care about elderly safety because of their poor health status and body movement abilities .

5. risk factor - why the elderly?
1- poor vision
2- cognitive dysfunction (confusion, disorientation, impaired memory or judgment )
3- impaired gait or balance and difficulty walking because of lower extremity dysfunction (e.g arthritis )
4 – difficulty getting in and out of chair /bed
5-orthostatic hypotension : These
individuals should be instructed to move slowly
and to remain seated until the dizziness passes.
6- urinary frequency or receiving a diuretics
7- medication effect ( sedatives, hypotonic, narcotic analgesics , diuretics )
8- reflexes may also be slower than younger. The increased amount of time it takes to react may make it harder to catch balance if you start to fall.

6. Common hazards Falls Burn Polypharmacy Pedestrian Choking
Automobile accidents

7. Fall fall is defined as “an event which results in a
person unintentionally coming to rest on the
ground or another lower level; not as a result of
a major intrinsic event (such as a stroke) or overwhelming hazard
Falls are the most leading cause of both fatal and nonfatal injuries in older adults.
Over 95% of hip fractures are caused by falls.
Any fall is the best predictor of future falls. Two thirds of those who have experienced one fall will fall again within 6 months

8. Many falls are linked to a person's physical condition or a medical problem, such as a chronic disease. Other causes could be safety hazards in the person's home or community environment.
Falls can result in
injury, loss of independence, reduced quality of life, and death in the elderly.
Fractures are the most serious health consequence ..
The most common fractures are of the vertebrae, hip, forearm, leg, ankle, pelvis, upper arm, and hand

9. Risk factors
hypotension, unsteady gait, altered mental status, poor vision, cognitive change, fear ,
• Impaired physical mobility
• Sensory deficits
• Lack of knowledge of health practices or safety precautions
• Hazardous environment
• History of accidents or injuries
• In the home or community setting

10. Older adults have trouble seeing the edges of stairs .
SAFETY ALERT
Older adults have trouble seeing the edges of stairs .
Painting white stripes on the edges of the steps will help increase contrast and may prevent falls

11. Nurse cane use an assessment tool called Get Up And Go in hospital o r home sitting – kimbell 2011

12. CLINICAL ALERT
Falls can break bones and self-confidence, leading to fear of falling causing decreased activity level and decreased muscle strength .

13. Falling prevention
1-Exercise regularly. It is important that the exercises focus on increasing leg strength and improving balance, and that they get more challenging over time. Tai Chi programs are especially good.
2-Make their homes safer by reducing tripping hazards by:

14. • .Assess for potential personal cause of falls:
hypotension, unsteady gait, altered mental status, poor vision, cognitive change, fear.
• In the home or community setting, assess for potential environmental causes of falls
Lighting: inadequate amount,
inaccessible switches Floors: presence of electrical cords
slippery surfaces Stairs: absent or unsteady railings, uneven step height or surfaces
Furniture: unsteady base, carpets are too high or too low, chairs with wheels
Bathroom: inappropriate toilet height, slippery floors or tub.
Absence of Grab Bars
fall out of bed : Place the matters directly onto the floor Place padding on floor next to bed or between client and side rails

17. Polypharmacy and Medication Errors
Older adults take considerably more medications than younger people The act of taking many medications 5 or more concurrently is termed polypharmacy “concurrent use of several drugs.” - Nonadherence is defined as the extent to which patients are not willing to follow the instructions they are given for prescribed treatments

18. An elderly person experiencing polypharmacy
is more susceptible to medication errors,
defined as taking the wrong medication or the
wrong dose at the wrong time or for the wrong purpose
There is an increased incidence of drug–
drug interactions in a patient experiencing
polypharmacy

19. Clinical manifestations .
may include varying degrees of
nausea, constipation, gastrointestinal bleeding
urinary incontinence, muscle aches, sexual dysfunction,
insomnia, confusion, dizziness, orthostatic
hypotension, and falls

20. Reducing medication risks in older adults
. Discuss with patients the need to: -keep an accurate list of all medications, including generic and brand names, dosages, dosing frequency, and reason for taking the drug -keep a complete list of medical providers and their contact information . Teach patients about: - Supported self-administration of medications if possible - importance of taking medications exactly as directed - avoid sharing medications Also, if appropriate, help patients establish memory aids. For instance, advise patients to link drug administration to their daily routine or to use color-coded charts, automatic dispensers with bells, or voice-activated message services to remember to take their doses Ensure that the patient/caregiver is an informed

21. Burns
A study of elderly burn victims in the Journal of Burn Care and Rehabilitation observed that 70 percent of the burn victims surveyed were burned in their homes ("A Survey of Risk Factors for Burns in the Elderly and Prevention Strategies," 2002).
Burns are common injuries in case of explosions and fires. Specifically, thermal burns are caused by contact with sources of high heat, such as flames, hot liquids and hot surfaces,
contrary to what happens with chemical and electrical
burns. Every year over 1,000 deaths due to burns among elderly are reported in the United States

22. RISK FACTORS FOR BURN INJURIES AMONG ELDERLY PEOPLE
The main risk factors for fatal burns among elderly people Are:
Careless smoking, especially in the bedroom
Absence of a smoke detector
Winter time
Electrical blanket of poor quality
Excessively hot water used when showering
or cooking oil or butter used when cooking

23. Elderly are at higher risk for house fire death for a number of reasons:
Reduced sensory and cognitive abilities, such as smell,
touch, vision and hearing, and mental diseases such as
dementia, Alzheimer and depression leading to slower
reaction or complete inactivity
Prescription drugs, when elderly alone and especially when combined due to decreased alertness
Mobility impaired, slowing or completely preventing escape and slow response time can diminish an older adult's ability to sense a burn when it happens
Lack of financial means for environmental improvements
aim to reduce risk of fire (portable heaters or heating blankets, older homes, etc.)

24. Choking
is one such real risk. Even though statistics show that the use of dentures has lessened due to attentive dental care, certain foods still pose a problem.
Here is a list of common choking hazards and easy substitutions
1 -Meat Large chucks of meat can be very hard to chew, and as such swallow safely. It is highly recommendable to avoid hard meats, like steak, and big pieces of meat in general.

25. Fruit Large chucks of fruit pose a serious danger to eating elderly
Fruit Large chucks of fruit pose a serious danger to eating elderly. Fruit that are especially hard, like apples, pineapples and plums should peeled completely and cut into easy to chew bites. Pureed versions of these fruits, like applesauce or blended plums might also be a great option to consider.
Bread Bread poses to a threat because if it gets stuck in the airway, water can cause it to swell and block the air passage. Cake and milk together poses a similar issue
Liquids Some liquids, like water, can pose choking hazards because of the lack of thickness. 
Better Choices: Foods With Low Choking Risks
Here are some food choices that are easier to swallow:
Fish, if it’s filleted
Ground meat
Soups
Chocolate (if it gets stuck, it melts)
Applesauce, pudding and Jello
Lightly toasted bread with butter or jelly

26. Dos and Don’ts of Eating
These tips will also help reduce incidences of choking:
Don’t drink fluids while you’re eating. People do this to make the food go down and it can lead to choking.
Don’t talk while you eat. The epiglottis—the hinge like flap at the base of your tongue that keeps food from entering your windpipe—doesn’t know whether to open or close because it doesn’t know whether food or air is coming.
Don’t eat lying down.
Do learn to eat more slowly.
Do put less on your plate so you can’t eat too much too fast. Have a second helping afterward instead.
Do julienne the food.
Do peel apples before serving or, better yet, serve applesauce

27. conclusion
Finally , elderly need holistic care to cover every weakness in there health or hazard in there environment.
Video

28. referanses Fundamentals of Nursing_Kozier & Erb's 9th Edition CDC
Gerontocological nursing
Community of Public health Nursing

29. ARTICLE Engaging Adolescents to Care for Elderly Safety in the Community
Asia Pacific International Conference on Environment-Behaviour Studies, Grand Margherita Hotel, Kuching, Sarawak, Malaysia, 7-9 December 2010
In Hong Kong, a study of the trends and characteristics of accidents involving older persons was undertaken in a railway system.
Participant: A team of gerontologist and psychologists and their students was engaged.
Purpose: Conducting a community project with older railway passengers to identify key factors related to accidents including physical environmental conditions.
Sample and procedures: A total of 32 undergraduate students in Lingnan University was recruited to participate in the project.
Students Role: They were briefed the objectives of the study, and trained basic skills in conducting field observations and face to face interviews.

30. Results:
There has been a slight increase in accidents among older persons in the past two years. The accidents involving older passengers tended to occur between 9am to noon since many of them needed to travel to a hospital. The major types of accidents are ‘lost balance and fell inside the train compartment’, ‘struck by the train doors’ and ‘stepped into the platform gap’. There may be under-reporting of accidents or near-miss accidents. The participants did not have a good knowledge of the rail routes, more than 20% had chosen a longer and/or indirect route that involved unnecessary change(s) of trains. Elderly passengers are in general satisfied with the rail services. The three aspects that received relatively low ratings were: train frequency, train seat availability, and elderly train seat arrangements.

31. Fnidings:
According to the safety attitude model, the railway corporation can impart more safety knowledge to elderly passengers
In the end, safety behaviour of elderly passengers can be enhanced.

32. DATA CLUSTER Mr.P.S suffered a stroke resulting in left-sided Weakness.As a result his gait is unsteady . The nurse noticed that his home has several throw rugs and furniture impending mobility .The bathroom doesn't have grab bars by the toilet

33. Nursing. Diagnosis Risk for injury r/to impaired mobility and potential home hazards /At risk of injury as a result of environmental conditions interacting with the individual's adaptive resources
Interventions : Environmental Management : Safety /Monitoring and manipulation of the physical environment to promote safety .
Sample Activities :
. Identify safety needs of client
Identify safety hazards
.Modify the environment to minimize hazards & risks
.Monitor the environment changes in safety status
Educate about enviromental hazards
*environmental
Outcomes:
Safe Home Environment