INSTABILITY AND FALLS

The falls are an important cause of wounds, incapacity and death in old people. These people have more problems to maintain the stability that is manifested by careful march (rigid posture, short and slow steps, instability),

Alarm indicator

 - Ocular: decrease of visual acumen, near and nocturne vision.

  - Hearing: excessive earwax, increase of threshold tone.

  - Nervous system: alteration of the reflexes, decrease of reaction time…

Consume of sedative is the most important element in the risk of falls how we can see in this article Epidemiología de caídas de ancianos en España. Una revisión sistemática, 2007 and in this other Factores de riesgo de accidentes en la edad geriátrica.

Other risk is negation to physical limitations, so the patient doesn't know about their her/his own limitation and she/he do all without some type of care causing much falls and other accidents.

The nurse must insist in this point, treat to convince her/his about the limitations y how to confront the problems that it cause.

Risk factors

  - More than 75 ages.

  - Alteration of stability and march.

  - Previous falls.

  - More than 4 drugs.

  - Fragile old people.

  - Muscle debility.

  - Decrease of vision.

Physical consequences

Fracture, hematoma, burns, pain injuries in delicate tissues.

Psychosocial consequences

Aggressiveness, behavior upset, loss of self-esteem and increase of social isolation.

After fall syndrome

The patient has to adopt measures to prevent other fall. The primary prevention includes:

  - Life habits: maintain functional capacity, exercise and not toxics habits.

  - Environmental security measures: in home and in community environment.

One form to count the risk fall in old people is with the Downton scale. 

The measures to prevent the falls:

  - Avoid slippery ground, irregular or wet.

  - Good illumination in all the rooms.

  - Rooms without obstacles and have to be organized.

  - Handrails in beds.

  - Use of canes.

What to do in a fall

• Evaluate the state of the patient and some possible injuries.
• Inform to the doctor or to the urgency service.
• Don’t move the patient if we suppose there would be a fracture.
• Observation.

Video. In this video is explained the risk factors and what to do when a patient suffer a fall.

Third prevention

The purpose of this prevention is reduce the consequences of falls to avoid the after – fall syndrome.

• Teach to the patient to stand up to avoid the dehydration, hypothermia, pneumonia…
• Rehabilitate the stability with an exercise program.
• Educate the march: help with canes.
• Therapy to support.

As in many geriatric syndromes, the best actuation we can do is the prevention. Normally we go to patient’s homes when we have to realize some cure, put an injection… but in my opinion we should visit their houses to observe the risks they can have. With this, we’ll advise to patient and family how they can fix this.