Elderly Care India Home Health Care

2. INDEX 1. How to Care for Aging Parents 2. How to care for your parents from a distance 3. 10 Tips to Take Care of Aging Parents 4. How to keep Homebound Seniors Active 5. An Elderly Parent transforming from Hospital to Home 6. Coping with Care giving for Ailing Elderly Parent 7. Arthritis – Causes & Symptoms 8. Caring for an Alzheimer’s Patient 9. Risk of Fall in Elderly 10. Fall Prevention in Elderly 11. Fall in Elderly – Physiotherapist Perspective 12. The Role of Nurses in the Elderly Fall Prevention Care Plan Page 1

3. HOW TO CARE FOR AGING PARENTS Page 2

4. How to Care For Aging Parents As we all get older we need to have serious discussion among our close family members (spouse, kids, siblings) about taking care of our Aging Parents. As they reach 70s and 80s we need to check their physical and mental well-being and make sure they are leading an independent living with excellent quality of life. If we don’t plan properly we all will end up in confusion, sadness, helplessness, frustration, exhaustion when we have to deal with inevitable health related challenges. With solid family support, professional support and good communication we can renew the sense of love, compassion and tenderness in to any family with Aging Parent.In order to do that effectively adult children should take care of the following diligently: 1. Find out their (Aging Parent) needs: Find out from your Parent what they want whether: • They want to stay at home • Move close to their kids • Move to a Senior independent living community with common dining hall, cleaning facility, medical facility etc. • Old age home /Nursing home. When you notice poor eating habits, poor hygiene, neglecting their home, forgetfulness, difficulty driving then you need to counsel them to get help 2. Find out your Parent’s assets :Find out your Parents assets including pension amount, the health insurance policies, and free medical facilities from the organization where they used to work etc. Page 3

5. 3. Decide whether you want to be their Caregiver: It may • Put emotional toll on you • You may have to quit the job • You may lose your benefits for your retirement. • Consider professional help • Make a Caregiver budget • Make your own retirement plan • Understand the costs of keeping your Parent in their home ( May need home health Nursing care or Medical Care Taker care if they have medical problem or just an assistant to do their day to day chores) 4. Make a joint decision: Discuss with your Parents, spouse, siblings and Children and make a joint decision about the location of the stay. 5. Financial Planning: Based on the above make a budget to take of care of your Parent with the contribution from your siblings to relieve the entire financial pressure on you.With careful planning we can provide conducive atmosphere for our Parents to Age gracefully. Page 4

6. HOW TO CARE FOR YOUR PARENTS FROM A DISTANCE Page 5

7. How To Care For Your Parents From A Distance Taking care of aging parents from distance is not only difficult but also is a cause of concern for many working professionals not only living abroad but Valso in a different city as their parents in India. Parents may require care or help during temporary health situation like surgery or even a chronic health condition. Other family members and relatives may step in at this time and help out for a while but most of the time they may have to leave before the patient recovers completely. India Home Healthcare provides reliable and coordinated care which is tailored to the patient’s requirement. The staff, not only stay in touch with the physician or surgeon, but also with the family members to update the progress of the patient. The online patient portal which gets updated regularly lets the family members anywhere to log in and follow the progress of the patient. This can also be used to take any second opinions if needed. Parents who have been active, healthy and working towards our well being all their life either at a job or taking care of family, show a change in their health status soon after retirement or once they ‘think’ they are getting old. This is sometimes called ‘empty nester’s syndrome’ where the parents start showing these symptoms when the family members (children) move out of the house and start setting up their own families abroad or even in a different city in India. The psychological factors of well being in old age are overlooked easily even by the family members. Page 6

8. Depression due to loneliness and decreased sociability in old age is real and may have significant effect on the health status. Even when there is no clear diagnosis of depression, it will affect the individual’shealth more than we can imagine. According to a study conducted by Singh and Misra in 2009 on 55 elderly people, there is direct relationship between loneliness and old age depression. India Home Health care provides care givers who provide companionship to the elderly patients, not only to keep them active and alert but also help them overcome activities which are difficult for them like evening walk to the park. These activities are needed to re- integrate them back in to the community and maintain the quality of life they deserve and want. The care givers also help to maintain a healthy diet plan and monitor even commonly found and commonly neglected disorders like hypertension and diabetes which are usually the risk factors for many diseases in elderly. India Home Health Care also provides monthly care plans which include regular doctor visits, nurse, dietitian and physical therapist visits every month to prevent and detect any disorders in the early stages.Aging surely involves many degenerative processes, but it need not include diseases. Adjusting to the changes that accompany old age require flexibility and new coping skills. India Home Healthcare helps not only the parents in the aging process but also family members who can be reassured that their parents are in the best hands. Page 7

9. 10 TIPS TO TAKE CARE OF AGING PARENTS Page 8

10. 10 Tips to Take care of the Elderly We are on this earth today because of our parents. They taught us the lessons of life, to succeed and to get a respectful social image. Children need parents’ help till they get settled in their life in all the aspects. The same way parents also need support when they become aged. And it is children’s responsibilities to give them a respectful retirement life. Here are 10 tips to make our parents happy during their evenings of life. 1. Avoid loneliness: Spend some time with parents, talk to them, keep them involved in family affairs, get their suggestions and work accordingly. 2. Dietary Needs: Their intake will be less because of poor appetite but we have to insist them to have balanced diet regularly. 3. Medical Needs: Take care of their health issues, physical and psychological. Talk to them if they need any medical assistance, provide them the required assistance. Risk of fall will always be there because of general weakness and fragile bones. We can avoid this by providing extra support. 4. Regular Exercise: Spare some time especially for your parents and take them for a morning or evening walk, they will be happy to spend time with you. 5. Finance : Parents were independent their whole life to take care of their own and the family’s financial needs but to meet their old age needs, they should have some insurance policies which make them feel confident. 6. Never be rude: At this age there is a tendency to repeat the same thing again and again but we should not behave rudely. The children must have patience to understand the situation. Page 9

11. 7. Listen and solve their problems: Children should listen to their problems patiently and try to solve them. 8. Make them feel special: By celebrating their Birthdays and Wedding anniversary. 9. Help them for even small things: They need help for each and every small thing like getting a glass of water, reading newspaper for them. Ask them what they need and deliver it. 10.Allow grand children to play with them: This is the best way to keep them happy always. It is like letting 6 and 60 year old children play together . These are the few simple methods to keep our aging parents happy so they can live with dignity and respect. Page 10

12. HOW TO KEEP HOMEBOUND SENIORS ACTIVE Page 11

13. How to keep Homebound Seniors Active Seniors as they get older may feel comfortable to stay at home. Some of them will be independent within their familiar surroundings but may feel bored at home. Some of them need minimal to moderate help to do their day to day activities because of their health condition. Some of them may need total assistance and may be bed bound due to severe disability due to the deterioration in their health condition. In all the above three situations one may feel lonely, boredom and depressed if they don’t have a proper inspiring companion or caregiver. In order to keep the Senior Citizen active we can formulate certain recreational activities to keep them physically and mentally fit and keep them happy. We can try the following methodology whichever works depending upon the individual’s interest: 1. Seniors who are independent a. Explore the world via the world wide web- Computer games, facebook/twitter/emails/Skype to stay connected with friends and families and make new friends with similar interests, whatsapp with friends and family, listen to the lectures/discourses/talks/songs of their interests in the computer or laptop with speakers attached b. Start a Book Club – Read books with big fonts or magnifying glass or digital books with large fonts and discuss with the club members through a Skype call or conference call about the characters in the book that they are focusing on. c. Puzzle, board games (chess, snake and ladder, Chinese checker, scrabble), solitaire, jigsaw puzzle, carom board, cards etc. d. Work from home if they are still able to do that for couple of hours a day e. Write a letter or call someone and speak to them on several topics that are interesting for them. f. Tinker- Able to fix little things at home and have a sense of fulfilment g. Painting, drawing, home indoor gardening, listening to the music h. Hire a care giver/companion to give company and have a partner to play several indoor games. i. Start a new hobby Page 12

14. 2. Seniors who need minimal to moderate help for day to day activities: a. Caregiver to help in personal hygiene, walking, dining, bathing etc. b.Formulate a recreational activity that gives interest to that Senior. For e.g. To listen to a good music for one hour in the morning, then do exercises for all the joints followed by walking inside the house with the help of a walker or a cane, then do a little writing or drawing or painting for another hour, then listen to a book or a magazine read by their care giver, then play chess or carom for another hour in the evening and go in the backyard or outside in the wheelchair to get some fresh air and watch their favorite program in the television 3. Seniors who are bed bound and need total assistance a. Bed should be closer to the window so that they can see outside for birds, people, traffic, workers doing some painting or road repair work so that they stay connected to the outside world. b. Keep a big clock and a large print daily calendar for them to look c. Put soft music/lectures/discourses/talk for them to listen These are the few tips to maintain a healthy, happy quality of life among the home bound Senior citizens. Page 13

15. AN ELDERLY PARENT TRANSITIONING FROM HOSPITAL TO HOME Page 14

16. An Elderly Parent Transitioning From Hospital To Home Despite the obvious relief of getting your elderly parent discharged from hospital after an illness or a surgery, it can be quite stressful to transition them back to life at home. The situation becomes more complicated when your parents live alone. With the hospitals focusing on reducing the length of stay, the burden of rehabilitating the patient falls more and more on the family. People are getting discharged with greater need for support and care at home. Even though you might love your parent and might want to take care of them to the best of your ability, it is becoming difficult for the majority. With demanding careers and taking care of your own home and children, it can be a daunting task to care for your loved one when he/she is recuperating. However, having a clear plan in place for life after discharge will be immensely beneficial to you and your family. Ideally, a smooth transition should ensure that, • The patient is clinically safe • There are no risks or threat of getting readmitted to the hospital for the same problem or other complications • The patient is confident of getting back to normal routine Here are some simple solutions to achieve these goals: 1. Assess your home environment: Before the discharge do a quick home check and look at it through the eyes of your fragile parent. Make a list of questions that you need to answer before the discharge, for example: Will there be a need for a hospital bed or oxygen supply? What consumables like diapers, gloves, etc. need to be kept in stock? 2. Be part of the discharge planning process: Speak to the physician and the hospital nursing team about your concerns. Understand how you could help and the specific tasks your parents would need assistance for. Get a rough estimate of how long the recuperating period might be. Page 15

17. 3.Make the necessary changes at home: If your parent needs a hospital bed or other equipment, you might need to choose a room for them with enough space. Ensure that there is enough lighting, especially the path from the bed to the bathroom. Consider the possibility of installing grab bars in the bathroom. If you plan to involve additional caregivers, plan on a comfortable space to accommodate them. 4.Get support for the health care tasks:This is the actual bulk of care-giving at home. It requires your physical presence and assistance in getting your parent back on his/her feet. Daily tasks like feeding, medication administration, monitoring for complications or infections need to be performed consistently. Evaluate if you can perform these tasks and how much time you can devote to being the primary caregiver. If it is not a responsibility that you can handle, engage a home health care provider. Before choosing a provider, do a research on the providers in your locality, understand their credentials, evaluate the care packages they offer, short list and interview them. Involve the home health care provider in the care, even before the discharge from the hospital. This helps them in understanding the specific condition of the patient and therefore to draw the care plan that he/she needs. Check the daily tasks that they need to perform, the signs of complications that they need to watch for and provide them with a list of emergency contacts. Availing support from professional healthcare companies is therefore a valid option, as it allows the elderly patient to recuperate in their known surroundings, while reducing the pressure on you and your family. Home healthcare has shown better results in patient recovery by reducing the recuperation period by an average of 15%. Page 16

18. Dr.AnithaArockiasmay, Head of Clinical Operations at India Home Health Care, India’s largest home healthcare provider, has experienced the impact of home healthcare on the patient’s recuperation and transition to home. “We have served a number of patients, where they were clinically stable but not fully recovered from the illness. Shortly after discharge to their home under our care, a significant improvement was seen. It was surely a combination of many factors, one being the comfortable and known home surrounding, and another one being the professional care given by the family in support with our care provider.” This transition is not just about your parent, it is also about you evolving from being a child to a care giver. No doubt, it is a challenging and critical phase in your life. To make it a rewarding and fulfilling experience, understand your options and limitations. Ensure that you have a solid plan in place and execute it efficiently. Page 17

19. COPING WITH CAREGIVING FOR AILING PARENT Page 18

20. Coping With Caregiving for Elderly Parent In our Indian communities, caring for elderly parents is considered a core traditional value, that we take pride in. Irrespective of the westernisation of our societies, majority of Indians choose to care for their parents at home. With the age expectancy of our population increasing and the number of children in a family decreasing, the length of time that the parents are cared for and the intense pressure that results out of it, has increased quite significantly. The demands of being the care giver can be quite high. It needs a lot of dedication, time and effort. The critical challenge, for many, is juggling a busy career, caring for their own kids and home plus the aged parents. The pressure from all sides can lead to a condition known as the Care Giver Burnout, which is defined as the physical and emotional strain that results from taking care of someone. Though it is a rewarding and fulfilling experience for many, it can take a toll on the quality of life for the entire family. It could result from not sleeping enough, working too much, having too many tasks to attend to and just not having enough time to care for yourself. Add to it the financial implication or the emotional turmoil of watching the parent suffer from a degenerative condition like Alzheimer’s or the unresolved family issues that resurface, these are enough to leave anyone overwhelmed with the situation. The demands of being the care giver can be quite high. It needs a lot of dedication, time and effort. The critical challenge, for many, is juggling a busy career, caring for their own kids and home plus the aged parents. The pressure from all sides can lead to a condition known as the Care Giver Burnout, which is defined as the physical and emotional strain that results from taking care of someone. Though it is a rewarding and fulfilling experience for many, it can take a toll on the quality of life for the entire family. Page 19

21. Care Giver Burnout can manifest as 1. Depression – “I am not interested in any of this” 2. Anxiety – “I cannot step out of the house, what if my mother needs me?” 3. Guilt – “Am I doing enough?” 4. Exhaustion – “I am just too tired to eat” 5. Inability to concentrate – “I completely forgot my spouse’s birthday” 6. Loss of sleep – “What if she tries to get out of the bed and falls down?” 7. Excessive irritability – “I just need to be left alone” Physically, it can be present as headache, body ache, weight loss, weight gain or insomnia. Though our body is capable of handling stress for a short time frame, it loses the fight after some time and the stress starts wreaking havoc on our systems. This is more common in women, as they are mostly more hands on than men. While men tend to involve with the coordination of care, driving to and from hospitals and taking care of the financial matters, women tend to be the personal care givers and keep the relationship going within the family members, while attending to their own children and maybe careers. The warning signs of Care Giver Burnout need to be taken seriously as the quality of the care you provide to your parent is directly proportional to your well being. You need to take care of yourself as the stress can only be a detrimental factor in these situations. Let us now, look at a few tips to overcome the Care Giver Burnout. 1. Give yourself priority: You should get away from the guilt and need to understand that you need regular breaks to keep you going. Do things that you love during those breaks. Set your mind free and come back refreshed. Simple relaxation techniques like meditation, going for short walks are great stress busters. Page 20

22. 2. Seek Help: There are organized providers that provide at home healthcare. At home healthcare providers, give the same quality of care that you get in hospitals in the comfort and convenience of your homes. India Home Health Care Pvt. Ltd.(IHHC) is one such provider which takes care of the elderly through a wide range of care plans that is developed and customized to your parent. Dr.AnithaArockiasamy , Head of Clinical Operations, IHHC points out that “ Over 30% of our patients come to us after trying to care for their parents by themselves. By the time they approach us, they are exhausted physically and mentally. They feel like they are fighting a losing battle. However, once they engage with us, they realise that they have a team that works with them for their parent and that they have someone with confer with. They understand that they can delegate the hands on care and get their life back”. While starting a service for an elderly parent, India Home Health Care administers a questionnaire for the patient’s family to deduce how much of psychological support they need, which helps in stemming the Care Giver Burnout. 3. Garner support: Accept help and support from other friends or family. Discuss the issues you have at hand and the specific tasks that they could help with. If you are open and honest about the situation, you will be surprised by the positive responses you will get. Create partnerships with other siblings. Even if they live far away, speak to them to relieve you for a few weeks.Try confiding in friends, unloading can make you feel a lot better. 4. Accept the reality: Things can go wrong and you cannot control everything. As is often said, there is no such thing as a perfect care giver. Do not feel guilty if you fall short of things, at times. Your house need not be perfectly kept at all times. 5. Take care of your health: Going for regular physical check-ups is even more important when you are a care giver. Make sure you get enough sleep, eat well and exercise regularly so that you feel fit and fine. Remember that your parent wants you to be happy and healthy, above everything. It will hurt them to watch you weaken while taking care of them. So watch out for those warning signs, learn to lighten the stress and the risk of burnout. Page 21

23. Arthritis Causes & Symptoms Arthritis is a nagging problem when managed diligently can be controlled effectively. The person who is affected can lead a normal qualitative life when he understands his/her problem better. There are many types of arthritis namely Osteoarthritis, Rheumatoid arthritis, psoriatic arthritis, gout etc. Among these, osteoarthritis and rheumatoid arthritis are more common. Osteoarthritis is due to degenerative changes in the joints due to wear and tear resulting in joint inflammation, pain, swelling, restriction of joint mobility thereby affecting the basic function like sitting, standing and walking, Knees are the most common joints that are affected. Then, comes the hips, small joints in the hands, and ankles. With proper medical consultation and physiotherapy these individuals can lead a pain free normal life. Rheumatoid arthritis is a condition with severe joint inflammation with remissions ad relapses. The cause is unknown. It can start with any joint. Usually this is symmetrical. Both the knees will be affected and then both the ankles, both the hands, both the elbows, both the shoulders and then the spine will also be affected. If not treated properly the joints can result in crippling deformities. These patients should consult a Rheumatologist periodically to control the joint inflammation with proper medications along with a comprehensive physiotherapy care. Page 23

24. ARTHRITIS CAUSES AND SYMPTOMS Page 22

25. Physiotherapy plays a vital role in the management of arthritis. If there is a joint swelling it is better to apply a soft gel type ice pack wrapped over a thin cloth for 10 to 15 minutes. Any acute pain and swelling in the joint will respond better to cold pack. This is followed by gentle isometric exercises. For example if there is a pain and swelling in the knee, knee pressing exercises can be done by keeping a turkey towel role under the knee. As the pain and swelling comes down the exercises can be progressed. In the case of sub-acute and chronic joint pain, heat therapy is ideal. Electric hot pack or hot water bag can be applied at home after finishing the simple exercises. Exercises should be done methodically. When exercises are done methodically the muscles in and around the arthritic joints will get strengthened and improve the blood circulation thereby do the repair process resulting in pain reduction. The strong muscles will stabilize the joints and improve the endurance too. Page 24

26. CARING FOR AN ALZHEIMER'S PATIENT Page 25

27. Caring For An Alzheimer’s Patient Alzheimer’s disease is an illness of the brain. It is caused by a large number of brain cells dying which leads to loss of memory and the ability to think clearly. This often leads to the entire family getting affected and not just the patient. Since Alzheimer’s patient becomes forgetful and disoriented which gets worse as the disease progresses, it is often a close family member that steps in as the primary care-giver. Caring for an Alzheimer’s patient is hard because the family member also needs to deal with the personality changes that happen due to the disease and the dependency increases as the condition progresses. The following points can help the primary caregiver to understand their loved one better and to care for them more efficiently: 1. Maintaining a stable daily routine in a familiar environment can bring down the patient’s stress levels to a great extent 2. Keeping them amidst family members and reminding them about the past will be essential to keep them engaged with the present 3. Keeping the surrounding area free of fall risk will be critical to prevent falls and further complication 4. Nutritious food at regular time is essential for maintaining good health. 5. Caring for yourself is a necessity as it brings you relief. You could do this by taking assistance from friends, other family members, opting for partial/full home care assistance, getting exercise and eating well. Page 26

28. RISK OF FALL IN ELDERLY Page 27

29. Risk Of Fall In Elderly An old woman aged 70 years fell on her face during early morning hours causing severe bruise and swelling in her cheek. When you assess this particular lady you gather so many pre-existing fall risk factors for her. A patient with rheumatoid arthritis for 25 years, taking psychiatric medications for many years, diabetic, post R breast removal cancer prevention medicines, thyroid medicine with inactivity resulted in muscle weakness, poor balance and giddy/dizzy/syncope spell due to multiple medicines. This is a perfect example of a few risk factors for falls in elderly. Out of 1.27 billion people in India, 60 and over population contribute 7.7%. Falls are the major problem and in medical terminology it is known as ’Geriatric Giants’. What are the reasons for the fall in elderly? There are two main reasons. They are intrinsic factors and extrinsic factors. 1. Intrinsic factors: 1 .Balance and Gait (ambulation): Legs and spinal muscle weakness due to stroke, parkinsons, arthritis, neuropathy, neuro-muscular disorder, vestibular disorder etc. 2. Medications (Polypharmacy): Taking more than 4 medicines and sedatives increases risk of fall. 3. a. Vision: Visual impairment like glaucoma, macular degeneration, retinopathy, bifocals etc. b. Visual motor reaction time is extended 4. Cognition: Dementia, confusion etc. 5. Cardio-vascular causes: Orthostatic hypotension, carotid sinuses syndrome neuro-cardiogenic syndrome, cardiac arrhythmias, valvular disease etc. 6. Urinary Incontinence Page 28

30. 2. Extrinsic factors: 1. Poor lighting 2. Stairs with inadequate handrails. 3. Rugs and floor surfaces with low friction. 4. Loose clothing 5. Poorly fitting footwear 6. Lack of equipment (assistive devices) like walking sticks, walking frames, Zimmer frames, etc to assist them in ambulation Consequences of fall: 1. Black eyes and soft tissue injuries suggest that the faller was not conscious as they fall. 2. Fracture & Dislocation: 5% of falls end up having a fracture out of which 1% will be fracture neck of femur. 3. Disuse atrophy and muscle wasting during recovery period. 4. Long term bedridden patients develop pneumonia, pressure sores, dehydration and hypothermia. 5. Psychological: Fear of falling falls under the Psychological category. Interventions: Multi-disciplinary approach to assessment and treatment results in best outcome. Provisions of safety devises such as grab handles, high friction/non -slippery floors, selection of proper footwear , high power lighting to name a few, hip protector, regular exercises, monitoring medications and addressing the environmental issues are the key. Page 29

31. FALL PREVENTION IN THE ELDERLY Page 30

32. Fall Prevention In The Elderly Falls are one of the most common fears of the elderly. Although any one could fall, the chance of falling gets higher and the after-effects of the falls become more serious with age. Falling causes injury, loss of mobility and even death. However, it is not something that should give you sleepless nights as these can be prevented, once you evaluate your personal risks for fall and learn about ways to overcome those. Falls are common in the elderly age group because of normal changes related to aging such as poor balance, impaired vision, reduced mobility or side effects of medication. As we age, our reaction time to avoid hazardous situations declines as the nerves that conduct impulses from the brain to the muscles weaken with age. By incorporating a few changes in your lifestyle, you can bring down the chances of falling quite drastically. Here are some tips to get started upon: 1. Exercise regularly: It is important to keep moving as regular exercise keeps your muscles stronger and nerves more alert. Yoga and other forms of exercise like Tai-chi are often recommended for seniors as they focus on muscle strength and balance. 2. Check your vision: Poor eyesight puts you at a high risk for falls. Plan to visit your Ophthalmologist for a vision check at least once a year. With age, the chance of developing glaucoma or cataract becomes quite high. This is more significant if you have diabetes or hypertension. 3. Review your medication with your physician: The changes in the different systems as people age, affect how the body is able to absorb, use and eliminate the excessive medication. The same medicines which you took earlier may have different effects with age. Some of them may cause excessive sleepiness or muscle weakness which again puts you at a risk for falling. So make it a point to discuss the medication you take, including the non-prescription ones, with your physician and understand their side-effects. Page 31

33. 4. Use Mobility Aids: If you have problems with balance and coordination, your doctor will prescribe mobility aids like canes or walkers. These devices help you keep moving safely. 5. Make your home safer: Assess your homes for potential hazards and address them. Simple things like the way your furniture is arranged, avoiding use of rugs or mats on the floor, de cluttering the floor, making sure the path from the bedroom to bathroom is well lighted have a great effect on your safety within the house. 6. Enrol in a regular health assessment program: There are a few healthcare providers who provide at home health assessment including checking your immediate environment for potential hazards and work with you to make your health better and home safer. This helps in promoting independent living Who is India Home Health Care and how can we help? India Home Health Care Pvt. Ltd. is a leading at home health care provider based in Chennai and Bangalore. We offer quarterly visits by doctors and monthly or bimonthly visits by Registered Nurses to assess the health status of the elderly. We have developed a detailed health assessment tailored to the Indian population. Our Registered Nurses are trained professionals with experience in hospital setups and are therefore well equipped to handle any situation at the patient’s home. Each visit is structured to identify any changes in the health status, in addition to reviewing the medication intake and check the environment of the patient’s home to assess the safety from a health perspective. Page 32

34. FALLS IN ELDERLY - PHYSIOTHERAPISTS PERSPECTIVE Page 33

35. Falls In Elderly- Physiotherapist Perspective An 85 year old lady fell down while draping her 7 year old Grand Daughter with a blanket and didn’t have pain or discomfort in her body immediately. After couple of days she was having pain in her back for which she went for an orthopaedics consult followed by MRI which revealed multiple crush fracture in the lumbar and dorsal spine. She had complete rest with back brace for few weeks followed by comprehensive physiotherapy. Overall it took six months for her to recover from the day of fall and affected her quality of life especially to lead an active and independent life. About one third of people over the age of 65 and almost half of people over the age of 80 will fall at least once a year. Doctors, Nurses, para- medical persons, family member ,and friend etc can identify fall risk person in their life and refer them to Physiotherapist for further management. Physiotherapists can help reduce a person’s risk of falling by: • Assessing a person’s risk of falling. • Helping his home as safe as possible. • Educating that person about the medical risk factors linked to fall • Designing individualized exercises and balance training. • Working with other health care professionals and community services to create programs for people who want to reduce their risk of falling. Physiotherapist can do a thorough evaluation which includes: • A review of one’s medical history • A review of one’s medication • A simple vision test • A home safety assessment • A simple screen of one’s thinking abilities. • A check of one’s hear rate. • BP measurements while changing position from sit to stand. • Feet and footwear assessment. Page 34

36. • Assessment of any nervous system disorders such as stroke, Parkinson, etc • Measure one’s leg strength using simple tests such as timing how long it takes you to rise from a chair. • Determine how quickly and steadily one can walk. • Assess one’s balance – for instance , by having one stand on one leg or rise from a chair and walk • Use special test to measure the balance Based on the evaluation results, Physiotherapist will design an exercise and training program to improve one’s balance and strength. A recent systematic review of many published studies found that exercise based programs in the home or in group settings are effective in preventing falls. These programs are especially effective when balance exercises are performed in a standing position without using much arm support. 1. Balance Exercises Balance training has been shown to be an important and effective part of falls prevention. One’s Physiotherapist will design exercises that challenge his ability to keep his balance including such exercises as single leg standing 2. Walking and Moving When people walk very slowly or unsteadily, they are at risk for falling. His Physiotherapist can improve his walking ability by making him do such activities as: • Dance steps • Walking in circles • “Figure 8”, exercise to strengthen the core abdominal muscles that help stabize one’s body • Obstacle course Page 35

37. 3. Doing more than one thing at the same time safely Older adults who have difficulty walking and talking at the same time are at high risk of falling. To help increase their safety during activities one’s Physiotherapist can design a,”dual task”, training program. This kind of training will challenge one to maintain a walking speed while he do another task such as counting backwards, engaging conversation or carrying a bag of groceries. 4. Strength Training Strengthening exercises are a key element of fall prevention when they are done in conjunction with balance training. One’s Physiotherapist will design strengthening exercises that focus on his leg and the muscles used in maintaining posture. 5. Aerobic Training Walking is one of the safest way of aerobic training. Physiotherapist will formulate walking program according to the patient’s capacity. 6. Education& Fear Management Physiotherapist will talk to the patient how best to manage his own risk of falling and to build his self esteem to overcome the fear of falling. 7. Community Program Physiotherapist can participate with local groups in organizing different fall prevention activities at the community level like in the malls, senior citizen centres, clubs etc. Page 36

38. THE ROLE OF NURSES IN THE ELDERLY FALL PREVENTION CARE PLAN Page 37

39. The Role Of Nurses In The Elderly Fall Prevention Care A Nurse has got a major role in preventing falls in Elderly population. From the time of admission to the hospital to the time of discharge she can categorize the patients in to low risk, moderate risk and high risk. From that category she can formulate a care plan to prevent fall in the hospital, at home and in the community.Falls can be due to multiple reasons. Patients who take benzodiazepines, antipsychotic, diuretics, anti-depressants, narcoleptics, opioids, insulin, oral hypoglycaemic, anti -coagulants, cardiac and hypertensive will lead to disorientation, giddiness and fatigue. Patients who have dementia, hip fracture, Parkinsonism, stroke, osteoporosis, arthritis and depression should not be left alone. Patients who have urinary and faecal incontinence need bladder and bowel habit retraining, diaper care to prevent rash/pressure sore.In addition patients who have visual impairment, functional disability and prior history of fall should have appropriate intervention to prevent further falls. Nurse can initiate fall prevention care plan for the above mentioned patients as follows: 1. Toileting needs: To ask the patients every one to two hours whether he/she needs to use the bathroom, answer call light promptly, remind the patient to ask for assistance and reorient to call night if necessary, eliminate side rails and asses need for bedside commodes and individual toileting schedule and/or bowel and bladder training. 2. Sync opal Episodes: To evaluate postural hypotension and/or cardiac arrhythmia and consult with physician, review medications with pharmacy consultant and physician, consider fluid volume deficit then evaluate intake and output, teach the patients to change the position slowly, especially from lying to sitting to standing, maximize the patient’s time out of bed as much as clinically possible to increase tolerance, keep the bed in the low position, assist with all transfers, consider use of TED hose and perform a nutrition consultation. Page 38

40. 3. Environmental hazards: Eliminate potential hazards such as uneven surfaces, debris or water on the floor, keep the light and water within the reach, keep eyeglasses within reach and ensure adequate lighting . 4. Weakness/Unsteady gait: Evaluate for possible therapeutic interventions, remind patients to request assistance, keep call light within reach, confer with rehabilitative services and the interdisciplinary team and assist the patient to obtain and wear appropriate, non-skid shoes. 5. Sensory/perception deficits: Frequently reorient the patient to the environment, keep furniture and other objects in the same position, evaluate presence and adequacy of glasses and hearing aids, assess the environment to maximize safety, consult with vision/hearing specialist as needed, refer to occupational therapy and consider a conference with rehabilitative services. 6. Knowledge deficit: Ensure assistive equipment is used appropriately, be sure the patient is comfortable with adaptive and assistive devices, ensure the resident is able to use the call light. If the light is difficult to press, consider a foam pad call light or other adaptive call lights and ensure frequent visitors are aware of the use of assistive devices. Once the care plan is formulated among the three categories (low risk, moderate risk and high risk) then appropriate staffs are delegated to perform the task. In all the categories the nurse should maintain the safe unit environment which includes removal of excess equipment/supplies/furniture from rooms and hallways, coil and secure excess electrical and telephone wire/cords, clean all spills in patient room or in the hallway immediately and place a signage to indicate wet floor danger. For low risk individuals apart from maintaining above mentioned safe unit environment the following safety interventions should be taken: i) Orient the patient to surroundings, including bathroom location, use of call light. ii) Keep bed in lowest position during use unless impractical (when doing a procedure on a patient) iii) Keep the top two side rails up. iv) Secure locks on beds, stretcher and wheelchair. Page 39

41. v) Keep floors clutter/obstacle free (especially the path between bed and bathroom/commode) vi) Place call light and frequently needed objects within patient reach. vii) Answer call light promptly viii) Encourage patient/family to call for assistance as needed. ix) Assure adequate lightening especially at night. x) Use proper fitting non-skid footwear. For moderate risk individuals apart from maintaining safe environment as mentioned earlier and follow low risk intervention plus institute flagging system. Institute Flagging system: a. Apply fall risk arm band b. Falling star (yellow) outside the patient’s door c. Falls risk sticker on the medical record and monitor and assist patient in following daily schedules: • Supervise/assist bedside sitting, personal hygiene and toileting as appropriate. • Reorient confused patient as necessary. • Establish elimination schedule and use of bedside commode if appropriate. Evaluate the need for: • Physical therapy consult if patient has history of falls and or mobility impairment. • Occupational consult Page 40

42. For high risk individuals apart from maintaining safe environment as mentioned previously follow low and moderate fall risk interventions plus institute flagging system: 1. Apply fall risk arm band. 2. Falling star (red) outside the patient’s door. 3. Falls risk sticker on the medical record. • Remain with patients while Toileting • Observe 6o minutes unless patient is on activated bed or chair alarm. • When necessary transport throughout hospital with assistance of staff or trained care givers. Consider bedside procedure. Evaluate need for following measure going from less restrictive to more restrictive: • Moving patient to room with best visual access to nursing station. • Activated bed/chair alarm • 24 hour supervision • Physical restraint – only with authorized prescribed order Once the patient is ready to go home the nurse should make a home safety assessment by following above mentioned guidelines and then transfer the patient to a safe home with proper caregiver if necessary. At community level the nurses can address the senior citizen group on fall prevention and safe mobility. Looking for well-trained and compassionate caregivers for your family, visit http://goo.gl/oX5tRt Page 41