Introduction
Purpose
The purpose of the proposed project resides in defining the role that the change of the physical environment of elderly patients plays in performing effective fall prevention. Hence, the project targets to point out the significance of the environmental factor for the elderly people, aged 65 years old and more that are exposed to falls. It is proposed to define whether the number of falls is likely to reduce with the change of the environment or it will remain equal to that existing under the normal environment.
Background and Clinical Significance
Primarily, it is essential to point out that the problem of falls in elderly patients aged 65 years old and above is highly acute and needs to be addressed in a most efficient manner. Hence, in their research, Ambrose, Paul, and Hausdorf (2013) show that about 40% of patients have experience of falling (p.51). The researchers point out the fact that such falls cause a series of negative consequences including severe injuries and psychological fears of losing the balance.
Therefore, it is evident that the need for an effective intervention designed specifically for this population is very strong. Therefore, the question consequently comes up regarding the choice of the approach to falls prevention. In other words, it is critical to decide which factor should be primarily addressed. Researchers distinguish various factors that affect the risk rate of falls in elderly patients. Thus, such aspects as impaired balance, elderly age, and surrounding environment are most commonly pointed out (Leland, Elliot, O’Malley, & Murphy, 2012).
Theoretical Framework
In the framework of the proposed research, it is suggested to put a particular emphasis on the environmental factor. It is assumed that it is one of the key factors affecting the risk rates of falls in elderly patients. It should be noted that the method of fall prevention through changing the environment has been discussed intensively throughout the past decades. Thus, it is assumed that a positive change in the home environment is likely to reduce the risks of falling. First of all, the environmental factor implies physical factors that might increase the risks of falls in elderly people (Leland et al., 2012). Hence, for instance, such items as floor mats, bathroom handrails, rugs, etc. can represent a hazard to the mobility of elderly people in case they are poorly fixed or installed.
In the meantime, the physical side of the environmental factor is not the only aspect that is significant for fall prevention. Hence, some studies have been carried out in order to evaluate the psychological aspect of the environmental factor in the framework of a falls prevention program. Thence, for instance, recent research has revealed that consistent home modification results in a series of positive outcomes.
The research was conducted in the framework of the American Occupational Therapy Association’s Evidence-Based Practice Project. The examined population was comprised of elderly patients exposed to falls. According to its findings, the change in the environment can reduce the psychological fear of falls in elderly people. Otherwise stated, it is proposed that a large number of falls in elderly patients might be partially explained by the fact that they experience severe psychological pressure because they are afraid of repeated falling.
Therefore, it is essential to create such an environment that will be psychologically comforting and will contribute to the feeling of safety in elderly people (Chase, 2012). As a result, the described scientific evidence shows the significance of the target problem and the importance of the environmental factor for preventing falls.
The rationale for Selecting the Theory
A successful strategy for preventing falls needs to consider all factors that contribute to falling among people aged 65 years and above. Such people have psychological fears that they have lost balance. Balance is an important factor that determines the capability of an individual to move while in a variety of environments, including rough terrain, smooth floor, climbing staircases, and/or walking on carpeted floors among others (Pighills, Torgerson, Sheldon, Drummond, & Bland, 2011).
Therefore, a discussion of fall prevention among people of different ages must not fail to include the environmental factor. The rationale for selecting environmental modification as the theory reviewed in terms of how it helps in preventing falls among people aged 65 years and above is founded on the notion that people must always interact with the environment in their daily activities. Any other theory attempts to explain how well people should interact with the environment when moving to ensure that falls do not occur.
Falls among old people constitute a leading cause of mortality. Despite putting amicable efforts to try various interventions for preventing falls, there remains a wide variety of components of interventions in a clinical context. Hence, policymakers, patients, and clinicians have not yet clearly understood the essential aspects of preventing falls. This challenge underlines the rationale for selecting environmental modification as an important theory for helping to understand the potential interventions to falls in the attempt to reduce mortality and morbidity associated with falls among senior citizens.
The literature on falls prevention among old people identifies various factors that contribute to falls, including reduced strength that naturally comes with old age, the number of medications taken, and other factors that are external to the old people such as the nature of the floor and lighting conditions. However, environmental conditions remain important factors in which all other risk factors collectively interact to the extent that when the number of risk factors rises, the risk of falls linearly goes up (Shilpa, Sengupta & Anoop, 2015).
It is important to note that interventions to falls focus on reducing the risk factors. However, the essential aspects are not well understood. To this extent, this paper focuses on examining the literature on falls that arise from the condition of the environment. This review has the implication of helping to develop a greater understanding of how the environment contributes to falls and the possible interventions for reducing falls through appropriate environmental modifications.
Literature Review
The majority of households have elements that can potentially cause falls. Such aspects include slippery floors, poor lighting conditions, loose rugs, walkways that have obstructions, and unstable furniture (Shilpa et al., 2015). Coincidentally, many elderly people relate their falls to trips and/or slips while at home or within the immediate surroundings (Pighills et al., 2011). Responding to this concern, researchers have proposed the making of appropriate modifications at home as an integral and incredibly important aspect of preventing falls.
Nevertheless, Shilpa et al. (2015) point out that the contribution of the environment in increasing the risk of falls is not straightforward. This assertion is important since people’s physical abilities and problems that the environment poses do not interact in a simplistic manner. This situation lowers the chances of deducing cause-effect relationships.
Clinicians theoretically contend that the environmental condition is an important contributing factor to morbidity and mortality, which are associated with falls. However, all buildings are built in compliance with specified standards to guarantee safety for all. This requirement eliminates any possibility of modifying the household environment to help in demonstrating the contribution of home-related hazards in increasing falls among elderly people (Shilpa et al., 2015).
Therefore, the only data available on this cause-effect relationship is where safety assessments reveal that falls occur due to non-compliance of a house hosting elderly people with building requirements. Therefore, testing of the efficacy of the environmental interventions in preventing falls among old people cannot be practically understood. However, the contribution of falls in impairing the health of old people warrants scholars to study it, despite difficulties in demonstrating the efficacy of the environment in contributing to the problem.
Falls are common among old people. Indeed, Kumar et al. (2013) assert that falls involve losing balance unintentionally to the extent of leaving an individual in contact with the ground, floor, or any other surface. To demonstrate the intensity of the problem, Shilpa et al. (2015) quote the World Health Organization’s data gathered in 2008 indicating that 424,000 people die annually due to fall-related causes. Fall injuries correspond to 11% of the total unintentional damages that lead to deaths across the world. El-Sobkey (2011) asserts that 33% of people who are more than 65 years old fall every year.
In the Indian context, Gutta, Joseph, Chakraborty, and Alexander (2013) reveal that 51.5% of the total elderly population has reported having fallen at least once. Impaired balance, diseases such as arthritis, visual problems, and even depression are some of the strongest factors that contribute to falls. Traumatic injuries of the brain, fractured hips, and injuries in upper limbs are major causes of admissions that relate to falls among the elderly people. Gutta et al. (2013) insist that despite the ability to demonstrate the interaction of various factors that lead to falls, people should understand that it is possible to prevent these occurrences via appropriate environmental modifications.
Gyllencreutz, Bjornstig, Rolfsman, and Saveman (2015) studied falls among senior citizens in a Swedish context. The researchers state that their main concern was to examine injuries related to senior citizens with an important focus on healthcare costs encountered by the study group because of falls. However, the study only focused on pedestrian falls. Deploying injury data and questionnaires, the researchers reported that 300 elderly people had attended an emergency department with injuries sustained from falls.
The majority of these people suffered from fractures. About 20% of the studied sample was hospitalized. This number incurred 6.3 million Euros within a period of 8 days. The study deduces that ice was a major environmental factor that contributed to the falls. While some of the elderly people claimed they were not responsible for the fall, some others proposed important outdoor environmental improvements to reduce the problem. Those who evaded responsibility claimed that the municipality should take the blame. The authors recommend using preventive products, consistent preventive maintenance of roads, and alteration of people’s behaviors (Gyllencreutz et al., 2015).
In the context of the United States, falls constitute the leading cause of death among people aged 65 years and above. For example, Edwards (2011) observes that about 1.8 million falls occur every year leading to patient admission in emergency rooms in the US. To reduce these health problems, Gutta et al. (2013) propose the importance of home modification to ensure that frail people are free from hazards that contribute significantly to falls.
This strategy is important since many falls (over 50%) occur inside homes among old people. More than 23% of falls occur within the vicinity of houses while about 22% occur far away from the residences of the old people (Gutta et al., 2013). Hence, many of the falls among old people occur within their dwellings. One mechanism for reducing these risks is by ensuring that such residences of old people do not have loose rugs on which they can trip over. The houses should have handrails installed. The replication of the environmental variable is in many situations of falls implies that it is sensible to reduce environmental hazards, especially within dwellings for old people to manage the problem of falls.
England exemplifies how home modification can be integrated into the national policy for promoting the health of the elderly. As a national policy, England recommends an assessment of living environments to be conducted with the primary objective of identifying and eliminating all potential hazards. To accomplish this objective, builders and homeowners should hire only highly skilled personnel.
The nation upholds this requirement, despite difficulties in relating falls’ epidemiological studies with the manner in which hazards lead to falls. In addition, studies on environmental assessments coupled with home modifications give rise to conflicting results (Pighills et al., 2011). Nevertheless, this observation does not suggest that appropriate home modifications should not be adopted to manage the risks of falls among old people.
The estimate of environmental assessment and modifications, including how these two strategies contribute to the reduction of falls varies based on participants’ level of risk. This level varies with age, the history of taking medications, stability, and the person conducting the estimates. A meta-analysis of modifications based on the environmental assessment has reported about a 21% decrease in falls (Pighills et al., 2011).
Such analysis has also concluded that occupational therapists play an important role in providing interventions to old people. The interventions effectively reduce falls among high-risk groups. The most successful intercessions comprehensively evaluate and/or identify falls hazards by not only deploying validated assessment tools but also conducting an intensive analysis of participants while in their environments. Such interventions also guarantee adequate and effective follow-ups accompanied by supportive measures that increase the participants’ adaptability to the environment.
One of the important hindrances in providing effective interventions and modifications that reduce the risk of falls among elderly people is the availability and affordability of professionals to offer the services. Where their services are available, they are prohibitive in terms of cost. Therefore, a potential intervention is to evaluate whether untrained people who have ardent access to falls of high-risk elderly people can effectively provide the much-needed services.
However, such evaluation is difficult since no study has been conducted evaluating the differences in the effectiveness of trained and untrained people in the provision of environmental interventions that address the issue of falls among the vulnerable elderly people. Indeed, Pighills et al. (2011) report, “all non-occupational therapists (OT)-lead trials were of low intensity and in low-risk populations” (p.27). This finding does not tackle the problem of addressing falls that can be prevented through environmental interventions among high-risk groups.
A drop of falls among senior citizens is necessary and significant if deaths that are related to falling injuries among this group of people is reduced. In the case of falls that occur outside the home environment, community planners need to guarantee accessibility to pedestrian environments among people aged 65 years and above (Edwards, 2011). In addition, emphasis should be placed on ensuring that outdoor and indoor environments are safe for elderly people. This recommendation underlines the need for conducting environmental assessment coupled with the modification that can help to improve the mobility of senior citizens in a less risky manner (Pighills et al., 2011). While the aid of a trained or untrained person may be important in ensuring that elderly people do not fall, it is imperative to ensure that they retain their freedom of independent mobility.
Conclusion
Falls are significant health risks among people aged beyond 65 years. Although falls are associated with various risk factors, the environment constitutes one of the leading causes of falls among senior citizens. Slippery floors, lack of handrails, and loose rugs are also environmental factors that contribute to falls among the elderly citizens. Indeed, other factors such as old-age instability, poor eyesight, and historical background of ailments, for instance, depression and arthritis, contribute to falls when interacting with the environment. Hence, there is a need to improve the interior house environment, the immediate external environment of the dwellings of old people, and even the pedestrian surroundings to minimize incidents of falls among high-risk people.
One way of accomplishing this goal is by complying with strict building guidelines to enhance the safety of elderly people. Secondly, there is a need to conduct an environmental assessment and/or put in place interventions for reducing falls. Although past literature documents no significant reduction of falls due to environmental assessment, it is important to remove hazards such as loose rugs and slippery floors that can increase the risk of falls among senior citizens. Environmental modification as a mechanism for reducing falls among senior citizens has the benefit of cutting down costs incurred in emergency admissions that arise from injuries sustained from falls.
Reference List
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