Research Paper Sample on Risk of Falling High Among Adults Aged 65 and Above with Cognitive Decline

Introduction

At least one in every three adults aged 65 years and above falls every year (Ansai et al., 2019). Ansai et al. noted that between 60% to 80% of these patients are those that exhibit cognitive decline. Most falls are unwitnessed because the larger proportion of the affected patients are ambulatory, which means most falls occur in areas that have low staff presence. The risk of falling among inpatients with mental illness is high both in their acute care phase and after they register improvement and can perform basic activities. Preventing falls remains a priority for the majority of mental health settings. However, with behavioral and psychiatric health settings recording between 4.5 and 25 falls for every 1,000 patient days, the urgency remains relevant (Seijo-Martinez et al., 2016). Falls result from intrinsic, extrinsic, situational factors, and require novel approaches to prevent.

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Intrinsic, extrinsic, and situational factors contribute to patient falls. Intrinsic factors that increase the risk of falls among mental health patients are impaired cognitive capacity that stems from chronic mental health conditions. Some of the common mental health conditions are Alzheimer's and delirium (Fernando et al., 2017). Adverse reactions resulting from psychotropic medications also increase the risk of patient falls. Also, patient falls may be the result of balance, vision, gait, and mobility disorders. Extrinsic factors are environmental elements that lead to increased risk of patient falls. Most of these factors are infrastructure-related such as lack of canes, walkers, and other critical support equipment. The design of mental health settings may also increase the risk of patient falls. For instance, side rails, wired beds and chairs, and corded call systems expose mental health patients to falls. Situational factors often occur due to multitasking, meaning the patient has divided attention. All these factors may contribute independently or jointly to the risk of patient falls.

Literature Review

The risk of patients fall in a mental health setting depends on the level of attention given to patients (Allali & Verghese, 2017). There are three primary mental health treatment settings; outpatient, hospital inpatient, and residential. Hospital inpatient settings offer overnight or longer stay within an independent psychiatric hospital or a psychiatric unit in a general hospital. Psychiatric hospitals offer exclusive mental health treatment and rehabilitation, while residential mental health settings offer long-term care and are better designed for patient-centered care. Outpatient environments, on their part, offer mental health therapy. Whatever solutions designed to prevent patient falls must recognize the strengths and limitations of these settings. Extant studies on patient fall examine the risk factors, severity, and management.

Ansai et al. (2019) examined risk factors for falls in older adults with mild cognitive impairment and mild Alzheimer's disease. The study assessed sociodemographic and health variables, including depressive symptoms, patient functional status, dual-task instances, caloric expenditure, and functional mobility. The authors posited that understanding fall risk factors in mental health setting was essential for planning fall prevention. The prospective approach used in the study was useful in understanding patient fall risk factors at baseline and six months after the start of the study. The study sample consisted of older adults aged 65 years or older who fall within the high-risk bracket for risk of falls. The final composition of the study sample included individuals whose clinical dementia rating scores ranged between 0.5 and 1.0. A fall follow-up allowed the researchers to track the development of fall risk among mental health patients over time and depending on the environment.

According to Seijo-Martinez et al. (2016), there is a direct correlation between cognitive decline and fall risk, which is most prevalent among older adults. Hence, potential fall risk factors include behavior, medications, neuropsychological disturbances, and motor function. On their part, Fernando et al. (2017) identified dementia as a leading cause of cognitive decline among older people. Therefore, from their perspective, neuropsychological disturbances were the more pronounced fall risk factor among older adults. Ansai et al. (2019) noted higher fall risks among people with mild cognitive impairment (52.6%) compared to those with Alzheimer's disease (51.4%). They further noted that the high fall risk among individuals with mild Alzheimer's disease was due to lower time spent on the walk test. Hence, they recommended increased turn-to-sit activities for individuals in mental health settings with high fall risks.

Coordination

The coordination between vision and balance helps one to avoid obstacles and maintain their gait. However, individuals with mental health problems lack this balance, hence their higher fall risks. Fernando et al. (2017) noted that decreased coordinated stability and increased postural sway were associated with increased fall risks. Gait and balance disorders, as well as postural hypotension, are critical measures within mental health settings (Allali & Verghese, 2017). According to Allali and Verghese, fall frequency becomes prevalent in the later clinical stages of dementia because of the progressive impairment of an individual's planning, judgment, decision-making, and prioritization capacities. Hence, an individual is more likely to misjudge distance or mistime their steps, which constitutes impaired vision. Addressing the locomotor needs of an individual is as important as helping them to reduce the risk of falls. As the vision impairment becomes severe, proper gait support systems must exist.

As regards the fall-risk progression, Fernando et al. (2017) noted that a history of falls in the previous year led to higher fall risk in the next year in both community dwellings and institutional dwellings. The researchers determined that fall risks were higher for individuals with a past record of injurious fall. Allali and Verghese (2017) explain this relationship, noting two things. One, when an individual falls the first time, they develop a fear of falling, which contributes to the high fall risk. Secondly, that initial fall likely results in the impairment of the individual's mobility. The resulting gait impairment increases the individual's dependence on support, which might be needed at all times. Nonetheless, mental health environments are not adequately prepared for all-time support.

The discussion of fall risk in mental health settings is not complete without mention of the role of caregivers. Fernando et al. (2017, p.169) observed that, in community dwellings, caregivers exhibited higher risks of developing "depressive symptomatology and higher levels of emotional stress." Such factors not only affect the health of the caregiver but also distract them away from their critical role in supporting their patients. When the mental health patient does not get the required attention, they are at a higher risk of falling. Factors like poor eyesight, reduced reaction time, and decline in muscle strength for mental health patients implies that they become more dependent on the caregiver as they age. However, since nurses and caregivers face personal and professional challenges, neglecting them becomes counterproductive despite the investments made to better mental health settings.

Mental Health Challenges

Everyone ages and with age comes mental health challenges. While it may be challenging to reverse mental health challenges for older adults, structures must be established to offer them the most conducive environments. Allali and Verghese (2017) advise that individuals in mental health settings should be kept in motion if fall risk is to be lowered. A regular exercise program with the help of a caregiver helps to maintain gait. The article also recommends having water workouts in a pool, which helps to align the muscles for the entire body. The severity of the exercise is dictated by the level of mental health suffered by an individual and is prescribed by the doctor. It is noteworthy that physical therapy needs to be individualized, the more reason for the proper staffing of mental health settings to reduce fall risks.

Following the observations by Ansai et al. (2019), increased clinical medication raises the risk of falls. Hence, as much as possible, medical equipment and medication should be limited to special scenarios. Individuals must be encouraged to use support tools such as walkers and canes, to secure balance when walking. An individual needs to be moving more and safely if they are to overcome their fear of falls and reduce the risk of fall. Community dwellings must include safe spaces that allow mobility with fewer obstacles. Checking regularly for hazards helps to ensure the safety of the individual. Also, as a caregiver, one should continuously remain in touch or use emergency monitoring devices to aid in communication and ensure that support is offered.

Conclusion

In conclusion, the severity of cognitive decline increases falls risk. Fall risks in mental health settings also result from medication, motor function, behavior, or neuropsychological disruptions. An individual's gait and vision also determine their fall risk. The initial fall instance should be prevented for two reasons. First, it affects an individual's functionality and increases their dependence on supports. Secondly, a fall increases one's fear of a second fall. As such, mental health settings, whether institutionalized or community dwellings require round-the-clock support so that the patient is assured of safety. Also, the most affected individuals are older adults, meaning their gait and mental health continue to decline with age, and they require continued and improved support.

References

Allali, G., & Verghese, J. (2017). Management of gait changes and fall risk in MCI and dementia. Current treatment options in neurology, 19(9), 29.
https://doi.org/10.1007/s11940-017-0466-1

Ansai, J. H., de Andrade, L. P., Masse, F. A. A., Gonçalves, J., de Medeiros Takahashi, A. C., Vale, F. A. C., & Rebelatto, J. R. (2019). Risk factors for falls in older adults with mild cognitive impairment and mild Alzheimer's disease. Journal of geriatric physical therapy, 42(3), E116-E121. doi: 10.1519/JPT.0000000000000135

Fernando, E., Fraser, M., Hendriksen, J., Kim, C. H., & Muir-Hunter, S. W. (2017). Risk factors associated with falls in older adults with dementia: a systematic review. Physiotherapy Canada, 69(2), 161-170. https://doi.org/10.3138/ptc.2016-14

Seijo-Martinez, M., Cancela, J. M., Ayán, C., Varela, S., & Vila, H. (2016). Influence of cognitive impairment on fall risk among elderly nursing home residents. International psychogeriatrics, 28(12), 1975-1987. https://doi.org/10.1017/S1041610216001113