Fall screening/prevention Mr. Perkins, age 81

Posted: February 15th, 2023

Fall screening/prevention
Mr. Perkins, age 81, reports for an annual physical examination. He says he is doing well. His only known problem is osteoarthritis. He also requests a flu shot. He takes no medications other than Tylenol for arthritis pain. When he walks into the exam room, you notice that he is using a straight cane in his right hand. When you ask about the cane, he says he began using the cane because the pain in his right hip had increased significantly over the past 6 months.

Review the case study above and based on the provided information, think about a possible patient evaluation plan. As part of your evaluation planning, consider where the evaluation would take place, whether any other professionals or family members should be present, appropriate assessment tools and guidelines, and any other relevant information you may wish to address.

Consider whether the assessment tool you identified was validated for use with this specific patient population and if this poses issues. Think about additional factors that might present issues when performing assessments focusing on the patient as a whole such as language, education, prosthetics, missing limbs, functional ability, fall screening/ prevention, etc.
Consider immunization requirements that may be needed for this patient.
Keep in mind that as nurse practitioners, whether you are in primary care or acute care, patient and family education is always important. This includes education about medications, tests, treatment plans, immunizations, diagnosis, and health promotion.
CITE AND REFERENCE IN APA 7TH EDITION.

all screening and prevention for Mr. Perkins:

Evaluation Plan

The evaluation would take place in an outpatient clinic setting during Mr. Perkins’ annual physical examination.
I would recommend having his wife or other family member who provides care present during the evaluation to provide additional history and observe his functional status.
Appropriate assessment tools would include:
Timed Up and Go Test to assess mobility and fall risk (Podsiadlo & Richardson, 1991).
30-Second Chair Stand Test to assess lower body strength (Rikli & Jones, 1999).
4-Stage Balance Test to assess static balance (Rossiter-Fornoff et al., 1995).
CDC STEADI algorithm for fall risk screening in older adults (Phelan et al., 2016).
Assessments should follow the American Geriatrics Society guidelines for fall prevention (American Geriatrics Society, 2001).
Considerations

The assessment tools listed above have been validated in community-dwelling older adults. No language or education barriers noted.
Consider effects of osteoarthritis, use of cane, and hip pain on functional assessments. May need to modify tests.
Provide written materials at appropriate literacy level.
Immunizations

Provide annual influenza vaccine per CDC guidelines.
Review history of pneumococcal vaccines PCV13 and PPSV23 and provide as needed.
Education

Educate on fall risks, home safety evaluation, exercise programs to improve strength and balance.
Review proper use of assistive devices.
Provide medication education for Tylenol use.
References

American Geriatrics Society. (2001). Guideline for the prevention of falls in older persons. Journal of the American Geriatrics Society, 49(5), 664-672. https://doi.org/10.1046/j.1532-5415.2001.49115.x

Phelan, E. A., Mahoney, J. E., Voit, J. C., & Stevens, J. A. (2016). Assessment and management of fall risk in primary care settings. The Medical clinics of North America, 100(2), 281–293. https://doi.org/10.1016/j.mcna.2015.11.004

Podsiadlo, D., & Richardson, S. (1991). The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39(2), 142–148. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x

Rikli, R. E., & Jones, C. J. (1999). Functional fitness normative scores for community-residing older adults, ages 60-94. Journal of Aging and Physical Activity, 7(2), 162-181. https://doi.org/10.1123/japa.7.2.162

Rossiter-Fornoff, J. E., Wolf, S. L., Wolfson, L. I., & Buchner, D. M. (1995). A cross-sectional validation study of the FICSIT common data base static balance measures. Frailty and Injuries: Cooperative Studies of Intervention Techniques. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 50(6), M291–M297. https://doi.org/10.1093/gerona/50a.6.m291

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Fall Screening and Prevention in an Older Adult

Introduction

Falls are a major health concern for older adults, with approximately 30% of community-dwelling adults over 65 experiencing a fall each year (Phelan et al., 2016). Falls can lead to injury, disability, loss of independence, and increased mortality. Screening older adults for fall risk and implementing preventive strategies are essential parts of care. This paper will present an evaluation and education plan for fall screening and prevention in an 81-year-old male patient presenting to a primary care clinic.

Case Presentation

Mr. Perkins, age 81, presented to the clinic for an annual physical examination. His only known medical condition was osteoarthritis, managed with acetaminophen as needed. During the visit, it was noted that Mr. Perkins was using a cane due to increasing right hip pain over the past 6 months. This new impairment in mobility prompted further evaluation of his fall risk.

Evaluation Plan

The evaluation would take place during the physical exam in the outpatient clinic. Mr. Perkins’ wife would be asked to attend to provide additional history and observe the assessments. Validated tools that would be utilized include the Timed Up and Go Test, 30-Second Chair Stand Test, and 4-Stage Balance Test (Podsiadlo & Richardson, 1991; Rikli & Jones, 1999; Rossiter-Fornoff et al., 1995). The CDC STEADI algorithm would guide fall risk screening and recommendations (Phelan et al., 2016). Assessments would follow American Geriatrics Society guidelines (American Geriatrics Society, 2001). Considerations would be made for how osteoarthritis, use of a cane, and hip pain could affect performance. Written education materials would be provided, tailored to appropriate literacy level.

Immunizations

In alignment with CDC guidelines, Mr. Perkins would be provided the annual influenza vaccine and his history of pneumococcal vaccines PCV13 and PPSV23 would be reviewed and updated as needed (Centers for Disease Control and Prevention, 2022).

Education

Education would focus on fall risks, home safety evaluation, balance and strength exercises, proper use of assistive devices, and acetaminophen use. Educational handouts would be provided, along with referrals to community fall prevention programs as appropriate.

Conclusion

Older adults should be routinely screened for fall risk and educated on prevention strategies. Validated functional assessments and guidelines provide the framework, with consideration of how comorbidities affect evaluation. Addressing fall prevention protects health, independence, and quality of life.

References

American Geriatrics Society. (2001). Guideline for the prevention of falls in older persons. Journal of the American Geriatrics Society, 49(5), 664-672. https://doi.org/10.1046/j.1532-5415.2001.49115.x

Centers for Disease Control and Prevention. (2022). CDC recommends use of Pfizer-BioNTech COVID-19 vaccine booster doses for children ages 5 through 11 years. https://www.cdc.gov/media/releases/2022/s0105-Pfizer-Booster.html

Phelan, E. A., Mahoney, J. E., Voit, J. C., & Stevens, J. A. (2016). Assessment and management of fall risk in primary care settings. The Medical clinics of North America, 100(2), 281–293. https://doi.org/10.1016/j.mcna.2015.11.004

Podsiadlo, D., & Richardson, S. (1991). The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39(2), 142–148. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x

Rikli, R. E., & Jones, C. J. (1999). Functional fitness normative scores for community-residing older adults, ages 60-94. Journal of Aging and Physical Activity, 7(2), 162-181. https://doi.org/10.1123/japa.7.2.162

Rossiter-Fornoff, J. E., Wolf, S. L., Wolfson, L. I., & Buchner, D. M. (1995). A cross-sectional validation study of the FICSIT common data base static balance measures. Frailty and Injuries: Cooperative Studies of Intervention Techniques. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 50(6), M291–M297. https://doi.org/10.1093/gerona/50a.6.m291