Safeguarding the Safety of Elderly Individuals with Visual Impairment in their Homes

Safeguarding the Safety of Elderly Individuals with Visual Impairment in their Homes

Response

Hello,

Thank you for your enlightening post. You’ve brought up the issue of safeguarding the safety of elderly individuals in their homes, which is very important in healthcare. As you indicated, the Home Safety Self-evaluation Tool (HSSAT) and the Home Environment Assessment for the Visually Impaired (HEAVI) are excellent evaluation tools. These tools are extremely useful in recognizing potential hazards and assisting patients and their families in proactively avoiding falls. Falls can have serious repercussions for older persons, and these tools are critical in improving their well-being.

It is important to share the results that indicate the need for further assistance or a change in the care setting. Additionally, it is critical to identify and address fall dangers through home modifications, lighting improvements, and referrals to specialists such as ophthalmologists. Moreover, recognizing whether cognitive difficulties or recurring falls demand a move to a more monitored living arrangement is also important for healthcare practitioners. Healthcare providers must regularly monitor patients’ medical histories and prescription regimens, as certain drugs can increase the risk of falls (Disdier Moulder et al., 2019). Any instances of medication-related adverse effects or interactions affecting balance and stability should prompt a review of the patient’s care plan. Furthermore, periodic reassessments of the patient’s physical and cognitive capacities are required to alter the care plan as their needs change.

Consistently, your explanation of the nurse practitioner’s role in assisting patients and families with care transitions is thorough. Education, interventions, and linking patients with community resources are critical to facilitating a successful transition (Keup & Petschauer, 2011). Furthermore, mentioning telehealth for monitoring home safety provides a creative twist to the conversation, demonstrating how technology can be used to improve patient care. Finally, your emphasis on referrals to home physical therapy, skilled nursing or assisted living facilities, and communication throughout transitions displays a thorough knowledge of the nurse practitioner’s role in care coordination. Overall, your essay provides useful information about assessing and caring for elderly adults in their homes.

References

Disdier Moulder, M. P. A., Hendricks, A. K., & Ou, N. N. (2019). Towards appropriate polypharmacy in older cardiovascular patients: How many medications do I have to take? Clinical Cardiology, 43(2), 137–144. https://doi.org/10.1002/clc.23304

Keup, J. R., & Petschauer, J. W. (2011). The first-year seminar: Designing, implementing, and assessing courses to support student learning and success. National Resource Center, First-Year Experience and Students in Transition, University of South Carolina.

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Discussion Response to a Classmate

Identify at least TWO assessments that can be used to determine whether a client is safe in their current living environment.

Falls among older adults are a public health problem and can result in minor or major injuries, decreased quality of life, and morbidity or mortality. The fear of falling can affect older adults’ lives, limiting their normal daily activities, physical activity levels, and socialization. As nurse practitioners, we must make sure that our patients are safe in their homes. One assessment that can be used to determine whether a patient is safe in their current living environment is the Home Safety Self-Assessment Tool (HSSAT) which is used by patients and their caregivers to identify and address fall hazards in the many areas of their home. It also allows them to create solutions to these hazards as well (Fritz et al., 2022). Another assessment is the Home Environment Assessment for the Visually Impaired (HEAVI) which is a tool created to assess risk factors in the home setting of patients with visual impairments. The HEAVI helps the visually impaired patients calculate the amount of fall-related hazards in all the rooms of their home such as inadequate lighting or change in elevation. This tool is important to help capture the fall risks that are specifically an issue for patients with vision problems (Ramulu et al., 2021).

Discuss results that indicate the client may require additional assistance or a transition in the care environment.

The HSSAT helps the patient, family or caregivers identify the total number of hazards in 9 areas of the home such as the front yard, entrance way and bathroom. Based on the identified hazards, the patient and family may need to come up with fall prevention strategies to help decrease falls (Schiller et al., 2019). Patients may need extra assistance with home modifications like adding handrails, rearranging furniture to make a clear walkway, or adding non-slip rugs. In addition, patients may need more assistance if they have consistent falls and injuries, have cognitive problems, or are unable to care for themselves. Moreover, the results of the HEAVI tool showed that poor lighting in the home was associated with higher fall rates among visually impaired individuals (Ramulu et al., 2021). Patients may need extra assistance with installing extra lighting in their homes or need referrals to ophthalmology to assess vision.

Describe the NP’s role in working with the client and family to assist with care transitions.

The NP can provide fall prevention interventions to the patient such as reducing medications that the patient takes that may increase their fall risk, provide suggestions on how to eliminate hazards in the house, promote vision and footwear interventions, and educate patients on other fall risk strategies (Fritz et al., 2022). In addition, based on the hazards in the patient’s home, it is important to educate the patient on safe modifications of their home to decrease falls such as safe lighting levels required in the home which is a lighting level of 323 lux. Most homes were shown to have less than or equal to 100 lux lighting in stairways, bedrooms or hallways which are areas where the highest amount of falls occur (Ramulu et al., 2021). Also, through telehealth, the NP can also assess the safety of the patient’s home as well. The nurse practitioner can work to provide the family with information about resources available in their area for safe housing and caregiver assistance which are appropriate for the patient’s needs and income level. The NP can also make sure to provide the patient with education and information about their need for a safe care environment, as well as factors which can adversely affect the safety of their living situation.

Identify at least TWO appropriate referrals for a client who requires a transition in the care environment. How does the NP ensure coordination of care during transitions?

One referral would be to home physcial therapy for increasing strength and balance of fall risk patients. Immobility can increase the patient’s risk for falls. It was shown that patients who already had a previous fall and who participated in home-based exercise programs created by a physical therapist were able to prevent secondary falls (Liu-Ambrose et al., 2019). The patients at greatest risk for falls are those patients with a history of falls and cognitively impaired. These patients may require a change in their living situation and would require a referral to a Skilled Nursing Facility or an Assisted Living Facility. The nurse practitioner can ensure coordination of care during these transitions by providing the patient with information about their condition and their limitations which could result in further fall related injuries or hospital admissions. It is important to educate the patient on their need for extra supervision, help with activities of daily living, greater surveillance, and rehabilitation assistance needed before discharging home. The nurse practitioner should also provide the patient with options of skilled nursing facilities or an assisted living facilities in the community to allow the patient and family to choose the best option for them. To ensure coordination of care during transition to the nursing facility, the nurse practitioner should provide the facility with the an updated medication list and specific patient requests that the patient has for their care (Hoffman et al., 2019).

Identify at least TWO public or private resources that are available for clients with limited resources in your intended practice area.

For patients who do not have a safe living situation there is help for housing via the U.S. Department of Housing and Urban Development (n.d.) which can help low-income individuals have access to affordable housing. The Florida Department of Elder Affairs (2023) also helps to provide caregiver assistance programs for seniors who need help around the home. This can be very helpful for seniors who are not safe performing certain activities around their home. UF Health Shands Hospital also provides patients without insurance affordable health care services such as additional referrals to meet the patient’s needs, medications for acute and chronic conditions, and social services to assist disadvantaged patients (University of Florida Health, 2023).

References

Florida Department of Elder Affairs. (2023). Caregiver assistance program. https://elderaffairs.org/resource-directory/caregiver-assistance-programs/

Fritz, B. A., King, C. R., Mehta, D., Somerville, E., Kronzer, A., Abdallah, A. B., … & ENGAGES Research Group. (2022). Association of a perioperative multicomponent fall prevention intervention with falls and quality of life after elective inpatient surgical procedures. JAMA network open, 5(3), e221938-e221938. doi:10.1001/jamanetworkopen.2022.1938

Hoffman, G. J., Liu, H., Alexander, N. B., Tinetti, M., Braun, T. M., & Min, L. C. (2019). Posthospital fall injuries and 30-day readmissions in adults 65 years and older. JAMA network open, 2(5), e194276-e194276. doi:10.1001/jamanetworkopen.2019.4276

Liu-Ambrose, T., Davis, J. C., Best, J. R., Dian, L., Madden, K., Cook, W., … & Khan, K. M. (2019). Effect of a home-based exercise program on subsequent falls among community-dwelling high-risk older adults after a fall: A randomized clinical trial. Jama, 321(21), 2092-2100. doi:10.1001/jama.2019.5795

Ramulu, P. Y., Mihailovic, A., Jian-Yu, E., Miller, R. B., West, S. K., Gitlin, L. N., & Friedman, D. S. (2021). Environmental features contributing to falls in persons with vision impairment: the role of home lighting and home hazards. American journal of ophthalmology, 230, 207-215. https://doi.org/10.1016/j.ajo.2021.04.022

Schiller, M., Gilkey, S., Mendez, J., & Dunleavy, K. (2019). An interprofessional team experience—value and timing in a Doctor of Physical Therapy curriculum. Journal of Physical Therapy Education, 33(2), 126-133. DOI: 10.1097/JTE.0000000000000088

University of Florida Health. (2023). UF Health care one clinic. https://ufhealth.org/locations/uf-health-care-one-clinic

U.S. Department of Housing and Urban Development. (n.d.). Rental help: Florida. https://www.hud.gov/states/florida/renting