Running head: HOME SAFETY 1

Home Safety: Falls, Medications, Abuse, and Safety Proofing

Linda Moody, Allison Rogers, Justin Day, and Michael Compton

King University
HOME SAFETY 2

Home Safety: Falls, Medications, Abuse, and Safety Proofing

Introduction

This lesson will be held at the Mountain Empire Older Citizens: Program of all-inclusive

care for the elderly, also known as the PACE program, in Big Stone Gap, Virginia. The

participants for this group project include individuals enrolled in the PACE program. These

individuals live at home with a family member or caregiver, and attend PACE during daytime

hours as needed when family or caregivers are not available. Through education of fall

prevention, home medication safety, protection against abuse, and safety proofing the home,

these individuals will become more knowledgeable of the potential risks, and have a better

understanding of simple safety measures that can be taken at home to decrease poor outcomes.

Definition and Description of the Problem

According to Sandberg-Cook and Hadidian (2017), falling is defined as an unintentional

loss of balance that results in a position change and contact with the ground (p.89). Falls

sustained by the aging adult can lead to serious complications such as subdural hematoma,

fractures, and soft tissue injury. The risk of sustaining a fall increases with age. Sandberg-Cook

and Hadidian (2017) state, falls are a major contributor to death in the older population and

contribute to forty percent of nursing home admissions (p.90). The contributing factors listed by

Sandberg-Cook and Hadidian (2017), are lower extremity weakness, poor balance, orthostatic

hypotension, central nervous system disease, cognition and sensory abnormalities, and unsafe

environments (p. 90).

The geriatric population is at increased risk for medication related problems, as a result of

age related changes in the body, multiple disease processes, and polypharmacy. Sandberg-Cook
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and Hadidian (2017) explain that as one matures there is a decrease in lean body mass, body fat

increases, and blood flow to the kidneys and liver decline. This process has an impact on drug

distribution and clearance of medications from the aging body. Because of this course of action,

the elderly more likely to suffer from side effects and complications from medications. When

multiple disease processes are present, typically the treatment regimen becomes more

complexed, oftentimes with the need for multiple medications. The use of multiple medications,

both prescription and non-prescription, increases the risk of adverse drug reactions. In turn,

adverse drug reactions put one at increased risk for changes in mental status, sedation, falls, and

other more serious complications and outcomes (Sandberg-Cook & Hadidian, 2017).

A common issue that is often over looked in the elderly population is abuse. Abuse to

elders is becoming a serious problem in our society. With most adults, due to under-reporting,

poor understanding of elder abuse, and the absence of a nationwide uniform reporting system, it

is difficult to determine the scope of this issue. The National committee of Prevention of Elder

Abuse or the NCPEA, distinguishes between seven different types of elder abuse. These include

physical abuse, sexual abuse, emotional abuse, financial/material exploitation, neglect,

abandonment, and self-neglect. (NCPEA Staff, 2012).

When it comes to home safety, many homes are not safe for elderly adults. According to

the U.S. Consumer Product Safety Commission (CPSC), almost 1 million people who are over

65 years old go to the emergency room for treatment for injuries that happen in everyday life at

home ("Home Safety for the Elderly - InterNACHI," 2016). Slips, falls, burns, and house fires

are major causes of elderly injuries. Elderly adults are three times more likely to be injured or

die from accidental injury than the younger population ("Home Safety for the Elderly -
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InterNACHI," 2016).

Description of Possible Solutions

There are many solutions that can be implemented to prevent falls from happening. First

is risk assessment. A falls risk assessment should be performed during wellness visits at primary

care provider offices with special attention to medications, complete history and physical,

hearing and vision testing, and testing of mobility and gait. Questions geared towards

dependency in activities of daily living is important as well as a home evaluation if warranted.

Other fall prevention solutions are geared toward patient education. It is important to

discuss fall prevention and any fear patients have regarding falls. Education should include

safety proofing the home by eliminating clutter, trip hazards, and slippery surfaces, installation

of safety bars in bathrooms, and making sure the home is well lit. Older adults need to be

educated about physical training that can improve strength and balance, wearing well-fitted, low-

heeled footwear, and the utilization of assistive devices such as canes or walkers. Education

should also include potential side effects of medications that can increase the risk of falls.

Sandberg-Cook and Hadidian (2017) suggest from a provider standpoint, all medications,

including prescription and non-prescription, should be reviewed at each healthcare visit. The

Beers list should be utilized with all patients over the age of 65, as well as drug risk/benefit

consideration with any new medication prescribed. As a general rule, when prescribing

medication to anyone, especially the elderly, one should begin with the lowest dose possible and

titrate slowly to the most effective dose (Sandberg-Cook & Hadidian, 2017). Patients should be

encouraged to carry an up-to-date list of their medications with them at all times, and ensure the

family knows where this information is in the event of an emergency (Sandberg-Cook &

Hadidian, 2017). Patients should be educated about side effects of medications and encouraged
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to report any side effects or anything concerning to their provider or pharmacist. Education and

empowerment of patients leads to increased knowledge and compliance, which results in better

outcomes.

With elder abuse, the need to understand and identify the problems and risk factors is

extremely important. Patients should be able to go into their golden years without the fear of

someone harming or neglecting them. The APS or adult protective services are a resource that is

often overlooked and feared because of the concern maybe a family member or friend will get in

trouble or the possibility of the patient losing their independence at home. Proper education is

needed to reassure patients of the benefits of using the APS and the risks of letting abuse

continue. Patients need to have a clear understanding of what services are available and who

would be best to trust to assist in there care and the level of accountability involved. Proper

education on legal services available is necessary as well with the use of an advance directive or

living will, to ensure the patients wishes are carried out in the event of an emergency (NCPEA

Staff, 2012). By removing potentials for abuse, such as risk for provider neglect or finical abuse

and proper education of services we can effective eliminate the opportunities for harm and

actually empower our patients.

In order to prevent serious injury or death by accidents in the home, the home must me

safety proofed. It is recommended that the elderly have non-slip mats in the bathtub, grab bars,

and slip resistant rugs and handrails on stairs should be used throughout the home ("Home Safety

for the Elderly - InterNACHI," 2016). It is important to remove all tripping hazards and make

sure there is good lighting throughout the home ("NIHSeniorHealth: Falls and Older Adults -

Fall Proofing Your Home," 2013). It is also recommended that elderly adults turn the

temperature down on the water heater to lower than 120 degrees Fahrenheit to prevent burns and
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scalds from hot water ("Home Safety for the Elderly - InterNACHI," 2016). Smoke detector

batteries should be checked at least twice a year to ensure they are working properly.

Description of Implementation

According to Sandberg-Cook and Hadidian (2017), recommendations for health literacy

approach include using clear, simple-to-understand language, repeat instructions by highlighting

three to five key points in educational instruction, using pictures or visual tools to enhance

understanding, utilization of the teach back method for evaluation of learning, and empowerment

of patients.

The solution purposed for this group project incorporates an educational lesson about

home safety. The subjects included in the lesson will be fall prevention, medication safety,

protection against abuse, and safety proofing the home (Total Home Health, 2016, para 2). This

lesson will entail education on each subject, games to keep the class engaged, and door prizes

with objects integrated in each lesson.

The project was accomplished in collaboration with Donna Mayhan, the activities

director, and Donna Susong, program director at MEOC PACE program. The group contacted

the facility, asked permission, and proposed the potential problem and plan. The group met at

PACE and presented the Home Safety project in the dining hall during the activities session.

Design of the Project

The fall prevention lesson will include talking about staying active to maintain strength

and balance, wearing well-fitted shoes that are flat and non-slip, ensuring the home is well lit,

utilization of nonslip mats in showers and tubs, removing throw rugs, arranging furniture to

allow more room for ambulation and using night lights when walking in the middle of the night.
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Health promotion about medication safety was addressed through this presentation.

Topics for medication safety included the importance of keeping an up-to-date list of medications

with you at all times, age related changes cause an increased likelihood of medication related

side effects, importance of following instruction and reading labels on the prescription bottles,

and the importance of communication with the healthcare provider and pharmacist. The

participants were encouraged to always seek knowledge by using the acronym ASK. The

healthcare provider or pharmacist should always be ready and willing to answer any question,

especially if side effects are experienced, instruction is not fully understood, directions that are

not clearly heard, there is a problem with cost of the medication, or any concerns arise.

Abuse prevention was addressed through this presentation as well. The presentation

identified the types of abuse, risks and how to prevent and report such findings. It focused on

making participants aware of what to look for in their own lives and others around them that

may be facing the same challenges or have the same risk factors (Hardin & Hudson 2011). It

was important to assess the understanding of how to prevent such risks by incorporating trusted

people in their care and having legal documentation that would also act as potential protection.

If anyone noticed signs or had been experiencing abuse, they were encouraged to notify a trusted

individual or health care provider and if possible the adult protective services. This info also

educated patients on potential resources available if assistive services may be needed to prevent

self-neglect with utilities or medication assistance as well. Most participants appeared very

responsive to the presentation and even followed with questions.

Safety of the home was talked about in this project. This project educated participants on

how to use a fire extinguisher. Participants also learned how to check a smoke detector and were

educated on checking their smoke detectors at least twice a year. It was important for
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participants to know that they need to change the air filter in their homes frequently. The

maximum safe temperature for the water heater was discussed as well. Most participants seemed

aware of these preventative measures and gave good feedback indicating that they were retaining

the information presented to them.

Delivery of the Project

The individuals attending PACE were given instruction on key points of fall prevention,

home medication safety, protection against abuse, and safety proofing the home. A poster board,

which included key words and phrases, as well as pictures, was utilized in the presentation.

Visual tools, such as various pictures on the poster board, were utilized in order to enhance

understanding of the material and subject matter being presented. The individuals remained

engaged during the entire presentation.

Evaluation of the Problem

A Jeopardy game was incorporated in order to evaluate the effectiveness of the teaching

project. The participants at PACE engaged in the activity, and quickly were able to respond with

correct answers, to each question asked. Utilizing games provided an opportunity to evaluate

the level of comprehension using the teach back method, as well as empowering the patients

through showing they have understood and gained knowledge regarding the material provided.

With permission from staff, door prizes such as a personal medication record, pill cutters, night-

lights, hand sanitizer, and tissues were given to the participants as a thank you for allowing us the

opportunity to speak with them and giving their time and attention in this education session. The

door prizes were also used as a way of enhancing understanding and reinforcing the information
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taught about falls, medication safety, and health promotion and home safety, as well as way of

making the experience more enjoyable for the participants.

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References

Hardin, E., & Khan-Hudson, A. (2011). Elder abuse societys dilemma. Journal of the national

medical association, 97, 91-94.

Home Safety for the Elderly - InterNACHI. (2016). Retrieved from

https://www.nachi.org/elderlysafety.htm

NCPEA Staff (2012). Elder Abuse. National Committee for the prevention of Elder Abuse

Retrieved from http://preventelderabuse.org/elderabuse/

NIHSeniorHealth: Falls and Older Adults - Fall Proofing Your Home. (2013, January).

Retrieved from https://nihseniorhealth.gov/falls/homesafety/01.html

Sandberg-Cook, J. & Hadidian, P. (2017). Aging and common geriatric syndromes. In T. M.

Buttaro, J. Trybulski, P. Polgar-Bailey, & J. Sandberg-Cook (Eds.), Primary Care: A

Collaborative Practice (5th ed.), (pp.84-94). St. Louis, MO: Elsevier.

Total Home Health. (2016). Fall prevention for people with disabilities and older adults.

Retrieved from http://www.totalhomehealthinc.com/fall-prevention.html