Be yourself; Everyone else is already taken.
— Oscar Wilde.
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The rates of falls, injuries, and hospitalizations among the elderly population continue to impact them negatively. The psychological fear of falling affects their ability to function at optimal capacity, leading to the dependence on others for assistance(Schoene et al., 2019). Elderly falls lead to increased healthcare costs. According to Florence at al. (2018), 6% of Medicare expenditures, 8% of Medicaid expenditures, and 5% of other sources including out-of-pocket spending and private insurance spending are associated with falls; with falls attributable expenditures of $12billion for other payment sources, $28.9 billion for Medicare, and $8.7 billion for Medicaid. Innovative measures to prevent falls among the elderly will reduce these fall-related expenditures and mitigate the negative impacts of falls among this vulnerable population while promoting good quality of life.
Innovation is the process of implementing new marketing or organization strategies while creating various resources for sustainability (Dogan, 2017). Every organization requires some funding to keep up with the innovative process, therefore, it is necessary to determine the source of funding and their ability for sustainability. Also, innovation can sometimes be difficult, but knowing the source of funding and the right support will lead to successful innovation. Various innovative measures have benefited the elderly population in preventing them from falling, and this includes the utilization of durable medical equipment like wheelchairs and walkers.
Some organizations support innovative measures to prevent falls among the geriatric population, and one of them is the Arizona Falls Prevention Coalition. They promote fall prevention through their mission which is to reduce the risk of falls in Arizona through education, outreach, evaluation, and advocacy. The involvement and collaboration of stakeholders, and policymakers in the innovative process to implement fall prevention measures will impact the healthcare system positively by reducing medical costs and improving the health outcomes of the geriatric population.
References
AZDHS | Arizona Falls Prevention Coalition. (n.d.). Retrieved April 19, 2020, from https://azdhs.gov/prevention/tobacco-chronic-disease/healthy-aging/falls-prevention/index.php
Dogan, E., (2017). A strategic approach to innovation. Journal of Management, Marketing and Logistics (JMML), 4(3), 290-300. http://doi.org/10.17261/Pressacademia.2017.491
Florence, C.S., Bergen, G., Atherly, A., Burns, E., Stevens, J., & Drake, C. (2018). Medical costs of fatal and non-fatal falls in older adults. Journal of the American Geriatric Society, 66(4), 693-698. https://doi.org/10.1111/jgs.15304
Schoene, D., Heller, C., Aung, Y. N., Sieber, C. C., Kemmler, W., & Freiberger, E. (2019). A systematic review on the influence of fear of falling on quality of life in older people: is there a role for falls? Clinical interventions in aging, 14, 701–719. https://doi.org/10.2147/CIA.S197857
Technological innovation has impacted the world positively and has made it easier for people to have access to their healthcare information. Also, it has improved communication between individuals and allowed people to receive their healthcare treatments through telemedicine. There are various ways that health information technology (HIT) has impacted and transformed the healthcare system, and this includes improving clinical outcomes, facilitating care coordination, improving the efficiency of practice, tracking data, and reducing human errors (Alotaibi, & Federico, 2017). Regarding the geriatric population, technology would go a long way in keeping them safe. Medical alert devices, cameras, and other monitoring systems can improve the safety of the geriatric population and enable them to call for assistance when they fall.
One of the elderly patients I care for told me a story of how she ended up in a long-term care facility. She was living alone and had no one to assist her. One day she fell and couldn’t get up due to a fractured right hip. The woman stated that she laid on the floor for 2 days before one of her neighbors who had not seen her came to check on her. The neighbor knocked on her door and there was no response, so she went to the leasing office of the apartment complex. Her neighbor told the apartment manager that she hasn’t seen the elderly patient for some days. The apartment manager opened the door and found her on the floor, and she was in so much pain. The paramedics were called and upon assessment, they found out that she had fractured her right hip. After surgery, she went for rehabilitation and ended up in the long-term care facility where I work. Her discharge paperwork from the hospital stated that the patient was dehydrated, and almost lost consciousness when she was found in her room.
The scenario described above is a perfect example of where a medical alert device would be beneficial for this patient. Utilizing a medical alert device would have enabled her to call for assistance when she fell. The technological innovation through medical alert devices is effective in providing safety to the geriatric population. The advancement of technological innovation is important to the public and in the healthcare system, especially with the geriatric population. The utilization of information and communication technology as one of the ways to prevent falls among the geriatric population is necessary because it will assist them in maintaining their independence, while participating in interventions that are not supervised but remotely monitored by their healthcare providers (Hamm et al., 2016).
Additionally, it is imperative to address the privacy concerns surrounding the use of technology for patient care. Being able to easily access one’s information through technology is great, but measures to protect their identity should be emphasized. For the geriatric population, it is necessary to educate them about the importance of understanding their health-related information before signing any documents giving to them. The Health Insurance Portability and Accountability Act (HIPAA) is a privacy rule that controls how protected health information (PHI) is used and disclosed (Goldstein, & Pewen, 2013). By utilizing this rule, the elderly population won’t be divulging information that could lead to their identity being stolen. Technology has its advantages and disadvantages, but I believe that utilizing it would be significant in mitigating the impacts of falls among the geriatric population as they improve their health outcomes and enjoy a better quality of life.
References
Alotaibi, Y. K., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi medical journal, 38(12), 1173–1180. https://doi.org/10.15537/smj.2017.12.20631
Goldstein, M. M., & Pewen, W. F. (2013). The HIPAA Omnibus Rule: implications for public health policy and practice. Public health reports, 128(6), 554–558. https://doi.org/10.1177/003335491312800615
Hamm, J., Money, A.G., Atwal, A., & Paraskevopoulos, J. (2016). Fall prevention intervention technologies: A conceptual framework and survey of the state art. Journal of Biomedical Informatics, 59, 319-345. https://doi.org/10.1016/j.jbi.2015.12.013
In healthcare, collaboration yields impactful and positive results. The collaboration between the private sector, healthcare systems, and societal organizations is important when discussing public health issues and innovative change. Regarding falls among the geriatric population and the negative impacts on their health, it is significant to implement tailored fall prevention measures to reduce fall rates, prevent falls from recurring, and promote quality health. To accomplish this aforementioned mitigative steps, important stakeholders should be encouraged to participate in the innovative process (Bekkers, & Tummers, 2018). One of these stakeholders is the private sector which is often involved in healthcare as a result of various activities that are executed by non-state actors, including non-profit organizations, multinational companies, private individuals (general practitioners and consultants), and nongovernment organizations (Hallo De Wolf, & Toebes, 2016).
Various non-profit organizations in the United States focus on fall prevention among the geriatric population, and one of them is the Centers for Disease Control and Prevention. This organization promotes fall prevention through its STEADI (Stopping Elderly Accidents, Deaths, & Injuries) program. Their focus is on screening patients for falls, assessing modifiable risk factors of falls, and reducing fall risks by implementing effective fall prevention measures (CDC, 2016). By doing this, there would be a reduction in rate of falls, reduced Medicare expenditures related to falls, and improved health outcomes. Although in Arizona, only a few private sector organizations focus on elderly falls. However, there is a public sector organization known as Arizona Department of Health Services(AZDHS) that address elderly falls, and they promote fall prevention among older adults through Arizona Falls Prevention Coalition. The impacts of private sectors can influence public advancement through their collaboration with other organizations to implement fall prevention measures.
Additionally, different types of private sector involvement in healthcare make it possible to provide care for the public through various actors, and the geriatric population benefits from them. Payers are often involved through private health insurance companies and different charity organizations, healthcare providers are involved through private hospitals and clinics, private doctors and nurses, charities and civil society organization; and suppliers are involved through pharmaceutical companies and companies that supply medical equipment (Hallo De Wolf, & Toebes, 2016). For the geriatric population at risk for falls, durable medical equipment like walkers, and wheelchairs are among the tailored fall prevention measures that are effective in preventing them from falling. Fall prevention will eradicate any unwanted injuries, hospitalizations, increased Medicare costs, and unexpected deaths related to falls. The collaboration between sectors and the healthcare system is significant in disease prevention and health promotion, this will improve the health of the public while promoting healthy outcomes.
References
AZDHS | Arizona Falls Prevention Coalition. (n.d.). Retrieved March 22, 2020, from https://www.azdhs.gov/prevention/tobacco-chronic-disease/healthy-aging/falls-prevention/index.php#falls-prevention-about
Bekkers, V., & Tummers, L. (2018). Innovation in the public sector: Towards an open and collaborative approach. International Review of Administrative Science, 84(2) 209–213. doi: 10.1177/0020852318761797
Centers for Disease Control and Prevention. (2016). STEADI-older adult fall prevention. Retrieved March 22, 2020, from https://www.cdc.gov/steadi/about.html
Hallo De Wolf, A., & Toebes, B. (2016). Assessing private sector involvement in health care and universal health coverage in light of the right to health. Health and human rights, 18(2), 79–92.
The role of the federal government in healthcare has been very significant. Establishing Medicare and Medicaid in 1965 ensured access to insurance coverage for many of the United States population (Straube, 2013). The importance of healthcare, especially among the elderly population, who are vulnerable to different chronic conditions and falls cannot be over emphasized as it should be solely about improving health outcomes. Public sector institutions sometimes control what happens in the healthcare system, thereby affecting the care of the elderly population. The Affordable Care Act (ACA) is an influential federal healthcare legislation. The Affordable Care Act (ACA) explains various ways in which federal legislation addresses the inefficacy of current federal healthcare efforts, by emphasizing the importance of promoting good health and preventing diseases (Straube, 2013). This legislation has been beneficial to the elderly population as they manage their diagnoses while improving their health outcomes.
The foundation of healthcare reform should be about reducing the cost of healthcare and improving its outcomes. Unfortunately, most people don’t get to enjoy these benefits because of the direct and indirect influence of public sector institutions on healthcare outcomes. The elderly population is often affected by this due to some stipulations that accompany their insurance coverage, thereby limiting their ability to receive quality healthcare services. For the elderly population in Arizona, there is the availability of Arizona Health Care Cost Containment System (AHCCCS), but they are still mandated to meet specific income requirements before they can have access to services. It is important to consider the elderly population and what this means to their health as it affects their ability to seek quality healthcare services. The elderly population at risk for falls are sometimes hospitalized, and some of them don’t like going to the hospital after falling because of their inability to cover their healthcare cost, and the influence of insurance companies and other public sector institutions on healthcare.
In the United States, various fall prevention programs are directed towards preventing falls among the elderly population. Also, as previously mentioned, the Arizona Falls Prevention Coalition which was created by the Arizona Department of Health Services has its focus on preventing falls and injuries. Some public sectors are interested in improving health outcomes, while some are only interested in what benefits them. It is important to always consider the health of the public when making healthcare-related decisions because it will enable those who have chronic conditions and other health-related problems to seek healthcare services, and receive quality standard care while improving their health and healthcare outcomes.
References
Arizona Administrative Code. (2018). Arizona Health Care Cost Containment System – Administration. Retrieved from https://apps.azsos.gov/public_services/Title_09/9-22.pdf
Arizona Department of Health Services(n.d.). Arizona Falls Prevention Coalition. Retrieved from https://www.azdhs.gov/prevention/tobacco-chronic-disease/healthy-aging/falls-prevention/index.php
Straube, B.M. (2013). A role for government, an observation on federal healthcare efforts in prevention. Am J Prev Med 2013, 44(1), S39 –S42. http://dx.doi.org/10.1016/j.amepre.2012.09.009
The health of the elderly population in any society is very important, and the goal of healthcare is to prevent diseases and promote quality health. Also, preventing falls among the elderly population is to promote good health because the impacts of falls leave them hospitalized, while some are eventually institutionalized in Long Term Care facilities due to their inability to care for themselves. The National Conference of State Legislatures (2018) states that falls causes financial stress on the elderly population, and these expenditures might increase if nothing is done to prevent them from falling. The National Council on Aging (NCOA) states that in 2015, fall-related expenditures cost approximately $50 billion, and Medicare and Medicaid paid approximately 75% of these expenditures. This number shows that it is necessary to evaluate measures to reduce this cost, and this could be done by implementing interventions to prevent the elderly population from falling.
The United States of America is governed by laws, which makes up the Constitution. The United States Constitution did not state clearly the right to healthcare by the general population (Swendiman, 2010). The financial burden of healthcare is most times lessened through health insurance, and this is why Medicare is important for the geriatric population. According to the National Academy of Social Insurance, in 1965, Medicare was created because people who are 65 years and older could not get health insurance coverage. Through Medicare, older adults are able to receive treatments for their health-related problems. Although Medicare is available for the geriatric population, they still find it difficult to enjoy full health coverage due to the roles of institutions and actors in healthcare. Healthcare providers, political parties, and health insurance companies are part of the institutions that guide healthcare and they are also considered stakeholders (Santilli, & Vogenberg, 2015). It is necessary to consider the health of the public when making health-related decisions because the goal is to improve health outcomes.
Relevant Statutory and Regulatory Mechanisms related to Elderly Falls
There are different fall prevention programs available to improve falls among the elderly population. One of them is the Arizona Falls Prevention Coalition, which was created by the Arizona Department of Health Services and their goal is to prevent falls and injuries sustained by the elderly, and a mission to reduce the risk of falls in Arizona by utilizing the means of education, outreach, evaluation, and advocacy. Chronic diseases are among the contributing factors of elderly falls, therefore, interventions to manage these chronic conditions are important. This will promote good health and would prevent the elderly population from falling. Falls prevention will reduce the cost of expenditures by Medicare and Medicaid services, and prevent unwanted injuries and death.
References
Arizona Department of Health Services(n.d.). Arizona Falls Prevention Coalition. Retrieved from https://www.azdhs.gov/prevention/tobacco-chronic-disease/healthy-aging/falls-prevention/index.php
National Academy of Social Insurance. (n.d.). What is the history of Medicare? Retrieved from https://www.nasi.org/learn/medicare/history
National Conference of State Legislatures. (2018). Elderly falls prevention legislature and statues. Retrieved from https://www.ncsl.org/research/health/elderly-falls-prevention-legislation-and-statutes.aspx
National Council on Aging (n.d.). Falls prevention facts. Retrieved from https://www.ncoa.org/news/resources-for-reporters/get-the-facts/falls-prevention-facts/
National Council on Aging (n.d.). State policy toolkit for advancing fall prevention select resources. Retrieved from https://www.ncoa.org/wp-content/uploads/State-Policy-Toolkit-for-Advancing-Fall-Prevention-Select-Resources.pdf
Santilli, J., & Vogenberg, F. R. (2015). Key Strategic Trends that Impact Healthcare Decision-Making and Stakeholder Roles in the New Marketplace. American health & drug benefits, 8(1), 15–20.
Swendiman, K.S. (2010). Health care: Constitutional rights and legislative power. Congressional Research Services, 1-16. Retrieved from https://www.ncsl.org/documents/health/LegPowers.pdf
Falls has its implications because of the effects on the geriatric population, it prevents them from enjoying a normal functional life, leading to their dependence on others for assistance. According to the Arizona Department of Health Services, the Arizona Healthy Aging Plan (2014-2018) states that as the population of Arizona gets older, the health and life expectancy of individuals who reside in Arizona will be hampered by a variety of disease processes. These disease processes are contributing factors to falls that older adults experience. Geriatric fall is a worldwide problem that needs to be addressed and healthcare policymakers are often aware of the importance of finding solutions to problems that affect the public by creating policies. Healthcare policymakers introduce policies to improve the health of the population who are affected by chronic diseases (Pollack Porter, Rutkow, & McGinty, 2018). Since the geriatric population is often affected by the negative effects of falls, the goal of fall prevention is to prevent unwanted injuries and promote safety (Sharif et al., 2018). Also, promoting safety should be the goal of healthcare policy makers for this vulnerable population.
The elderly population remains at risk for falls mostly because of their desire to be independent, and sometimes being independent leads to falls and unwanted injuries due to unsteady gait and balance, which also leads to hospitalizations, and unexpected death. Healthcare workers and providers should always consider the importance of patients’ safety as well as the ethical principle of autonomy when providing care for patients, especially vulnerable populations like geriatric patients. The foundational aspects of medical ethics include the confidentiality between patients and their physicians during patient care, and respect for their autonomy (Pasha, 2014). Addressing the ethical impacts of healthcare policy surrounding elderly falls is important. It is imperative to understand the roles of policy-making in population health when making policy changes to avoid complicating ethical boundaries (Béland, & Katapally, 2018). Most times, these policies affect ethics because they are often focused on treating diseases rather than preventing them and promoting good health.
Policymakers must always consider the implementation process when they make policies because most times, they think that once a policy is enacted it is the end, without recognizing that implementation tends to determine if the policy will be successful or not (Pollack Porter et al., 2018). It is important to have clear guidance on what would be beneficial to create policies that are successful for the elderly population to improve and promote good health, which is why countries, institutions, and regions require commitment to create and implement policies which would benefit the geriatric population since policies on aging and health are sometimes fragmented, not coordinated, or nonexistent (WHO, 2015).
References
Arizona Healthy Aging Plan (2014-2018). A Framework to support healthy living and functional health for older Arizonan residents. Retrieved from https://www.azdhs.gov/documents/prevention/tobacco-chronic-disease/healthy-aging/reports-statistics/az-healthy-aging-plan-2014-2018.pdf
Béland, D., & Katapally, T. R. (2018). Shaping Policy Change in Population Health: Policy Entrepreneurs, Ideas, and Institutions. International journal of health policy and management, 7(5), 369–373. doi:10.15171/ijhpm.2017.143
Pasha, A. (2014). Ethical issues in geriatric care. Virtual Mentor, 16(5):327-329. doi: 10.1001/virtualmentor.2014.16.5.fred1-1405.
Pollack Porter, K. M., Rutkow, L., & McGinty, E. E. (2018). The Importance of Policy Change for Addressing Public Health Problems. Public Health Reports, 133(1_suppl), 9S-14S. https://doi.org/10.1177/0033354918788880
Sharif, S. I., Al-Harbi, A. B., Al-Shihabi, A. M., Al-Daour, D. S., & Sharif, R. S. (2018). Falls in the elderly: assessment of prevalence and risk factors. Pharmacy practice, 16(3), 1206. doi:10.18549/PharmPract.2018.03.1206
World Health Organization. (2015). Ageing and life-course. Retrieved from https://www.who.int/ageing/commit-action/en/
On a beautiful Saturday afternoon in May 2018, a resident of a long-term care facility with chronic medical diagnoses was walking from her room to the dining room for lunch. After taking a few steps, she lost her balance, fell, and started crying. She could not get up on her own and complained of being in pain and having difficulties getting up. Paramedics were called by the nurse who was on duty, and after further assessments, it was noted that this resident had a left hip fracture. Almost 48 hours after the fall a surgical procedure was done on her left hip, she went for a month rehabilitation and eventually went back to the long-term care facility where she resides. Through physical therapy, this resident was able to walk again without using any assistive device. Less than two (2) months after her first fall incident, she had another fall and fractured her right hip. She went through another surgical procedure and rehabilitation process but she was unable to walk again. She became non-ambulatory and started using a wheelchair for mobility. Less than two (2) weeks after the resident returned to the facility, she died.
The geriatric population often experience health-related challenges, and due to their frail nature, it is important to keep them safe. Older adults experience falls, and there are different factors associated with these falls. Gait and balance issues, side effects of medications, vision impairment, medical diagnosis, and functional status are some of the contributing factors of falls among the geriatric population (Fernando et al., 2017). Older adults with dementia experience twice as many falls due to their cognitive impairment, compared to older adults without any cognitive impairment (Bayen et al., 2017). The impact of falls among this population continue to affect them negatively because they lead to injuries that sometimes lead to unexpected death. The National Conference of State Legislatures (2018) stated that 20 to 30 percent of falls by the geriatric population leads to serious injuries, and these injuries limit their mobility, decreases their quality of life, and increases their risk for an untimely death.
The prevalence of falls among older adults who are 65 years and older continues to increase, they lead to hospitalization, thereby increasing fall-related healthcare expenditures (Kistler, 2018). According to Florence et al. (2018), in 2015, the amount spent on fatal and non-fatal falls was $50 billion; for nonfatal falls, $28.9 billion was paid by Medicare, $8.7 billion was paid by Medicaid, then private and other payers paid about $12.754 billion on fatal falls. Other than the physical injuries associated with falls, there are psychological impacts as well that include the fear of falling, and this could have a long-term effect on the person (Schoene et al., 2019). The annual cost of falls among the geriatric population showed that it is important to address falls and its impacts among the geriatric population, especially among those who are cognitively impaired to mitigate unwanted injuries, hospitalization, increased healthcare expenditures, and unexpected death.
References
Bayen, E., Jacquemot, J., Netscher, G., Agrawal, P., Tabb Noyce, L., & Bayen, A. (2017). reduction in fall rate in dementia managed care through video incident review: Pilot Study. Journal of medical Internet research, 19(10), e339. doi:10.2196/jmir.8095
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. Physiotherapie Canada, 69(2), 161–170. doi:10.3138/ptc.2016-14
Florence, CS., Bergen, G., Atherly, A., Burns, E., Stevens, J., & Drake, C. (2018). Medical costs of fatal and nonfatal falls in older adults. J Am Geriatr Soc. 2018 Apr;66(4):693-698. doi: 10.1111/jgs.15304. Epub 2018 Mar 7. PMID: 29512120; PMCID: PMC6089380.
Kistler, B. M., Khubchandani, J., Jakubowicz, G., Wilund, K., & Sosnoff, J. (2018). Falls and fall-related injuries among US adults aged 65 or older with chronic kidney disease. Preventing chronic disease, 15, E82. doi:10.5888/pcd15.170518
National Conference of State Legislatures. (2018). Elderly fall prevention legislation and statues. Retrieved http://www.ncsl.org/research/health/elderly-falls-prevention-legislation-and-statutes.aspx
Schoene, D., Heller, C., Aung, Y. N., Sieber, C. C., Kemmler, W., & Freiberger, E. (2019). A systematic review on the influence of fear of falling on quality of life in older people: is there a role for falls? Clinical interventions in aging, 14, 701–719. doi:10.2147/CIA.S197857
My name is Kate N. Ebea, a 3rd year Doctor of Nursing Practice (DNP) student at the Edson College of Nursing and Health Innovation at Arizona State University, and my specialty is adult gerontology. I am a registered nurse and I provide care for the geriatric population with dementia. This semester, I will be blogging about the impacts of falls among the geriatric population. Welcome to my blog site!
The Impacts of Falls on Geriatric Population with Dementia