You are helping a previously independent 85-year-old patient move into an assisted living situation after she experienced a hip fracture

Question

She had wanted to return to her home where she lived alone, but reluctantly agreed to the assisted living facility after being pressured to do so by her daughter.
a. Based on your understanding of the most common causes of falls in the elderly, what kinds of safety measures would you try to implement in her living environment?
b. What factors might make this patient more susceptible to depression. What signs or symptoms would alert you to the possibility of depression?

Answer 1

- Keep in mind the most common causes of falls in the elderly: age-related changes in mobility and reaction time; chronic conditions that lead to weakness and fatigue; weakness and immobility due to prolonged bedrest or restricted activity; and environmental factors. Precautions against falls may include
o Maintaining an uncluttered environment
o Reorienting patient and allowing ample time for patient to become accustomed to changes in the living environment
o Providing safety measures to prevent injury while ambulating or moving, for example, handrails in rooms and along hallways; access to wheelchairs and walkers; and staff support
o Assuring compliance with prescribed medical regimen and observing and reporting abnormal responses to treatments
o Encouraging a regular routine of exercise and activity

b.
- Factors in this patient that may cause an increased risk of depression: recent change in health status (hip fracture); loss of independent living situation; changing role/relationship with daughter; change in emotional and social support system.
- Monitoring for signs of depression would include assessment for symptoms of fatigue, sadness, or sleep disturbances; withdrawal from social interaction; lack of energy; sad or flat affect; loss of interest or pleasure in usual activities; slow cognitive or psychomotor processes; feelings of worthlessness or guilt; inability to concentrate; and thoughts of or attempts at suicide.