Don't underestimate fall injuries in elderly
ED nurses see 47,000 elderly patients each year for injuries from falls involving use of walkers and canes, says a new study from the Centers for Disease Control and Prevention that examined six years of ED medical records.1 Most (87%) of the injuries involved walkers. Older women were more likely to be injured than men; they sustained 78% of walker-related injuries and 66% of cane-related injuries.
Laura Aagesen, RN, BSN, MBA, trauma coordinator at Northwest Community Hospital, has seen patients arrive at the ED with mobility devices that are improperly fitted. "Some patients have a girth larger than the width of the walker, or the height is set too high or low for proper use," she says. "Many times these aids are purchased by the individual in a store and are not correctly sized."
ED nurses should look for cracked rubber tips or incorrectly sized aids, says Aagesen. "If staff see that a mobility aid is damaged, they will get it replaced," she says. "Without instruction from a health care provider, these devices can be dangerous and put the individual at great risk for a fall."
At Northwest Community, ED techs have been trained in fitting patients for walkers. "The ED nurse's role is to see that the device being used is not only proper for the injury and assisting in ambulation, but that the patient is using it in a safe manner," says Aagesen.
No matter how your patient received a fall injury, whether from tripping or a syncopal episode, always do a head-to-toe assessment, says Aagesen. If a patient comes to the ED after a fall and complains of severe shoulder pain, a lesser injury can be overlooked, she explains. For example, one ED patient had an obvious humeral fracture, but she was not fully undressed so a through head-to-toe assessment was not performed. The patient was discharged, but once home, she was unable to remove her shoe due to swelling. "The patient later returned and was diagnosed with a foot fracture," says Aagesen.
Keep mechanisms of trauma in mind when assessing your patient, such as evaluating the cervical spine for injury after a patient strikes his or her head. "Trauma patients need to be evaluated to rule out significant injuries, just as patients with chest pain need to be evaluated to rule out a myocardial infarction," she says.
Reference
- Stevens JA, Thomas K, Teh L, et al. Unintentional fall injuries associated with walkers and canes in older adults treated in U.S. emergency departments. J Am Geriatr Soc 2009; 57:1,464-1,469.
Source
For more information about caring for elderly patients with fall injuries, contact:
- Laura Aagesen, RN, BSN, MBA, Trauma Coordinator, Northwest Community Hospital. Phone: (847) 618-4005. E-mail: [email protected].
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