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Meeting Safety Needs of Older Adults

Did you know that 85% of older adults have done nothing to prepare their home for aging? And very few of today’s new builds have made a long term plan for aging either. As a society we need to remind ourselves that we will all be an Older Adult eventually, and planning for it is essential to staying safe and healthy.

Falls, burns and automobile accidents are the most common safety problems among older adults. Older adults are more susceptible to accidents and injuries than are younger adults because of internal and external factors. Internal factors include the normal physiologic changes with aging, increased incidence of chronic disease, increased use of medications, and cognitive or emotional changes. External factors include a variety of environmental factors that present hazards to older adults.

Internal Risk Factors

Vision and hearing are protective senses. When the acuteness of the senses diminishes with aging, the risk for injury increases. Diminished range of peripheral vision and changes in depth perception are common and can interfere with the ability of older adults to judge the distance and height of stairs and curbs or to determine the position and speed of motor vehicles. Night vision diminishes. Falls or motor vehicle accidents often result from altered vision. Decreased auditory acuity reduces an older person’s ability to detect and respond appropriately to warning calls, whistles or alarms. For example, they may not hear a warning call of impending danger, may not hear a motor vehicle or siren in time to avoid an accident, or may not respond to a fire alarm in time to leave a building safely.

Older adults often experience one or more physiological changes that increase their risk for falls and other accidental injuries. Any of these changes alone or in combination can reduce the older person’s ability to respond quickly enough to prevent an accidental injury. When these problems are combined with chronic diseases or health problems, the risk increases dramatically. Common physiologic changes that affect safety include the following: altered balance, decreased flexibility, decreased muscle strength, slowed reaction time, gait changes, difficulty lifting the feet, altered sense of balance and postural changes.

Conditions affecting the cardiovascular, nervous, and musculoskeletal systems are most likely to contribute to safety problems. Any cardiovascular condition that results in decreased cardiac output and decreased oxygen supply to the brain can cause older adults to experience vertigo (dizziness) or syncope (fainting). Common disorders with this result include anemia, heart block, and orthostatic hypotension. Studies have shown that approximately 52% of long-term nursing home residents older than 60 years, experience four or more episodes of orthostatic hypotension a day.

Older persons with a neurologic disorder such as Parkinson’s disease or stroke experience weakness and alterations in gait and balance that increase the risk for falls. Neurologic and circulatory changes can also decrease the ability to sense painful stimuli or temperature changes, increasing the risk for tissue injuries, burns, and frostbite. In fact, nursing home residents that have diabetes are more than twice as likely to suffer from falls as those that do not have diabetes.

Musculoskeletal conditions such as arthritis further reduce joint mobility and flexibility, decreasing the ability of the older person to move and respond to hazards and intensifying the likelihood of accidents or injury.

Medications often contribute to falls, and, because older adults generally take one or more medications, their risk for untoward effects is increased. Any medication that alters sensation or perception, slows reaction time, or causes orthostatic hypotension is potentially dangerous for older adults. Common types of hazardous medications include sedatives, hypnotics, tranquilizers, diuretics, antihypertensives, and antihistamines. Alcohol, although not a prescription medication, acts as a drug in the body. Alcoholic beverages, particularly in combination with prescription drugs, increase the risk for falls and other injuries.

Cognitive changes or emotional disturbances and depression may be overlooked as risk factors for falls or injury. For those that live with a dementia such as Alzheimer’s disease, can reduce the older person’s ability to recognize and process information. Distracted or preoccupied older adults are less likely to pay full attention to what is happening or what they are doing. This lack of attention and caution increases the risk for accidents and injury.

External Risk Factors

Environmental hazards include everything that surrounds older adults. Potential hazards are presented by the people and the variety of objects a person comes into contact with on a daily basis. Even the climate in which a person lives can present an environmental hazard. These hazards are everywhere: in the home, on the street, in public buildings, and in health care settings. Although injuries can and do occur often in the home, a change in environment, such as hospitalization, travel, or any other move from a familiar environment, increases the likelihood of injury for older adults.

Older adults are among the highest risk groups for injury or death due to fire. Most of the injuries are a result of cooking accidents, whereas the majority of the deaths are smoking related. Many of these deaths could be prevented by instituting these basic fire safety precautions in the home: install smoke detectors, ensuring that batteries are working and replacing them twice a year. Use caution with cigarettes; make sure ashtrays are emptied into metal containers or the toilet. NEVER smoke in bed. If oxygen is in use in the home, ensure that are no open flames such as cigarettes or candles. Oxygen does not burn, but it supports the combustion of other flammable items. Be sure to turn off the stove or oven if you are leaving the area. Keep baking soda and a pot lid available to smother a fire if it occurs. For those with dementia you can turn off the breaker or unplug the stove to prevent injury.

People, particularly strangers, present a risk to the elderly. Older adults are more vulnerable than younger person to attack and injury from those who prey on weaker or more defenseless people, such as the elderly. Older adults need to be aware of the risks presented by strangers and learn to institute measure to reduce the likelihood of injury.

Probably the most dangerous hazards, because of their size and speed, are motor vehicles. Motor vehicle accidents are more likely to occur with aging, whether the older person is a pedestrian or a driver. Crossing roads is a significant problem for elderly pedestrians. Older adults are often unwilling to stop driving in spite of the serious risks to themselves and others. Independence is the main reason voiced by elderly adults for continued driving. A driver’s license is a ticket to freedom. As our baby boomers age, we will soon have even a larger proportion of elderly drivers on our streets and highways. A few tips for our older drivers include: plan ahead to know where you are going, let someone else know of your travel plans, allow extra time so you don’t feel rushed, avoid distractions such as talking and the radio, wear appropriate hearing aids and eyeglasses, use extra caution when approaching intersections, and drive at a safe distance behind other cars.

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