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When assessing an older adult who has a history of falls but no cardiovascular issues, it is important to remember that there are many possibilities as to why this may be occurring. Firstly, falls occur more often with old age regardless of other predisposing factors. As a person ages, they are more susceptible and falls are one of the top causes of hospitalization amongst the elderly community (Phelan et al., 2015). Aging leads to decreased muscle strength, unsteady gait and decreased proprioception which all contribute the the increase in fall risks (Appeadu, 2021). Another reason that a person may fall is related to medications that increase the risk of orthostatic hypotension, which is the sudden drop in blood pressure with sudden movements to sit up or stand. Taking these two factors into consideration, while assessing a patient there are some questions that I would personally ask. A medication history would be of importance so asking your patient what medications they are currently taking may help. Some medications contribute to unsteady gait, sedation and postural hypotension which can lead to falls (Phelan et al., 2015). Additionally, asking the patient if they have had a decrease in vision recently or are/have been wearing their glasses if they have them. Also, because the patient has not seen a primary care physician in a year, we are unaware of recent history, so asking the patient of any changes they have noticed within the last year related to their gait and level of consciousness may be beneficial. Lastly, ensuring that the patient has a clear and visible walkway in their home is important. Many falls are simply related to environmental factors such as clutter or unevenness in their home (Phelan et al., 2015). Environmental factors such as tripping and falling over an uneven carpet or some clothes on the floor is a possibility that can be easily adjusted if necessary.
With advanced age, it comes with the wear-and-tear of physiological function, which can be challenging to distinguish age-related versus pathological-related changes. In the older adult population, one of the largest barriers is the lack of access to primary health care providers, and that’s how this group of clients usually suffer delayed diagnoses and worsen symptoms. Without proper education and guidance, the elderly often neglect the symptoms of cardiovascular disease as normal aging signs. The assessment questions and necessary considerations that nurses should be aware of are to assess the risk factors, lifestyle, and hereditary aspects of cardiovascular disease.
- “Do you have any medical history?”
- “Does anyone in your family have a history of cardiovascular disease?”
- “Do you ever experience palpitation?”
- “Have you ever experienced chest pain or tightness?”
- “Do you ever have shortness of breath?”
- “Do you have any pain in the upper back or shoulders?”
- “Do your feet or ankles ever get swollen?”
- “Do you get tired easily or find that you need more rest than usually needed?”
- “Do you smoke? If so, how often and how long have you been smoking?”
- “Do you drink? If how often?”
- “How often do you exercise weekly?”
- “How often do you fall by accident?”
It is important to thoroughly assess the client’s risk factors in developing cardiovascular disease to prevent any further morbidity and mortality. According to Miller, there are two types of risk factors: modified and unmodified factors. With unmodified risk factors such as age, gender, race, heredity, and socioeconomic status, there are no interventions to avoid the development of disease. On the other hand, modified factors such as stress, weight, metabolic syndrome, smoking, drinking, inadequate diet, physical inactivity, etc can be prevented by better knowledge of the disease, smoking cessation or avoiding passive smoking, healthy dietary pattern, weight control, blood pressure control, coping mechanism with stress, and keep physically active. It is also necessary to provide them with available government resources in order to manage their health and improve life quality.