SPLAT blog Friday
The job of the aging professional or geriatric care manager is often to be the messenger. When you assess a client and find problems like falls you report the falls to the primary physician. This is being the messenger.
How do you code the message about a fall?
I mention SPLAT in my You Tube Video on Mobility and Falls SPLAT is an acronym to document falls. This can be used by a geriatric care manager or other aging professional
Symptoms -When you visit the client and they report a fall- what were the symptoms, before the falls such as lightheadedness-
Previous- Ask if they had previous falls
Location of the fall.
Activity- ask what they doing previous to the fall
T- Time of the fall.
After you document a fall, the next step is to report the fall to the older person’s primary physician. Dr. Dr. Alicia Arbaje from Johns Hopkins Medicine discussed the effects of elderly falls as well as how they can be prevented. Watch her You Tube on Falls and learn more
The Daily Shower Can be a Killer was the headline of the NY times article on January 29, 2013. As we have covered activities of Daily living as a part of a Functional assessment, the deadly nature of bathing for the elderly comes up as a giant red flag Falls are the most common cause of death in the elderly, as I discussed in the You Tube on Mobility and falls yesterday. According to the CDC , if you are over 65 falls are the leading cause of injury and death.
What can a geriatric care manager or aging professional do to prevent these falls?
Most elders fight with bad vision, thereby making them an easy prey to falls is the bathroom. GCM can take steps to increase the bathroom safety for elders living in at home and have vision examinations updated normally
Most senior eyes may require extra light to see things clearly. GCM or aging professional can increase the light in the bathroom by fixing bulbs with high voltages and dimming light.
Besides this, slippery surface can serve as a perfect recipe for bathroom falls.
The GCM or aging professional needs to take preventive measures before things get worse? Fixing an overflowing tap, purchasing some non-slippery carpet on the ground and suggesting any other any tool that you think can help you get rid of the slippery bathroom surface.
Clutter in the bathroom can be addressed. A cluttered place will increase the chances of injury. All clothing and other required materials should be kept in a safe place from where they do not fall very often.
Grabs bars should be a necessary fitting in your bathroom. It’s important that you have stainless steel and solid grab bars that can offer firm support. Grab bars can come very handy when a person loses his/her balance. Also, a GCM or aging professional can have the elder invest in a good shower chair. More than often, elders slip while performing some basic movements in a standing position.
By introducing a shower chair can enable elders to sit comfortably while having a shower, thereby reducing the chances of getting injured. . The GCM or senior professional can make sure there is a non- slip bathmat in the tub.
Besides this, make sure that you make life easier for elders in your family by keeping things within their reach. Your best bet over here would be to store all bathroom related amenities in a place where they can easily reach without bending or stretching their body. This will prevent the instances of bathroom falls. Elderly people suffering from arthritis and other bone diseases will thank you a lot.
Assessing for a care providers or family member to do standby with bathing is another safety assessment to prevent bathroom falls. Remember , the bathroom is the most dangerous room in the house.
Functional assessment does dovetail. You can see now how doing the ADL evaluation of bathing is integrally related to mobility in functional assessment. All the parts of a functional assessment and the whole geriatric assessment can help older people not only functional better in their home and avoid falls that can obviously be a killer.
In a Functional Assessment you test mobility. Direct observation can identify problems in gait and balance. Early detection of deficits in mobility can identify those clients at risk of injury. Whenever possible, rehabilitation can then assist in restoring functional losses and reduce the risk of falls. For those deficits that cannot be rehabilitated, assistive equipment such as a cane or walker can be provided.
The Tinetti Balance and Gait Evaluation is a 28-point assessment tool that is performed by a trained evaluator. This can be done by a GCM, an OT or an RN but all should be trained in the test.
A condensed version of the Tinetti is also available. This test, the Get Up and Go Test, is simple to administer, requires no special equipment, and can be conducted in a brief amount of time. The test begins with the client sitting up straight in a high-seat chair, which allows the person to sit with hips at a 90-degree angle to knees. The client is then instructed to (1) get up (without using armrests if possible), (2) stand still, (3) walk forward 10 feet, (4) turn around and walk back to the chair, and (5) turn and be seated. The evaluator notes sitting balance; transfers from sitting to standing; pace and stability of walking; and ability to turn without staggering. Statistical verification of the test by the developers showed good correlation between test scores and other measures of gait, which in some cases involved more sophisticated laboratory-based measures of balance and gait.
Today we are going to again cover activities of daily living. Why? Because I have been blogging about a geriatric assessment and we are now covering a functional assessment. This is the second part of a geriatric assessment, with the first part a psychosocial assessment, which you can review in former blogs.
The term Activities of Daily Living was coined in 1949 by Edith Buchwald in Physical Therapy Review
In 1950 Katz and colleagues came up with scale in Cleveland at Benjamin Rose Hospital and designed Katz scale
Designed 6 indexes
v Feeding- late loss
v Continence- late loss
v Transferring- late loss
v Toileting early loss
v Dressing –early loss
v Bathing – early loss
Today we are covering mobility
q As a geriatric care manager, you are looking for
q Ability to transfer
q Joint function
Early detection of mobility problems and assistive devices, rehab prevent falls
Ø Observation- watch him/her walk, get up out of chair, listen to talking for clarity cognitive problem (not making sense)
Ø Ask caregiver or family member to confirm if cognitively impaired
Ø Reframe question say “ Did you drive here” instead of “ Are you still driving?”
Ø 30% of older adults living at home fall each year- makes them at risk for nursing home placement
Ø Ask them to get you a drink of water (you can watch them get out of chair and walk)
Ø Observe the older person sitting balance, transfer from supine to sitting, and sit to chair sit to stand
Ø If in bed watch transfer from one surface to another
Ø Ask client if they have shoulder pain
Ø Ask them to lift and rotate each arm
Ø As the client to two of the GCM’s fingers – measure grasp
Ø Ask client to pick up small object like toothbrush, penny, and spoon- measuring dexterity
Ø 1-5 older adults have a gait disorder, which is an excellent reason to administer the activities of daily living test.
Ø More on this tomorrow