Related Issues:
Mobility, ambulation, transportation, neuropathy
Why Gait is Important:
Normal Age-Related Changes:
Older adults are at increased risk if they have any of the following:
Falls Specific Risk Factors (Shanthi, 2005; Capone, et al, 2012; Costa & de Jesus, 2015; Bloch et al, 2010)
Conditions
Behavioral Risk Factors
Medication-Related Risk Factors
Chemotherapy-Related Risk Factors
Surgery-Related Risk Factors
Radiation Risk Factors
Cancer Diagnoses
Assessment:
1. Screening Questions
2. Observations
3. Screening Tests and Measurements
This is performed with patient wearing regular footwear, using usual walking aid if needed, and sitting back in a chair with arm rests
On the word "go", the patient is asked to do the following:
Time the second effort
Observe patient for postural stability, steppage, stride length, and sway
Scoring:
Low scores correlate with good functional independence; high scores correlate with poor functional independence and higher risk of falls
Number of steps taken to turn 180 degrees is counted; more than four steps indicates increased risk of falls (Simpson, Worsfold, Reilly, Nve, 2002)
4. Physical Assessment: Standard examination with special focus on
Grading Motor Strength |
|
Grade |
Description |
0/5 |
No muscle movement |
1/5 |
Visible muscle movement, but no movement at the joint |
2/5 |
Movement at the joint, but not against gravity |
3/5 |
Movement against gravity, but not against added resistance |
4/5 |
Movement against resistance, but less than normal |
5/5 |
Normal strength |
Assess patient standing still with their heels together; ask the patient to remain still and close their eyes; if the patient loses their balance, the test is positive
Using monofilament (a piece of plastic fiber) test patients feeling of sensation on feet using varying degrees of pressure
Assess patient walking heel to toe, placing the toes of the back foot against the heel of the front foot
Assess patient walking on heels only
Assess patient walking on toes only
Nursing Intervention:
Bloch, F., Thibaud, M., Dugue, B., Rigard, A.S. & Kemoun, G. (2010). Episodes of falling among elderly people: a systematic review and meta-analysis of social and demographic pre-disposing characteristics. Clinics (Sao Paulo), 65(9), 895-903.
Capone, L.J., Albert, N.M., Bena, J.F. & Tang, A.S. (2012). Predictors of a fall event in hospitalized patients with cancer. Oncology Nursing Forum, 39(5), e407-15.
Centers for Disease Control and Prevention. Falls among older adults: an overview. Retrieved March 16, 2011, from http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html.
Costa dos Reis, K.M. & de Jesus, C.A.C. (2015). Cohort study of institutionalized elderly people: fall risk factors from the nursing diagnosis. Rev Lat Am Enfermagem, 23(6), 1130-1138.
Gewandter, J.S., Fan, L. Magnuson, A., Mustian, K., Peppone, L., Heckler, C., Hopkins, J., Tejani, M., Morrow, G.R. & Mohile, S.G. (2013). Falls and functional impairments in cancer survivors with chemotherapy-induced peripheral neuropathy (CIPN): A University of Rochester CCOP Study. Support Care Cancer, 21(7), 2059-2066.
Gillespie, L.D., Robertson, M.C., Gillespie, W.J., Sherrington, C., Gates, S., Clemson, L.M., & Lamb, S.E. (2012) Interventions for preventing falls in older people living in the community. Cochrane Database for Systematic Reviews, 9, CD007146.
Shanthi, G.S. & Krishnawamy, G. (2005). Risk factors for falls in elderly. Journal of The Indian Academy of Geriatrics, 1(2), 57-60.
Simpson, J.M., Worsfold, C., Reilly, E., & Nve, N. (2002). A standard procedure for using TURN180: testing dynamic postural stability among elderly people. Physiotherapy, 88(6), 342-53.