Iatrogenesis in the elderly. Contributors to falls

Iatrogenesis within long term care facilities

Seniors living within long term care facilities have higher incidences of frailness, chronic disease, and deterioration as compared with seniors living in the community. There is increasing evidence within the literature that some of this deterioration is caused by the very facilities they are living in. This article discusses the iatrogenic factors associated with living in long term care facilities and the consequences of such factors on older adults. Following this, an exploration of the relevancy of this issue for occupational therapists will take place. Occupational therapists must be particularly alert to the dangers of iatrogenic effects and be concerned with making changes within the long term care system to prevent further harm to older adults and work on promoting an environment that promotes optimal health.

Farm work exposure of older male farmers in Saskatchewan

BACKGROUND

The average age of farmers in North America is increasing each year. Research has determined that age and health status are both related to increased risk of injury. The purpose of this research was to determine the association of health and medication factors with exposure to farm work in older male farmers.

METHODS

As part of a cohort study to study determinants of injury on Saskatchewan farms, 5,502 farm people associated with 2,386 Saskatchewan farms were surveyed by mail questionnaire during the winter of 2007. The primary dependent variable was average hours per week of farm work. Independent variables included illnesses, age, and medication use.

RESULTS

The mean number of hours worked per week by farmers aged 55 years and older was 48. There was a significant relationship between age and hours worked with each year of age accounting for about 0.85 hr less work per week. Medication use was related to a reduction in weekly work hours during the busy fall season but was not related to work exposure averaged over the whole year. In multivariable linear regression analysis, the main contributing variables to farm work exposure were: retired status (-), working off farm (-), and age (-).

CONCLUSION

The amount of hours older farmers work on the farm is considerable compared to any other occupational category. While there is a declining trend in the amount of work, a 75-year-old farmer still works, on average, about 34 hr per week. Some farmers do appear to self-limit during busy times of the year if they are taking medication.

Health, medication use, and agricultural injury: A review

BACKGROUND

Agricultural work in the United States and Canada continues to be one of the most dangerous vocations. Surveillance evidence suggests that older farmers (>60 years of age) are at greater risk of serious injury than their younger counterparts. The purpose of this article was to outline illnesses and medications that may contribute to older farmers' increased risk of agricultural injury and to determine a minimum set of health-related covariates that could be used in farm injury studies.

METHODS

A review of English language literature in Medline, CINAHL, and NIOSH databases was conducted examining disease and medication factors related to farm injury.

RESULTS

Health- and disease-related factors most commonly reported as significantly contributing to agricultural injury included previous injury, hearing problems, depression, arthritis, and sleep deprivation. The use of "any medication" was identified as a significant risk factor for injury in a number of studies. The use of sleep medication was significantly related to injury in two studies.

CONCLUSIONS

Based on the findings, it is recommended that at a minimum, researchers collect information on the prevalence of previous injury, hearing problems, depression, arthritis/muscular-skeletal problems and sleep disturbance as these have been identified as significant risk factors in a number of studies. In addition, where subjects that identify any of these afflictions, further information should be sought on any medications used in their treatment which can add data on disease severity. More research and surveillance activities need to be focused on the older farm worker. This population is critical to the maintenance of the agricultural base in North America and health and safety research initiatives need to address this. By integrating research from the fields of gerontology, occupational health and safety, and injury prevention, innovative interventions could be constructed to assist the aging farmer in the continuation of safe farming.

Factors associated with falls in an inpatient palliative care unit: an exploratory study

In one inpatient palliative care unit falls were identified as a frequent and distressing, yet potentially avoidable, concern. The unit had the highest rate of falls in this long-term care setting, exceeding even that of dementia care units. No literature could be identified that examined falls in the palliative care population. The objective of the exploratory study was to examine factors associated with falls through retrospective archival data collection. Detailed information was collected on all 177 falls that occurred in the unit in 1999. Data were also gathered on patients who had not fallen for comparison. Analysis was conducted comparing risk factors of those patients who fell once and those who fell multiple times. It was found that advanced age, longer length of stay and a previous history of falls might be risk factors for future falls. Patients who fell multiple times had less symptom distress than patients who fell once.

Acute health status and its relationship to falls in the nursing home

1. Falls represent a major health threat to the elderly, often resulting in injury, disability and/or death. 2. A significant association between acute changes in health status and falling was revealed in this study over 1-month, 2-month and alternating time periods. 3. Nurses' fall prevention efforts should be more attuned to the more relevant predictor of changing health status and functioning capability of residents.

Falls in the elderly population: a look at incidence, risks, healthcare costs, and preventive strategies

The number of elderly people in America is growing, and falls among the elderly population are a significant problem. Injuries and their complications can have serious consequences requiring medical attention, hospitalization, and nursing home admission. Seventy percent of the fall-related deaths in the United States occur among elderly people. Risks for falls are categorized as extrinsic factors involving the environment, intrinsic or host factors, those associated with nonbipedal falls, risks related to nonclassified falls, and agent, or iatrogenic, risk factors. Lawsuits related to falls and restraints are increasing. Fall prevention programs, assessment, evaluation, and lobbying for legislation to assist elderly people who fall are some of the responses made by the healthcare system. Rehabilitation nurses must be aware of the incidence and consequences of falls. It is imperative that nurses become involved in coordinating fall prevention and fall reduction programs, monitoring risks for falls, and implementing corrective measures.