Hypertension in older people is common phenomenon due to the increased incidence of asymptomatic chronic disease, cardiovascular mortality and morbidity. To reduce the impact of these health issues certain medications are prescribed to reduce the risks of renal, cardiovascular and cerebrovascular diseases. Majority of person aged more than 70 years have the hypertension and reduction of blood pressure is the major focus. The result of hypertensive medication to such older persons leads to increased tendencies of falls. The injuries that occur include head and hip injury (Tinetti et al., 2014). This study exclusively focusses on the falls experienced by the older due to the hypertensive medication.
The topic chosen is falls experienced by the older persons due to the anti-hypertensive medications. Anti-hypertensive drugs are prescribed to reduce the incidence of the high blood pressure among the older people due to the several chronic diseases as well cardiovascular morbidity and mortality (Moh.gov.sg, 2018). Although the medications are helping in reducing the hypertension but why the medications are resulting into falls in older individuals is a prime concern and it requires deep research. Thus, in order to find the validity of the proposed subject, an evidence based implementation plan will be required.
Although the cause of the falls is the anti-hypertensive medication, however the medications cannot be stopped. Because if the medications are stopped then there are no other alternative way to reduce the hypertension among the older people. Thus, the objectives of the implementation plan include the following: Ensure the proper use of walker and cane; proper use of hip protector and footwear within the period of six months; To reduce the chronic conditions, hypotension and cardiovascular disorders (Angelousi et al., 2014); To educate the patients in terms of effective utilization of the medical equipment, safe behaviors related to footwear choices; To promote exercise programs among the older persons which will target the gait, strength training and balance training; To modify the medication which will emphasize on the administration of structured medication, removal and modification of the unnecessary medication that contributes to the falls (Milos et al., 2014). Proper medication management through adjustments that will emphasize on the underlying conditions of falls; To ensure the intake of proteins adequately, proper hydration with adequate consumption of the vitamin D supplements; To correct the low vision among the elderly people (Moyer, 2012).
There are several strategies that can effectively reduce the falls in the older people which are as follows: Consumption of healthy and nutritious food can effectively fulfill dietary requirements of the older people providing them with the necessary nutrition; Drinking sufficient amount of fluids is an effective way to keep the body and brain hydrated and in a well functionable condition; Maintaining an active and healthy lifestyle, which includes regular exercises. This will prevent weakening of muscles and prevent stiffening of joints; Taking medication as prescribed by the physician in a timely manner, so that medicines effect in a proper way; Wearing perfect fitting shoes that are flat and comfortable with wide heel and buckles. The soles must be made of rubber to increase the grip of the soles; Walking in socks must be completely prevented; Wearing of long clothes must be avoided, to negate any sort of trip over during walking.
The potential impacts of the proposed plan include the various benefits that will be experienced by the aged people are through the following ways: the usage of the walker and cane and hip protector will help to reduce falls and will further help assisted walking and reduction of any injury. The reduction of the cardiovascular issues, hypotension and chronic conditions will help in reducing the dependency upon the anti-hypertensive medications. Educating the aged people regarding the usage of the proper footwear and medical equipment will help them to inculcate the safe behaviors regarding the walking (Kelsey et al., 2012). Exercise programs exclusively directed for the aged people exhibit the potentiality of improving the correct gait, balance and strength that are required during the walking. Proper medication on the other hand will reduce the overdependence on any specific medicine that have several side effects. The proper consumption of vitamin D supplements can effectively help in strengthening the bones. Low vision is always a common problem within the aged population, thus correcting the low vision can effectively reduce falls (Bolland et al., 2014).
Indicators- the indicators that can be used to properly used to evaluate these impacts are: regular blood pressure checks revealing the reduction in hypertension; reduction in the overdependence of the anti-hypertensive medications taken to reduce the hypertension; improved gait and reduction are the other potential indicators (Margolis et al., 2014).
Monitoring the indicators- Monitoring the indicators involves the usage of medical equipment: blood pressure is a serious indicator of hypertension, thus both the rise and fall in blood pressure is an effective indicator; dual energy x-ray absorptiometry can be used to monitor the bone density as well as tendencies of the development of osteoporosis; weekly blood test that will monitor the levels of blood glucose, cholesterol levels. Assisted walking and watching the gait of the aged people to see if there are any disorientation in the gait (Clegg et al., 2013).
Whenever a plan is framed, it has some inherent barriers as well as some unavoidable issues which arise as an inhibition. Aged people due to their reduced ability to memorize their medication often forget their assigned medications. This is an important barrier that hinder the treatment process. The effective strategy can be providing checklists to the aged people so that they can take the necessary medication according to the checklist. The second barrier is that aged people know the risks associated with falls, but they are not aware the various ways through which they become vulnerable to falls. This increases the tendency of fall among the aged people and to reduce such tendency, communication plays a major role. Communicating with the aged people and educating them regarding the falls can be beneficial (Kenny, Romero-Ortuno & Cogan, 2013).
Conclusion
Therefore, from the above discussion it can be concluded that, falls among the aged people are common due to the intake of anti-hypertensive drugs. Although, at this old age disease are very common, such as cardiovascular diseases, hypertension. Medications like anti-hypertensive drugs taken to reduce such problems affect the aged people adversely. Thus, to reduce the adverse impact of medications an implementation plan is designed which can effectively reduce the incidence of falls upon the aged people. However, through the assignment the medication issues, lack of proper diet plan, the issues of fall regarding the gait are identified. Along with the identification, the effective are also elaborated which help to reduce falls.
The refection is based on Gibbs (1988) reflective cycle (Bulman & Schutz, 2013) which focusses description (what happened?), feelings (what were I thinking and feeling?), Evaluation (what was good and bad about the experience?), Analysis (what sense can I make of the situation?), conclusion (what else could I have done?), Action plan (If it arose again what will I do?)
Description- Falls experienced by the aged people due to the ill effect of anti-hypertensive drug. I have seen that the aged people suffer a lot from several diseases like cardiovascular disease, renal diseases, hypertension and thus to reduce such impact; the anti-hypertensive drug are administered. The important factor here is that due to the lack of proper intervention and awareness regarding the medication and proper posture and gait is increasing the rate of falls in aged people.
Feelings- Before the start of the assignment, I was not aware of the fact that anti-hypertensive drugs result in falls among the older people. However, after the start of the assignment I felt anxious and depressed because other than the medication, there are several factors that are contributing to the falls in aged people. Thus, if such issues are not addressed, falls cannot be reduced.
Evaluation- Through the evidence based learning process, I had some negative as well as positive experiences. The negative experiences are that the aged people although know about the fall, but due to the age and the impact of several diseases the aged people tend to forget. However, at the same time the positive feelings are that identifying the reasons of the falls which can be attributed as: wearing improper shoes, long clothes, eye vision related issues. These issues if addressed are bound to reduce falls in older people (Yip et al., 2013).
Analysis- I have found from the evidence based learning practice that, patient’s eating habits affect a lot to their health. which results in increasing intake of anti-hypertensive drugs. This anti-hypertensive drugs on the other hand results in increased tendencies of fall in aged people (Pérez Rivas et al., 2012). whereas, I analysed that putting a check on the diet can effectively reduce both the intake of anti-hypertensive drugs.
Conclusion- through the evidence based learning process, I have learnt that this kind of learning helped me to assess the falls in aged people. First of all, the evidences and the literature are the valid references through which knowledge can be procured. This knowledge on the other hand helped me to understand the serious condition existing within the aged people. However, through the implementation plan, I have learnt that implementation plan through maintaining proper health condition, gait, posture and eating habit and proper medication management, the falls in aged people can be reduced to a greater extent. I have gained the skills and knowledge from the evidence based nursing practice and the practical aspects through the implementation plan.
Plan of action- In future if the same condition arises again, then I believe the implementation that I have framed can be applied to the aged people. I know, that the care delivery depends on needs of a particular person. However, plan is overall applicable to a wide range of population experiencing falls due to intake of anti-hypertensive drugs.
References
Angelousi, A., Girerd, N., Benetos, A., Frimat, L., Gautier, S., Weryha, G., & Boivin, J. M. (2014). Association between orthostatic hypotension and cardiovascular risk, cerebrovascular risk, cognitive decline and falls as well as overall mortality: a systematic review and meta-analysis. Journal of hypertension, 32(8), 1562-1571. doi: 10.1097/HJH.0000000000000235
Bolland, M. J., Grey, A., Gamble, G. D., & Reid, I. R. (2014). Vitamin D supplementation and falls: a trial sequential meta-analysis. The lancet Diabetes & endocrinology, 2(7), 573-580. https://doi.org/10.1016/S2213-8587(14)70068-3
Bulman, C., & Schutz, S. (Eds.). (2013). Reflective practice in nursing. John Wiley & Sons. p51-63.
Clegg, A., Young, J., Iliffe, S., Rikkert, M. O., & Rockwood, K. (2013). Frailty in elderly people. The Lancet, 381(9868), 752-762. https://doi.org/10.1016/S0140-6736(12)62167-9
Kelsey, J. L., Procter-Gray, E., Hannan, M. T., & Li, W. (2012). Heterogeneity of falls among older adults: implications for public health prevention. American journal of public health, 102(11), 2149-2156. DOI: 10.2105/AJPH.2012.300677
Kenny, R. A., Romero-Ortuno, R., & Cogan, L. (2013). Falls. Medicine, 41(3), 155-159. https://doi.org/10.1016/j.mpmed.2012.12.007
Milos, V., Bondesson, Å., Magnusson, M., Jakobsson, U., Westerlund, T., & Midlöv, P. (2014). Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care. BMC geriatrics, 14(1), 40. https://doi.org/10.1186/1471-2318-14-40
Moh.gov.sg. (2018). Moh.gov.sg. Retrieved 12 January 2018, from https://www.moh.gov.sg/content/dam/moh_web/HPP/Doctors/cpg_medical/withdrawn/cpg_Stroke%20and%20Transient%20Ischaemic%20Attacks.pdf
Moyer, V. A. (2012). Prevention of falls in community-dwelling older adults: US Preventive Services Task Force recommendation statement. Annals of internal medicine, 157(3), 197-204. DOI: 10.7326/0003-4819-157-3-201208070-00462
Pérez Rivas, F. J., Santamaría García, J. M., Minguet Arenas, C., Beamud Lagos, M., & García López, M. (2012). Implementation and evaluation of the nursing process in primary health care. International journal of nursing knowledge, 23(1), 18-28. DOI: 10.1111/j.2047-3095.2011.01199.x
Tinetti, M. E., Han, L., Lee, D. S., McAvay, G. J., Peduzzi, P., Gross, C. P., … & Lin, H. (2014). Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA internal medicine, 174(4), 588-595. doi:10.1001/jamainternmed.2013.14764
Yip, J. L., Khawaja, A. P., Broadway, D., Luben, R., Hayat, S., Dalzell, N., … & Foster, P. J. (2013). Visual acuity, self-reported vision and falls in the EPIC-Norfolk Eye study. British journal of ophthalmology, bjophthalmol-2013.https://dx.doi.org/10.1136/bjophthalmol-2013-304179
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