tile slip-resistant treatment, grab bars and ramp installation in the flat or main entrance. After installation of devices and enhancements, it will enable older adults to safely move around their home, thus reducing risk of fall.
Exercise has produced consistent positive effects in fall and fall related injuries reduction. Exercises to promote balance, strength and movement, and programs that last at least three hours a week were shown to have the best effects (Kiel, 2018). St Luke’s Eldercare center is an excellent option for the client as it is nearby her residence. The center has a Day Rehabilitation programme which includes physiotherapy sessions that target gait training and fall prevention (St. Luke’s Eldercare, 2017) which will be beneficial to the client. A referral from the nearby Hougang Polyclinic is needed for her to avail of the services. In addition, the client can also practice Tai Chi as this exercise has also been found to reduce fall risk significantly (Hu et al., 2016) and improve balance, symptoms of arthritis, and physical performance (Song, Lee, Lam & Bae, 2003). Link to Tai Chi instructional videos online can be given to client and she can follow it in the comfort of her home.
Inappropriate footwear, being barefoot, or wearing socks without shoes have been identified as causes of elderly falls in the home ((Kelsey, Procter-Gray, Nguyen, Li, Kiel, & Hannan 2010). The client prefers being barefoot in the home which can cause her to slip accidentally and fall. She can be advised to wear shoes with non-slip shock absorbent soles, comfortable, good heel support and well fitting, Velcro or buckle fastening (Grant, 2019) and low heeled (Moncada, 2011) inside or outside the house. Proper footwear will enable her to maintain balance and ambulate safely. More information on proper footwear can be derived from the Diabetic Foot Screening service at the Hougang polyclinic after getting an appointment.
The client is taking Atenolol, Hydrochlorothiazide and Isosorbide Mononitrate for blood pressure control and is on Tramadol, Anarex and Arcoxia for osteoarthritis pain. A study done by Dhalwani, Fahami, & Sathanapally (2017) revealed that fall rates were found to be higher in people with polypharmacy. A medication review that entails finding a balance between decreasing the amount of medications related to fall and effective treatment of conditions (Browne, Kingston, & Keane, 2014) would be useful for the client to find out if there are any medications that can be discontinued or tapered down to reduce side effects such as dizziness which can lead to fall. The client can seek assistance with this though Hougang polyclinic consult with the physician, APN, or Pharmacy Service.
Visual problems can occur due to diabetic retinopathy as a complication of the client’s diabetes mellitus (Nentwich & Ulbig, 2015). Although the client does not have visual changes at present, it is still beneficial to have an annual eye check to detect diabetic retinopathy early as it is associated with higher probability of falls in individuals with diabetes mellitus (Gupta et al.",2014). Diabetic Retinal Photography service is offered at Hougang polyclinic as well so reinforcing annual eye check is part of the management for the client.
Fall related injuries have lasting physical, psychological and financial impact not only to the client but also to their families. Early detection of modifiable fall risk factors is critical in planning fall prevention strategies. A multifaceted approach to fall prevention such as combination of education, home modification, exercise, management of complications of chronic conditions linked with community resources is recommended to effectively reduce the client’s risk of fall.