By | June 25, 2019

If you care for older adults, you should be aware that the risk of fractures accompanies the risk of falls and that both could have serious consequences. Osteoporosis, which tends to affect people age 50 and over, makes fractures more likely because the bones tend to become brittle.

While working with older patients, you must be able to identify risk factors for osteoporosis, the signs and symptoms of fracture, treatment options for osteoporosis and fall prevention strategies.

Osteoporosis, the most common cause of bone disease, occurs when bone tissues become thinner, brittle, porous, and less dense over time. This happens when the body’s ability to produce new bone is unable to keep up with the bone resorption process or when an excessive amount of bone is resorbed, causing brittle bones. A fall, leaning over or coughing can cause a fracture in brittle bones.

The disease is more common in older, female, Caucasian adults. In fact, 8 million of the estimated 10 million people in the U.S. with osteoporosis are women, according to the National Osteoporosis Foundation (NOF). Nonetheless, NOF reports that the annual number of hip fractures in men is approximately 80,000, and men are more likely than women to die after hip fractures.

Because osteoporosis is usually asymptomatic until a fracture occurs, all healthcare professionals should help identify appropriate timing and methods for screening those at risk. The challenge for healthcare professionals is to:

  • Recognize persons at risk for developing osteoporosis.
  • Make the appropriate diagnosis.
  • Implement appropriate treatment strategies to prevent fractures.

Risk Factors

There are risk factors associated with osteoporosis that put some men and women at higher risk for developing the condition. Some can be controlled and changed, while others cannot. For women, bone loss is most significant in the first few years after menopause begins.

Other specific risk factors include:

  • Drinking alcohol and smoking
  • Diet poor in calcium and vitamin D
  • Sedentary lifestyle
  • Non-modifiable risk factors such as, but not limited to:
    • Age (50 and older)
    • Ethnicity (Caucasian and Asian)
    • Family history
    • Bed confinement
    • Having certain diseases and pathophysiological abnormalities

Physical Assessment

Screening for osteoporosis should begin with a thorough physical assessment. Additionally:

  • Examination of a person’s active and passive range of motion (ROM) can help identify spine, hip, wrist or other bone pathology.
  • A neurologic exam can help rule out any spinal cord or peripheral nerve compromise.

Other symptoms that would indicate existing osteoporosis are tenderness over a vertebra or other suspected fracture site, or indications of increased fall risk. Such indications include balance or gait irregularities, weakness in the lower extremities, impaired vision or hearing, and cognitive impairment.

Screening

The U.S. Preventive Services Task Force recommends that women age 65 and older be screened routinely for osteoporosis with bone measurement testing. They also recommend that screening be performed for postmenopausal women under age 65 who are at increased risk for osteoporosis. Current evidence is insufficient to make a standard recommendation for screening men for osteoporosis.

Treatment and Relief

The goal of treatment is to:

  • Reduce and control pain from the disease.
  • Slow down or stop the process of bone loss.
  • Maintain existing bone mass and density.
  • Prevent fractures with medicines that strengthen bone.
  • Maximize quality of life.

These goals can be met using pharmacological and non-pharmacological approaches.

Fall Risk and Prevention

Older adults who have already had one fall are more likely to fall again. In fact, the best predictor for falls is a previous fall, according to JAMA. A fall risk assessment should be completed by the admitting healthcare professional at admission. Your organizational policy will tell you who is responsible for this assessment, but it is usually a nurse or a therapist. This assessment is repeated periodically throughout the duration of services and any time there is a significant change in the individual’s condition or behavior.

Fall risk can be reduced in organizations using comprehensive fall-reduction programs. These programs are structured to improve and maximize environmental safety, create high standards and consistent staff training, and improve all responses to falls.

The keys to fall prevention are screening for fall risk and acting in ways that address the risk factors that can be changed. Initiatives such as the CDC’s STEADI, which stands for Stopping Elderly Accidents, Deaths and Injuries, can help with assessing fall risk, educating individuals and selecting interventions.

The likelihood of a fall depends on personal and environmental factors.

Personal factors include what a person can do to prevent falls:

  • Having vision and hearing checked regularly
  • Using hip padding or hip protectors
  • Looking closely at floor surfaces that can be very slippery
  • Using a cane or walking stick in bad weather
  • Wearing warm boots with rubber soles for good traction in winter
  • Using a fanny pack or backpack to keep hands free
  • Stopping at curbs and checking the height before proceeding
  • Using caution at curbs that are designed for bike or wheelchair access, as the incline may be harder to navigate than a flat surface
  • Using a handrail when climbing stairs
  • Bending from the hips and knees when lifting and never from the waist
  • Wearing supportive shoes that fit well, are comfortable, and are in good condition with nonskid soles
  • Avoiding walking around in socks or slippers that have a slippery surface on the bottom

Environmental factors for prevention include:

  • Using nightlights throughout the organization
  • Keeping all rooms free of clutter, especially the floors
  • Making sure all carpets and area rugs have a nonskid backing or are secured to the floor
  • Avoiding using throw rugs on the floor
  • Keeping electrical cords and telephone wires out of walkways
  • Using fluorescent tape on the top and bottom edges of stairs
  • Installing grab bars on bathroom walls by toilets and in tubs and showers
  • Using a plastic chair in the shower and making sure it has nonskid feet
  • Keeping a flashlight with extra batteries by the bed

As you care for older adults, continue to learn about treatment options for osteoporosis, the signs and symptoms of fractures, and fall prevention strategies.

Relias’ online learning options can help you stay informed.

Jennifer Burks, RN, MSN

Jennifer W. Burks, R.N., M.S.N., has over 25 years of clinical and teaching experience, and her areas of expertise are critical care and home health. She earned her Bachelor of Science in Nursing from The University of Virginia in 1993 and her Master of Science in Nursing from The University of North Carolina, Greensboro, in 1996. Her professional practice in education is guided by a philosophy borrowed from Florence Nightingale’s Notes on Nursing, “I do not pretend to teach her how, I ask her to teach herself, and for this purpose, I venture to give her some hints.”

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