Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly
It is important to assess areas of risk within the older adult s residence.
95% of falls in older adults happen in and around the home, most in the bedroom or bathroom (Tideiksaar R, 1992).
For example, bathroom lighting is often inadequate, and the bathtub and toilet areas lack proper hand rails.
In addition, unsecured scatter rugs and personal items placed close by for convenience often create a cluttered, dangerous pathway between the bedroom and bathroom, creating a high risk for falling, particularly at night.
Other examples of external environmental safety hazards include pets underfoot, piles of papers and personal belongings, uneven flooring or lack of home repairs, and extension cords that present mobility hazards in common walkways.
Identifying such hazards and implementing an environmental modification plan can greatly reduce risk within the home.
Factors intrinsic to the individual elder also increase the threat of injury.
Decreased vision, equilibrium, sensory perception, and reaction time all increase the risk of falling.
Decreased strength and mobility also threaten balance.
Polypharmacy is a common problem among older adults, resulting in nocturia or dizziness. Medication side effects or drug interactions, along with increased confusion, also are often associated with increased age and greatly raise the chance of falling.
These problems are examples of innate factors that can threaten sense of safety, placing a person at an increased risk for falls.
Cognitive decision-making factors, such as being aware of pets or holding onto a grab bar when getting out of the bath, also are considered internal factors for purposes of this tool. Assessing internal risks and teaching clients how to maintain a safe, healthy environment are paramount to any nurse working within the home setting.
Individuals must be assessed for a history of falls, including near falls and previous actual falls, particularly at home.
A positive history of falls places an older adult at significantly higher risk for subsequent falls. In fact, a fall resulting in soft tissue injury in the home is a strong predictor that a future major fall with injury will occur (Tinetti ME,1994).
Reviewing the circumstances of previous risks can be useful in educating older adults about methods to avoid falls in the future and can reduce risk (Close J, 1999).
A certain level of risk within the home can be accounted for by assessing an older adult’s behavior there.
Personal precautions can minimize risk and the effects posed by existing hazards.
For example, a telephone should be available for easy access, with emergency and other essential numbers, including the resident's home number, placed close by.
It is important that the older adult know how to call and to whom emergency calls should be made; therefore, all important phone numbers should be displayed in large, legible print.
Older adults with limited resources often use space heaters to heat the home and save money. This and other sources of heat that emanate carbon monoxide can be quite dangerous. Ventilation within the home should be checked regularly, and the presence of carbon monoxide should be evaluated.
Also, the temperature of the home environment should be checked during a 24-hour period.
A common time in which falls occur among older adults is at night, resulting in potential exposure to hypothermia during winter months in cold regions.
In addition, first aid supplies should be available within every home, and each older person should be instructed in emergency first aid techniques.
A list of all current medications should be kept readily available and identifiable for an emergency response team to locate.
Vials of Life are prescription vials in which records of current prescriptions, including dosages and schedules, are recorded and kept in the refrigerator in case of an emergency.
Finally, body movement associated with mobility and activities of daily living can greatly increase the risk of falling in elders with compromised balance, strength, range of motion, and postural sway.
Thus, the use of personal precautions when moving should be assessed (Svanstrom L, 1999).
Exercise interventions accompanied by education about personal precautions that use methods to improve body mechanics and enhance safe mobility can greatly reduce behavioural risk (Mecagni C, 2000).
The home should be carefully assessed for electrical and fire hazards.
Many elders living in their own homes on fixed incomes cannot afford home repairs, placing them at risk for fire.
A fire escape plan from every room in the home should be formulated and practiced by the adults living in the home, particularly clients with limited mobility.
Working smoke detectors and fire extinguishers should be available in every home, and a plan should be devised for checking them regularly.
If a fire extinguisher is available, the client should be taught to operate it.
Finally, every older person should have a plan for responding to disasters that are feasible for that geographic area such as floods, earthquakes, gale force wind etc.
Home safety assessment also includes level of risk for crime in the home.
It is important to determine whether the client has ever been a victim of crime and whether or not he or she fears being a victim.
This assessment includes fraud and intangible forms of crime in addition to physical trauma. Fear of crime, with or without risk, frequently leads to social isolation and diminished quality of life.
The Environmental Assessment is one of 8 domains of the
Comprehensive Geriatric Assessment (CGA)
Back To : Comprehensive Geriatric Assessment
This Read More page is an extension of
Back To : Environmental Assessment
Staying Safe - Personal Security at home and out and about
An overview of steps that can be taken to feel more secure both at home and when out and about, including suggestions for organisations that can offer further information and advice.
AgeUK Guide 01, February 2014
view/access (Pdf 482 KB)
Care Homes - Finding the right care home
Moving to a care home is a big decision. This guide provides help for individuals and carers to decide whether it is the right choice, including suggestions for
organisations that can offer further information and advice.
AgeUK Guide 06, July 2013
view/access (Pdf 547 KB)
Many of us are anxious about crime. Taking a few simple precautions to make ourselves and our homes more secure can help us to avoid being targeted and give us peace of mind
Often a move into a care home is suggested because of a crisis – perhaps an illness or a fall – but it may not always be the only solution.
Where we live can have a big impact on our quality of life.
Housing Options - Different types of housing to suit your needs
Overview of different possibilities, including suggestions for organisations that can offer further information and advice.
AgeUK Guide 08, July 2014
view/access (Pdf 657 KB)
Adapting Your Home
By making some simple changes to our homes and the way we live in them, we can stay in them for longer.
Adapting Your Home - Services and equipment to help you stay living at home
This guide looks at some of the changes that can make, the equipment available and how to obtain it, and telecare options, including suggestions for organisations that can offer further information and advice.
AgeUK Guide 17, March 2014
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Winter Wrapped Up
Keeping warm both inside and outside the home can help reduce the risk of the serious health problems that are more common in the colder months, such as chest infections,
heart attacks and strokes.
Winter Wrapped Up - A guide to keeping warm and well this winter
Overview of what can be done to get oneself and one's home ready for winter, as well as where to go for more information and support.
AgeUK Guide 27, October 2014
view/access (Pdf 674 KB)
Staying Cool in a Heatwave
Very high temperatures and humidity can present a risk to health, and older people can be particularly susceptible to heat-related illness.
Staying Cool In A Heatwave - Tips to keep you cool when its very hot
Overview of helpful tips on how to protect oneself from the heat, how to recognise heat-related illness, and what to do if someone shows signs of it, including suggestions for
organisations that can offer further information and advice.
AgeUK Leaflet 01, March 2015
view/access (Pdf 628 KB)
Home Safety Checker
It’s important that we are safe in our homes, as more accidents happen at home than anywhere else. (For use in U.K.)
Home Safety Checker - Staying safe around the house
Overview of safety and checklists that will help identify and resolve any possible safety risks, and help prevent accidents, including suggestions for organisations that can give further information and advice.
AgeUK Leaflet 07, November 2014
view/access (Pdf 550 KB)
Home Safety Checklist
It’s important that we are safe in our homes, as more accidents happen at home than anywhere else. (For use in all countries)
Home Safety Checklist
Overview of safety and checklists that will help identify and resolve any possible safety risks, and help prevent accidents
view/access (Pdf 364 KB)