Group 1 Falls and ageing. IHCPSPRING2011
Introduction
An ageing global population is the successful result of improved healthcare, however,
increased incidence of falls in the older age group is of major social, economic, and personal
concern. According to the World Health Organisation (WHO, 2010) falls are the second
leading cause of accidental or unintentional injury deaths worldwide, and an estimated
424000 people die from falls annually. Furthermore, 37.3 million falls that are severe
enough to require medical attention occur each year. Considering the problem of falls, and
specifically focusing on the occurrence of falls in the elderly population is an important
problem globally, challenging economically, and socially complex. The overall economic cost
includes the use of human and material resources that are redirected from other services
and consumed as a result of the global ageing phenomena.
The social complexity of this problem is highlighted by the necessary collaboration of health
professions from all care sectors. Interdisciplinary insight and expertise is required in falls
prevention screening, and in the development of healthy ageing lifestyle plans. For the
purposes of this task a case study has been written based on general falls data. Framing this
problem allows the interdisciplinary health team to focus on individual needs with the
purpose of extrapolating findings to serve the larger community. The team will use the
Healthy Ageing Model (Potempa et.al 2010) to scaffold an individual care plan required to
assist successful rehabilitation. Identifying risk factors, for example, malnutrition (App.i),
and suggesting action plans that combat potential hazards, are core components of fall
prevention strategies. However, it is empowerment of the individual that leads to an
increase in perceived control that is at the key to “solving” this problem.
Group 1 Falls and ageing. IHCPSPRING2011
Development of the Question
How can we as health professionals in an interdisciplinary team enhance
the physical condition and rehabilitation of elderly clients who are affected
by falls?
Identifying and defining the key words in the question from scientific literature and
interdisciplinary mind map on falls (App.ii) narrowed the focus of the question.
"Rehabilitation is a person-centered, active and creative
process that involves adaptation to changes in life
circumstances. It is a shared activity between the ... person,
people close to them, and multi-professional teams who
recognise the contribution of all concerned," (Hawkey &
Williams, 2007, p.4)
A fall is an event which results in a person coming to rest
inadvertently on the ground or floor or other lower level”
(WHO, 2011)
Methodology and data.
1. Interdisciplinary role play was used to obtain an overview of the case, providing a
situation for multidisciplinary work. Minutes were recorded for independent and
combined reflection and analysis.
2. Independent search of scientific literature was undertaken to access knowledge from
other health professionals and to increase the scope of disciplinary research to
multidisciplinary research. This provided a rich source of information from every
profession and assisted in developing a personalised action plan for the patient.
3. Observations which were recorded in a patient journal and reflected on in the
interdisciplinary meeting were specific, personal and insightful.
4. Personal interviews with the patient provided the opportunity to discuss short and
long term goals. Building a relationship with the patient and learning about his
situation is important in collaboratively formulating an individualised plan. Assessing
the patient’s attitude to change and his perceived control in the situation contributed
to the formulation of strategies to enhance his rehabilitation.
Group 1 Falls and ageing. IHCPSPRING2011
5. Independent disciplinary work.
Nutritionist
Conversation with patient regarding short term nutritional goals established initial
contact with specialist care. The “Stages of Change” model was used to identify
whether the patient was ready to accept responsibility for change.
Nurses
Using Virginia Henderson’s “Fourteen fundamental needs” (1966) a plan is developed
to facilitate the patient’s recovery to independent living. Areas of concern are
identified and recorded in the patient’s journal for consideration by the
interdisciplinary team.
Health Educator
Combining information from a personal interview with the patient, the nutritionist,
nurses, other allied health professionals, and family, relevant, memorable, and
personal strategies for delivering information and motivating the patient are
considered.
6. An interdisciplinary team meeting was held to discuss findings and suggest action
plans based on “The Healthy Ageing Model” (Potempa et al., 2010). The Healthy
Ageing Model was used because of its client centred focus and the partnership
established with client and health professionals.
7. Maintaining a reflective journal from all professions that is accessed on an
interdisciplinary team e-platform ensures all team members are aware of ideas,
thoughts and processes relevant to the patient, for example, the nutritionist could
advise that the patient is in the contemplative stage of change.
8. Using a case study ......................
Case study
Mr Kajewski has been admitted to hospital after falling in his home and injuring his
hip. He is 69 years old and his wife of 48 years died 6 weeks ago. He has 2 adult
children with families who live nearby. In recent weeks he has not felt like eating
very much and is not skilled in cooking. He weighs 70 k and is 1.86m.
Analysis and discussion
“Perceived control is a cognitive attribute that is a
precursor to function, a mediator between social support
Group 1 Falls and ageing. IHCPSPRING2011
and psychological wellbeing, and instrumental for
effective disease self-management. ” (Jacelon, 2007. P.1)
The Healthy Ageing Model (Fig.1) focuses on health behaviour change for older
adults. As a model specifically for the elderly and based on motivation, it recognises
that a major challenge for health professionals is how best to support clients in
adopting healthy behaviours (Potempa et al., 2010). Supporting clients acknowledges
that perceived control is instrumental for effective disease self-management and
rehabilitation.
Figure 1. The Healthy Ageing Model: a practical model of health behaviour change for older adults.
(Potempa et al. 2010, p.53)
Considering this model from a client’s perspective, the interdisciplinary team
focuses on the case study to formulate an individual action plan for
rehabilitation. The four main components of this model which are used
collectively by the interdisciplinary team are:-
Group 1 Falls and ageing. IHCPSPRING2011
Goal driven approach is central to this model and assumes that the
goals are articulated by the client, individualised, specific, meaningful,
and achievable. Goals may be broadly defined but are usually small
specific goals designed to build confidence and improve a patient’s self
efficacy.
Individualised coaching strategy is a core strategy within this model.
Through counselling methods, the client’s own identification of health
care goals will assist the client’s behaviour change necessary to
achieve these goals. Motivational interviewing (MI) is shaped by an
understanding of what triggers change and outperforms traditional
advice-giving in the treatment of a broad range of behavioural
problems and diseases. This does not rely on information-sharing,
advice-giving, or scare tactics, is not confrontational, forceful, guilt-
ridden or authoritarian, it is shaped by understanding what triggers
change.
Client centred perspective where the care experience and expressed
needs of the individual are of primary concern. First-person accounts
are a rich resource in understanding health, illness and recovery.
Personal interviews with the patient for example, his personal likes and
dislikes in food are important factors for the nutritionist in planning an
individual diet. This approach ensures that the focus is client centred.
Personal health system perspective,
Independent research and observations by the individuals in the team highlight
specific clinical needs of the patient however it is important to truly listen to
the patient’s story. Recording the patient’s story in the interdisciplinary journal
provides all members of the team access. Listening to the client’s story
Group 1 Falls and ageing. IHCPSPRING2011
supports autonomy when solutions suggested by the client become part of the
rehabilitation plan.
Family and Nurses Communication,
friends. observations, reflective
practice, set goals,
Support activities that motivate/encourage to
promote positive self-care regain independence
Mr Kajewski
Nutritionist
Health Educator
Goal setting, motivating,
Establish ongoing truly listening, formulating
relationship, communicate diet plan, imparting
with all the team and knowledge
family, motivate to
achieve goals.