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Perform a thorough evaluation of the older adult's physical, mental, and emotional health. This includes a review of medical history, current medications, physical examination, and cognitive screenings. Utilize assessment tools such as the Geriatric Depression Scale or the Mini-Mental State Examination for cognitive and emotional evaluation.

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Abstract

This paper discusses the rationale behind performing a brief geriatric assessment as a first step in the management of older patients in primary care practice. While geriatric conditions are considered by older patients and health professionals as particularly relevant for health and well-being, they remain too often overlooked due to many patient- and physician-related factors. These include time constraints and lack of specific training to undertake comprehensive geriatric assessment. This article discusses the epidemiologic rationale for screening functional, cognitive, affective, hearing and visual impairments, and nutritional status as well as fall risk and social status. It proposes using brief screening tests in primary care practice to identify patients who may need further comprehensive geriatric assessment or specific interventions.

Keywords: (3-10) Screening, Older adults, Geriatric assessment, Primary care

Background

This paper describes the epidemiological rationale and scientific background for performing a systematic assessment of older patients consulting a family physician and proposes a pragmatic approach to screen for several frequent and usually under-detected geriatric conditions.

Why would a systematic assessment of geriatric conditions be useful in caring for older patients?

Given the aging of the population, primary care practitioners will manage an increasing number of older patients who often have multiple health problems. Besides the complexity of managing multiple morbidities, other concurrent factors can make care more difficult in older patients. First, health problems are less obvious to diagnose because of an atypical presentation or because of communication problems due to hearing loss or cognitive impairment. Banalization of symptoms considered by patients or health professionals as features of normal aging also frequently prevents health problems such as incontinence or cognitive impairment from being identified [ 1]. Indeed, the quality of ambulatory care in primary care patients with geriatric conditions has been shown to be lower than in those with non-geriatric conditions [ 2]. Finally, problems outside the traditional medical domain, such as those related to the psycho-social status or the environment, increase in importance in older patients because they frequently coexist with health problems and interfere with their management. Yet, physicians often lack guidance to assess these impairments [ 3, 4].

Comprehensive geriatric assessment (CGA) was developed as a multidimensional and structured approach aimed at the identification and management of these problems in older patients. The CGA process is not only limited to the evaluation of an older patient's global health status, with the mere mention of the presence of medical and functional problems, but also includes the identification of patient's resources, capacities, and preferences [ 4]. CGA is intended to help the physician select and prioritize therapeutic interventions that are best suited for a given patient. These latter aspects of CGAs are not addressed in this article, which proposes brief tools to screen for a selected set of geriatric conditions. In contrast to hospital or long-term care settings, where an interdisciplinary team usually performs a CGA, it is typically undertaken by geriatricians and/or trained gerontological nurses in the primary care setting [ 5, 6]. Such a comprehensive assessment of physical and mental health and social situation usually takes more than 60 min to complete, with additional time needed to define interventions [ 7].

The diagnostic yield of a CGA in identifying geriatric conditions and improving the management of unmet patient needs has been demonstrated in several populations, including the community and primary care practice [ 2, 8, 9]. In particular, a study in general practice highlighted that such an approach is particularly worthy when the patient-physician relationship has persisted less than 2 years, with a twofold number of problems newly found independent of the quality of the relationship [ 3]. Nonetheless, evidence to support the use of CGA in primary care practice remains weak because it has been less well studied.

What are the target group and objectives of a brief geriatric assessment?

Depending on the global health status of the patient, the objectives may range from health promotion to screening or early detection and to subsequent decision-making prior to therapeutic interventions. As conceptualized in the new public-health framework for healthy aging defined by the World Health Organization (WHO), target groups are defined based on the older person's intrinsic capacity (mental and physical) and functional ability. Physical and mental capacity as well as functional ability corresponds to health-related attributes that enable people to do what they value. Fit older persons, who have fewer chronic diseases and a high intrinsic capacity and functional ability, are an appropriate target for health promotion and preventative interventions, but universal CGA in this large group would be too time-consuming. By contrast, it has been shown that older persons who are already disabled need integrated care and do not benefit from a CGA performed during preventive home visits [ 10]. A CGA is likely more suited to the group in between, i.e., older people with two or more chronic conditions but no or minimal disability, with the aim of slowing the decline in capacity [ 11].

Patients who will undergo surgical or oncological interventions represent another potential target for a brief CGA to identify those at risk for adverse outcomes and to propose follow-up through the peri-operative period, with a reduction in complication rates and length of stay [ 12, 13].

Some consensus has emerged to propose a two-step approach for a brief CGA targeting primary care patients aged 75 to 80 years and older with two or more comorbid conditions, or before surgical or oncological interventions [ 8]. For instance, the EASY-Care tool helps primary care practitioners identify frail older patients who then have a comprehensive assessment by a specialized nurse during a home visit [ 14]. Similarly, the British Geriatrics Society recently proposed an approach using the PRISMA questionnaire, combined with an evaluation of gait and mobility [ 15].

In this paper, we propose a pragmatic approach for primary care visits and focus on the early detection of several geriatric conditions rather than on issues related to health promotion in older adults. Additionally, this paper does not extend to the identification of patients' resources and preferences, which are part of CGA and are needed to decide how to best address identified problems with appropriate and individualized interventions [ 16].

What might be the benefits for the patient?

Interest in managing specific chronic health problems has led to the development and testing of disease-specific interventions, an approach that is irrelevant in most older persons who have multiple health problems [ 17]. Conversely, CGA proposes an approach that focuses on function-related outcomes and addresses the problem of the poor correlation between symptoms and underlying causes in older persons with multiple chronic diseases. Moreover, CGA better addresses the increasing variability of individual expectations toward care as people age.

When initiated in community-dwelling, hospitalized, older persons, CGA reduced disability, extended home stay, and reduced the institutionalization rate by 20% over the following 12 months compared to usual care [ 18]. Among older persons receiving formal home care, CGA led to a decreased risk of hospital and nursing home admission. As health care costs were examined, the higher supply of home care interventions was more than balanced by the reduction in institutional costs in hospital and nursing homes [ 19].

In general practice, a study indicated that about half of problems newly identified through CGA were successfully managed by the physician at 12 months [ 3]. Most studies reported improvement in either the quality of care (e.g., indicators of fall-risk assessment and management [ 20]) or in patients' quality of life, while a few demonstrated a decrease in hospital admission rates [ 21].

Regarding CGA's cost-effectiveness, a meta-analysis of previous studies demonstrated conflicting results depending on the target population and specific interventions [ 18]. Evidence is still lacking regarding the economic benefits of a brief geriatric assessment performed in primary care [ 22].

Which dimensions should be assessed?

A systematic review of factors associated with the occurrence of disability identified functional, cognitive, affective, and social problems as well as, to a lesser extent, lifestyle habits and sensory impairments as modifiable risk factors for functional decline [ 23]. The domains usually selected for inclusion in CGA are risk factors that meet the usual criteria for appropriate screening. Impairment is frequently overlooked, the screening test is sensitive and specific enough, the diagnostic procedures have an acceptable risk to benefit ratio, and the condition may be improved by interventions. A study that specifically investigated common unmet needs identified by older people themselves proposed five priority domains: (a) hearing and vision; (b) physical ability, including functioning in activities of daily living (ADL), mobility, and falls; (c) incontinence; (d) cognition; and (e) emotional situation [ 8]. Assessing nutrition and the patient's social situation is frequently added to this list [ 24]. These dimensions have also been identified by a panel of experts who contributed to the WHO guidelines on integrated care for older people [ 4]. The guideline recommends assessing decline in physical and mental capacities (mobility, nutrition, vision, hearing, cognition, and depression) as well as assessing two geriatric syndromes (urinary incontinence and risk for falls).

How could CGA fit into primary care consultations?

Time investment is a major limitation in applying a full CGA in a busy practice. In order to fit into primary care physicians' tight schedule, several combinations of short instruments to identify geriatric conditions have been proposed [ 8, 24]. These instruments allow basic multidimensional screening in about 15 min and target patients who might benefit from a further in-depth assessment by the primary care physician or referral to a geriatrician for further assessment and management.

The psychometric properties of these instruments as well as their impact on clinically relevant outcomes have not been thoroughly examined. Consequently, there is little evidence to promote the use of one over another or a combination of their components. The choice should rely on issues of practicability and on the estimated suitability to the profile of the targeted population and particular health system.

In parallel, several instruments have been developed to help identify frailty in primary care [ 7, 8, 14, 15, 24], which include domains similar to those included in the brief CGA, consistent with the fact that frailty and functional decline are distinct but overlapping concepts that share common risk factors [ 25, 26].

This article proposes a pragmatic approach for primary care physicians to assess a selected set of dimensions when caring for older patients. Although this selection is not evidence-based, all proposed dimensions share common features in terms of prevalence of impairment, frequent under-detection, existing valid brief screening tests, and corresponding effective therapeutic or supportive interventions. For several of these dimensions, referral to the summary of evidence issued by the US Preventive Services Task Force (USPSTF) [ 27] and/or the Canadian Task Force on Preventive Health Care [ 27, 28] has been used. In several cases, the task forces considered the evidence from the literature regarding the impact of screening and subsequent management on clinical outcomes as being too scarce to support a formal recommendation. However, the very same dimensions have been included in the WHO guidelines based on expert consensus regarding the balance of benefit and harm, the match with older persons' values and preferences, and the cost and feasibility of assessment [ 4]. Such a brief evaluation might be completed in about 15 min. Although the precise timeline for repeating the evaluation is not defined, a yearly assessment has most frequently been proposed [ 29].

Screening for functional impairment

A core feature of CGA is the evaluation of a patient's functional ability, i.e., how he or she is able to perform usual ADL. Assessment of daily function is decisive to identify functional decline because it reflects the consequences of health problems. Moreover, functional status provides essential information about prognosis and the future functional trajectory [ 30]. Finally, the early identification of functional difficulties and search for etiology are the first steps toward interventions to prevent further loss of function, restore function, and address resulting needs for support or personal care.

Functional status is assessed as a difficulty or impairment in basic and instrumental ADLs, as detailed in Table 1 . Instrumental ADLs are more complex activities that require higher neuropsychological capacity than physical self-maintenance. They are therefore usually affected before basic ADLs [ 31].

Table 1

Basic activities of daily living include the following [73]:

Instrumental activities of daily living include the following [31]:

Bathing

Use the telephone

Dressing

Use public transportation

Toileting

Do grocery shopping

Transferring (in-out of bed/chair)

Prepare meals

Continence (bladder, bowel)

Handle own medication

Eating

Handle finances

Do housekeeping

Do laundry

Functional difficulties in instrumental ADLs are strongly related to cognitive function. For instance, the onset of impairment in four instrumental ADLs (using the phone, using public transportation, using own medications, and handling finances) has been shown to be associated with a 4 (when one instrumental ADL is impaired) to 10 (with 3 or 4 impaired ADLs) times higher odds of being diagnosed with dementia in the following 12 months [ 32]. Because a full assessment of basic and instrumental ADLs can be difficult during a clinical encounter, a first general question regarding the onset of difficulties in performing those tasks might be useful [ 24]. However, there is often a discrepancy between self-reported and actual performance in ADLs. Because of this, asking relatives about any difficulties in ADLS might be useful.

Screening for cognitive impairment

Screening for depression

Brief screening instrument

Very brief, 2-question tools are available that have excellent psychometric properties and seem especially convenient to use in primary care practice [ 42, 43]. The patient is asked whether, over the past 2 weeks, he/she has often had little interest or pleasure in doing things and whether he/she has often been bothered by feeling down, depressed, or hopeless. Negative answers to both questions essentially rule out depressive problems, whereas any positive answer should raise suspicion for depressive problems (sensitivity 95%, specificity 65% against clinical diagnostic interviews [ 42]) and trigger further assessment. Using more sophisticated coding of each answer (0 = not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day) has resulted in improved specificity, without affecting the sensitivity too much (sensitivity 83% and specificity 90% for a score of 3 or more) [ 44].

Screening for sensory impairments

Epidemiology

Sensory impairments rank first on the list of geriatric impairments. About 30-45% of persons aged 75 years and older have hearing impairment that impacts their ability to communicate [ 17, 45]. Visual impairment also affects nearly 50% of adults over 75 years, and up to 10% of older persons report being unable to read newspapers, even with their glasses or lenses (USPTSF). The impact of these sensory impairments on functional trajectory is likely to be underestimated because it most usually occurs through reduced social contacts, psychological well-being, cognitive functioning, and a higher risk for falls as regards visual impairment [ 17, 46- 48].

Brief screening instrument

Hearing impairment

The relevance of detecting mild (25 to 40 dB) hearing loss is uncertain regarding evidence of further clinical interventions; hence, a very first step in identifying patients with significant impairment might be to ask a single question about perceived hearing loss. This approach has a sensitivity and specificity of around 70% as compared to audiometry [ 17]. Among other tests, the whispered voice test seems best suited for use in primary care, with an overall good sensitivity (> 90%) and specificity (> 75%) as estimated in the USPSTF synthesis [ 27].

Visual impairment

Screening for visual impairment using the Snellen eye chart performs better than screening questionnaires [ 52]. An important caveat is that visual acuity testing identifies refractive errors well, but is inadequate for identifying early macular degeneration or early cataract.

Screening for nutritional problems

Under-diagnosis

Involuntary weight loss, especially among overweight patients, frequently goes undetected. Yet, such weight loss predicts a poor functional trajectory and other adverse outcomes either through a direct pathway or because weight loss is a consequence of dental problems, or physical or mental illness (ref).

Brief screening instrument

Body mass index (BMI) is frequently used as a single screening measure, but it lacks specificity. For instance, a BMI less than 22 kg/m ² should already hint at possible malnutrition in an older person as it is associated with increased mortality [ 55]. A question about involuntary weight loss over the last months is a frequently used alternative, with a loss of 5% or more over a month or 10% or more over the last 6 months being used as cutoff to define malnutrition [ 56]. Brief instruments have also been proposed to identify patients who need further detailed nutritional assessments. These screening tools include the following items: appetite or appetite loss, weight loss, and BMI, and are sometimes combined with questions about acute disease. Their added value over monitoring patient's weight and BMI is still unknown. Among these instruments, the Mini-Nutritional Assessment short-form (MNA-SF) has been developed specifically for older persons and is most frequently used [ 57].

Fall-risk assessment

Brief screening instrument

Given that risk factors for falling encompass diseases, drugs, cognition, and sensory and gait impairment as well as environmental hazards, a comprehensive review is unsuitable as a first step, but the assessment of the patient's global risk for falling should be part of a brief geriatric assessment.

Based on the American and British Geriatrics Societies guidelines and the input from health care providers, a fall prevention tool kit has been developed to support health care professionals in assessing and addressing fall risk [ 62]. A first set of questions identify whether the patient is at risk and investigates previous falls, fear of falling, and perception of unsteadiness when standing or walking. The performance in gait and balance is based on the up-and-go test (i.e., the patient gets up from the chair, walks 3 m, turns around, and sits back down) or by observing whether he or she stops walking when talking, a strong predictor of the probability of falling [ 63]. A simple measure of gait speed has also been shown to be a strong prognostic factor [ 64]. A gait speed less than 0.8 m/s (i.e., 5 s or more to walk 4 m at a usual pace) should trigger further assessment for future falls, frailty, and mobility impairment.

Social isolation

Rationale for screening

Social support is a major component to evaluate during CGA. This support is important because it buffers the effect of stressful events and improves the management of chronic diseases [ 65, 68, 69]. For instance, identifying potential social support in case of health problems has been associated with a lower likelihood of hospital use [ 70, 71]. However, older patients are not likely to discuss this issue spontaneously. For instance, in a study among primary care patients aged 65 years and older, only 15% of those reporting loneliness had mentioned it to their GP [ 66].

Conclusions

A selection of brief screening tests may help identify problems that are frequently overlooked in older patients. Results should trigger further assessments and management according to the patient's beliefs, preferences, and expectations. Although no formal data exists to inform on the best timeline to repeat this basic evaluation, yearly assessments have been shown to have a good diagnostic yield. A formal evaluation of this two-step approach is still needed, but we strongly believe that such an approach is likely to yield some, if not all, of the benefits of community-based CGA programs, provided identified problems are properly addressed after the initial assessment.

Acknowledgements

Not applicable

Funding

No funding was received for this work.

Availability of data and materials

Not applicable (no original data used)

Authors' contributions

Both authors contributed to the design of the work, literature search, and manuscript drafting as well as revisions. Both authors read and approved the final manuscript.

Notes

Ethics approval and consent to participate

Not applicable

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Laurence Seematter-Bagnoud, Phone: +41-21-314-3803, Email: hc.vuhc@duongaB-rettameeS.ecneruaL.

Christophe Büla, Email: hc.vuhc@aluB.ehpotsirhC.

References

4. World Health Organization. Integrated care for older people: guidelines on community-level interventions to manage declines in intrinsic capacity. Geneva: World Health Organization; 2017. [ PubMed]

5. King AII, Boyd ML, Dagley L, Raphael DL. Implementation of a gerontology nurse specialist role in primary health care: health professional and older adult perspectives. J Clin Nurs. 2017. [ PubMed]

8. Iliffe S, Lenihan P, Orrell M, Walters K, Drennan V, Tai SS, et al. The development of a short instrument to identify common unmet needs in older people in general practice. Br J Gen Pract. 2004;54(509):914-918. [[ PMC free article] [ PubMed] Google Scholar]

9. Stuck AE, Zwahlen HG, Neuenschwander BE, Meyer Schweizer RA, Bauen G, Beck JC. Methodologic challenges of randomized controlled studies on in-home comprehensive geriatric assessment: the EIGER project. Evaluation of in-home geriatric health visits in elderly residents. Aging (Milano) 1995;7(3):218-223. [[ PubMed] Google Scholar]

15. British Geriatrics Society . Fit for frailty--consensus best practice guidance for the care of older people living in community and outpatient settings. London: British Geriatrics Society; 2014. [ Google Scholar]

28. Canadian Task Force on Preventive Health Care. Clinical practice guidelines. The Canadian Task Force on Preventive Health Care 2017. Available from: www.canadiantaskforce.ca.

38. O'Connor E, Rossom RC, Henninger M, Groom HC, Burda BU, Henderson JT, Bigler KD, Whitlock EP. Screening for depression in adults: an updated systematic evidence review for the U.S. Preventive Services Task Force. Rockville: Agency for Healthcare Research and Quality; 2016. Contract No: No. 128. [ PubMed]

54. Milne AC, Potter J, Vivanti A, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev. 2009;2:CD003288. [[ PMC free article] [ PubMed] Google Scholar]

60. Panel on Prevention of Falls in Older Persons American Geriatric Society/British Geriatrics Society. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011;59(1):148-57. [ PubMed]

61. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012;9:CD007146. [[ PMC free article] [ PubMed] Google Scholar]

66. Due TD, Sandholdt H, Waldorff FB. Social relations and loneliness among older patients consulting their general practitioner. Dan Med J. 2017;64(3). [ PubMed]

73. Katz S. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living.[review]. J Am Geriatr Soc. 1983;31(12):721-7. [ PubMed]

Articles from Public Health Reviews are provided here courtesy of Frontiers Media SA

# data[].attributes.attachment_link.title
Brief assessments and screening for geriatric conditions in older primary care patients: a pragmatic approach

# data[].attributes.attachment_link.description
This paper discusses the rationale behind performing a brief geriatric assessment as a first step in the management of older patients in primary care practice. While geriatric conditions are considered by older patients and health professionals as particularly ...

# data[].attributes.body
Assess the older adult's nutritional needs, eating habits, and risk for malnutrition. Consider factors such as dietary restrictions, ability to obtain and prepare food, and potential interactions between food and medications. Nutrition screening tools like the Mini Nutritional Assessment can be employed to identify nutrition-related risks.

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Overview

What is the MNA®?

The MNA ® is a validated nutrition screening and assessment tool that can identify geriatric patients age 65 and above who are malnourished or at risk of malnutrition. The MNA ® was developed nearly 20 years ago and is the most well validated nutrition screening tool for the elderly. Originally comprised of 18 questions, the current MNA ® now consists of 6 questions and streamlines the screening process. The current MNA ® retains the validity and accuracy of the original MNA ® in identifying older adults who are malnourished or at risk of malnutrition. The revised MNA® Short Form makes the link to intervention easier and quicker and is now the preferred form of the MNA ® for clinical use.

MNA® Literature Database

You are being directed to another site that houses the MNA® Literature Database . The Literature Database houses valuable information on the extensive research that supports use of the MNA ®. Currently the database has more than 1100 published research articles that reference the MNA ®. The database will allow users to search for and access links to abstracts of all MNA ® articles and references cited on the MNA ® website.

Latest news about the MNA®

MNA® and Wound Care
Based on evidence showing the MNA® performed better than the Braden Scale and other measures in predicting pressure ulcer development,[I] the US Wound Registry established a CSM quality measure for screening wound care patients for nutrition risk (that can use the MNA®) and providing treatment as indicated. Click here to read an interview with the editor of Todayï¿½s Wound Clinic about use of the MNA® in wound care.

The Interactive MNA®-Short Form is now available in Basque, Bengali, Bosnian, Catalan, Chinese, Croatian, Czech, Danish, Dutch, English, Farsi, Finnish, French, German, Greek, Hindi, Hungarian, Indonesian, Italian, Japanese, Khmer, Korean, Lithuanian, Malayalam, Moroccan, Nepali, Norwegian, Portuguese, Polish, Romanian, Sinhala, Slovakian, Spanish, Swedish, Tagalog, Turkish, Thai , Urdu and Vietnamese.Interactive versions of the MNA®-Long Form are now available in Bosnian, Dutch, English, Norwegian, Thai and Tagalog.

For Older Adults - Self MNA®
The Self MNA® is a simple tool designed to help older adults see if they are getting the nutrition they need. This new tool was scientifically validated in community-dwelling older adults in a recently published study. Older adults may access the Self-MNA® on the MNA® Forms page, complete the 6 questions, and share the results with their doctor to help guide the discussion about nutrition and their health. The Self-MNA® is available in English, Bulgarian, Danish, Dutch, Finnish, French, German, Greek, Hebrew, Italian, Korean, Lithuanian, Portuguese, Spanish, Swedish and Turkish.

MNA® and the Electronic Medical Record
The MNA® may be incorporated into the electronic health record provided users comply with all copyright and trademark requirements. Please contact info@mna24.com for more information.

Self MNA®

Specifically adapted for self completion by older adults or caregivers

Determines the nutrition screening score

Easy to use

Results to be shared and discussed with healthcare provider

Access the Self-MNA® on the MNA® Forms page

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Nestlé Nutrition Institute - MNA® Elderly - Overview

# data[].attributes.attachment_link.description
Overview The MNA ® is a validated nutrition screening and assessment tool that can identify geriatric patients age 65 and above who are malnourished or at risk of malnutrition. The MNA ® was developed nearly 20 years ago and is the most well validated nutrition screening tool for the elderly.

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Evaluate the living environment for safety risks that can lead to falls or injuries. Inspect the home for hazards like loose rugs, inadequate lighting, and inaccessible storage. Recommend modifications to improve safety, such as installing grab bars in the bathroom, improving lighting, and reducing clutter. Provide resources on home safety for older adults.

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A guide on home safety for older adults, with a printable checklist to help assess your home for risks.

Key Takeaways

Prevent falls and other accidents by taking precautions and making safety modifications in the home.

When assessing your home's safety, consider going room-by-room with our comprehensive checklist to ensure you find all potential hazards.

Many safety modifications can be made to your home that are affordable and easy to do yourself.

As we age, our homes should continue to be a place where we feel safe, secure, and comfortable. But research shows the exact opposite is sometimes true. A 2014 study conducted by the Centers for Disease Control and Prevention (CDC) found 28.7% of adults over the age of 65 reported falling at least once in the last 12 months. Another study by the Hospital for Special Surgery found 60% of falls happen in the home. To help prevent falls and other accidents, you can make safety modifications to your environment and eliminate common hazards.

Our Reviews Team assembled this guide and checklist highlighting home safety tips and helpful devices to ensure your home, or your loved one's home, continues to be a safe environment for aging in place.

Help in an emergency

Having tools and processes in place to get help in an emergency and minimize damage from falls, accidents, or other dangers is vital. The systems and processes below can help ensure you get the help you need when you need it-with no time wasted.

Home security system

The first emergency tool you can use is a general home security system. A special report released by the U.S. Department of Justice showed about 93% of all crime experienced by adults 65 and older was property crime, which includes general theft, burglary, and car theft. Using even a small system that alerts you when certain home barriers are breached or if someone is near an entryway of the home can help you be more alert and reach out for help if it's needed.

Choosing a system with a camera and speaker system can allow you to preview people at the door from wherever you are in the home, so you can speak to them if necessary. This can help you determine whether it's even necessary to answer the door, as well as allow you to inform visitors it will take you a few minutes to get to the door. You can take your time instead, so you don't increase your fall risk by rushing.

Medical alert system

Useful for getting help in an emergency, medical alert devices often include a wearable help button, which, in the event of a fall or another emergency, the wearer can push to connect with a 24/7 monitoring center. Research shows a medical alert device can help give users a stronger sense of security and independence and can bring peace of mind, even for people not at high risk of falling.

Emergency phone tree

You'll want to establish a process for alerting family members and caregivers if there's an accident or if help is needed. An emergency phone tree, which specifies which caregivers and family/friends to contact in an emergency and in what order, can help alert others of an emergency and get the help you need quickly.

With some medical alert systems, you can set friends and family as emergency contacts. For example, when you push the button you can customize the alert to summon the operator as well as your first emergency contact. This can streamline your emergency phone tree and ensure your caregivers are the first people aware of an emergency.

Tip list:

Create an emergency phone tree

Consider purchasing a medical alert system if you or someone you care for are concerned about falls risks

Home security systems can help prevent theft and allow you to communicate better with visitors

Exterior home safety

Depending on how often you or your loved one leaves the home, making appropriate exterior modifications may be a good idea to keep your environment safe and comfortable. This starts with keeping entryways accessible by installing handrails and ramps, if needed, to get in and out of the home. Also make sure that lighting is working and is adequate by fully lighting up the space when it is dark.

Using bright solar lights or motion detection lights around steps and walkways will help you see where you're going and prevent falls, and since they aren't constantly on, they will need to be replaced less frequently than traditional overhead lights.

Seasonal and material considerations

During the winter months, take extra precaution when using steps or walking on icy concrete. If you're unable to do it yourself, see whether a neighbor or family member can help salt your steps and walkways to reduce ice build-up, and always use assistance (handrailing or another person) when using steps. If it's in the budget, there are snow removal services you can hire to keep your driveway and walkways clear.

Also, consider the impact of the elements on steps and walkways, which can degrade over time, causing these areas to break down and become uneven. Maintaining these high-traffic spaces is important for keeping your home free of fall hazards. If you start to notice bricks crumbling or the walkway becoming uneven, consult a concrete repair specialist.

Tip list:

Entryway lighting (motion detector or always-on lighting)

Ramps when necessary

Railings around all steps

Keep mats to a minimum (to prevent trips and falls)

Clear walkways leading to the point of entry

Make sure the front door (and storm door) is easy to open, lock, and unlock

Interior home safety

When assessing the safety of the inside of the home, it might be easiest to go through each room, taking notes as you go, to spot potential hazards and make changes as needed. Be sure to use the tips below and our printable checklist.

General considerations for home safety

First, we will discuss general safety considerations that should be applied throughout the home and then move through measures that are room-specific.

As a general rule, keep a list of emergency phone numbers in an accessible place, preferably near a phone or stored in your cellphone. Consider prioritizing contacts who live close to you, so if there's an emergency, they can reach you promptly.

Lighting

Increasing the lighting in your home doesn't need to be an expensive fix requiring an electrician or rewiring your home.

First, consider replacing current bulbs with LED lightbulbs with higher brightness in areas or rooms that need more lighting. These bulbs will also last longer, so you won't need to change them as often. If you're easily bothered by bright lights, you may want to install dimmer light switches, so you can adjust the brightness according to your needs. "Dimmer switches are an excellent suggestion for folks that have cataracts, too," noted Christopher Norman, a geriatric nurse practitioner in New York State. "While fluorescent lighting is often the worst for people with cataracts, bright LED lighting can sometimes create discomfort, too."

If you're looking to add lighting in places not currently wired for traditional light bulbs, consider purchasing LED light strips to plug into existing outlets. They can easily illuminate walkways and give extra lighting under cabinets in the kitchen or bathroom. Our Reviews Team found LED light strips for as little as $15 from Home Depot.

You might also want to consider adding motion-detection lights. These lights are great for interior and exterior use and are perfect if you don't want to worry about using switches or remotes to light up the room. Using motion-detection night lights in hallways can make trips to the bathroom easier at night, so you won't stumble looking for the light switch. "Light-sensor nightlights that can plug into outlets are helpful, too-they come on automatically when light dims below a certain point, illuminating hallways better," added Norman. We also found motion-detection lights at Home Depot starting at $14.

Removing trip hazards

One of the easiest ways to prevent a slip or fall is to wear nonslip footwear, like slippers, that are comfortable and easy to walk in. Look for footwear with a closed heel, to prevent the shoe from coming off your foot, as well as a rubberized or textured sole to create traction when walking. Norman noted that having a hard sole is often helpful. "Slippers can still be comfy and have a hard sole. A hard sole contributes to more sensation being transmitted from the bottoms of the feet, which in turn provides greater sense of stability and balance-thus falls prevention," he said. This is especially important for people with diabetes, he added. "Excess sugar in the blood over a long period of time decreases nerve function and sensation. This is why some people talk about a tingly sensation in their hands and feet when diabetes is 'uncontrolled.'"

When conducting your home assessment, pay special attention to the floor. Something as simple as a throw rug can bunch up under a walker, a cane, or your feet and easily turn into a fall hazard. Even traditional nonslip mats can become a hazard if the mat creates the slightest elevation rise between steps.

Consider removing all rugs, especially from high-traffic walkways, or at least replacing them with vinyl rugs. Vinyl rugs are low-profile, so they don't create an elevation change, and are made of slip-resistant material that won't bunch up under your feet or other walking aids. Any area rugs (larger rugs used in a sitting area) should be fixed to the floor to keep them from moving. "Another caveat to this is in bathrooms that have porcelain or tile floors: Having something nonskid that's appropriately tacked down can be, not only aesthetically pleasing, but falling onto a carpet rather than directly onto a tile floor can sometimes make a difference in the extent of fall-related injuries," added Norman.

Also, note any thresholds transitioning between flooring types and rooms. Ideally, they should be completely flat to make sure they aren't a trip hazard. If a threshold presents a drastic change in elevation, and you can't replace it with a flat one, you can install a small threshold ramp on either side of the threshold to make it less of a tripping hazard.

Replacing pulls

It can be difficult to grip certain handles or turn knobs, particularly if you have reduced dexterity or arthritis, so to keep day-to-day life more comfortable, consider replacing commonly used handles, doorknobs, and other pulls with more comfortable ones. "D" handles are known for being the easiest to use because you don't need to grip them to open them. Rather, you can simply loop your hand around the handle and pull.

If it's not in your budget to replace all handles throughout your home, prioritize replacing the ones getting daily use, like in the primary bathroom and on kitchen cabinets.

Accessibility of everyday items

As you're walking through your home, ask questions and take notes about what items are used every day and where they're stored. This includes large and small items. For example, if you or your loved one takes daily medication, consider using an easy-to-open pill container with clear labeling. Make sure larger items are in an accessible location, as well as in a location where you won't have to perform any overhead lifting and bending. Of course, it's impossible to put every item in a place that's easy to access. Ask for assistance from family and friends when needing to reach items that are not within reach.

Reducing the risk of burns

As we age, our skin becomes more likely to be hurt by heat because of changes in skin composition, noted Norman. If you'll be taking hot showers or using hot water in the kitchen, consider reducing the temperature setting on your hot water heater to prevent burns. Also be mindful when boiling water, and when possible, use an electric kettle with an easy-pour spout to boil water, rather than a pan over the stove.

Living area

The living area is a space in the home where the majority of your day is spent. Arrange the furniture to keep a clear walkway and pay close attention to coffee or other low-level tables, which can be tripping hazards. Consider removing coffee tables and replacing with tables placed adjacent to most frequently used couches and chairs. The most frequently used chairs should be high enough, so it's easy to get in and out of. If you use a landline as your primary phone, consider putting it close to the sitting area to make answering calls easier. If you use a cordless phone or cellphone, make a charging station nearby to keep devices at full power.

Also, consider pets, especially cats and dogs. According to a report released by the CDC, an estimated average of 86,629 fall injuries each year were associated with cats and dogs. While they make great companions, our pets can also get underfoot. You can try putting a bell or other noise-making device on your pet's collar, so you'll know where they are at all times. But if you're experiencing hearing loss, you might not hear a bell. Other ways to avoid tripping over pets includes training them, knowing their habits so you're not taken off guard, knowing your surroundings, and making sure they get enough attention and exercise.

Tip list:

Be sure heavy furniture is safely secured to avoid tip-overs.

Consider removing or moving low-level tables or furniture to prevent tripping

Keep a charging station next to the sitting area for easy access to devices

If using an area rug, make sure it's fixed to the floor and the edges won't bunch up under your feet or walking aid

Be aware of your pets

Walkways and stairways

Look for potential trip hazards, like throw rugs and thresholds, when assessing hallways, and consider adding handrails along the walls. Even if you or your loved one are fully mobile, installing a handrail is good for falls prevention. Adding bright contrast tape to uneven parts of the floor can help you be more aware when walking. If electrical cords or other lines or cables are crossing the path, relocate the device to another plug more out of the way to reduce the possibility of tripping over the cables.

If you or your loved one uses a walking aid and has a multi-story home, you may want to invest in a stair lift for the stairway. This can reduce the time it takes to move up the steps and remove the risk of falling up or down the stairs. If a stair lift isn't in your budget, adding nonslip treads or carpeting to steps with a smooth surface can also help reduce the risk of falling. Make sure there is adequate lighting at the top and bottom of the stairs and light switches in both places. If you'll be using the stairs at night, think about adding motion detection lights along the steps to keep the stairs illuminated. Adding a strip of reflective tape at the end of each step can also be helpful, noted Norman.

Tip list:

Add nonslip tread covers to steps

Use motion detection lighting to illuminate halls and stairwells

Install handrailing throughout halls and up the stairs

Consider installing a stair lift (if needed)

Move cables that cross high-traffic areas to prevent tripping

If there are thresholds or uneven flooring, use bright tape to mark the hazard

Kitchen

The first step of kitchen safety is making sure your appliances, smoke detectors, and carbon monoxide detectors are working correctly. Check appliances for frayed cords or malfunction when completing your kitchen safety assessment. Smoke and gas detectors should be installed according to National Fire Protection Association guidelines and should be tested at least once per month, and batteries should be replaced at least once per year. If you don't want the hassle of replacing batteries regularly, you may prefer smoke alarms with non-replaceable batteries, which last up to 10 years, and will alert you with a chirp when the battery is low.

According to the American Burn Association, adults 65 and older are at much higher risk of injury and death from a kitchen fire due to physical, visual, hearing, or mental impairments, which may slow the quick action necessary in a fire emergency. If you have a hard time hearing, choose a detector that will alert you by sound and strobe lights. If you ever have a fire emergency, or a detector goes off, call 911 immediately. You should not try to put out the fire yourself. Another helpful fire safety tip is to be aware of the flame height on burners when cooking with a gas stove, and avoid wearing long sleeves that could easily catch fire.

If using knives, purchase pierce-resistant safety gloves to protect from cuts, and use a rubberized cutting board to prevent the knife from slipping while chopping. Vegetable choppers are a safe alternative to using knives to cut or dice foods.

Tip list:

Maintain smoke and carbon monoxide detectors per the manufacturer's instructions

Check appliances for frayed cords and ensure they're in working order

Keep the phone number for poison control accessible

Wear appropriate clothing when cooking (short sleeves and fire-resistant material)

Purchase cut-resistant protective gloves and rubberized cutting boards

Bathroom

A study published in the Injury Epidemiology Journal reported that falls occurring in the bathroom are more than twice as likely to result in an injury, compared to falls occurring in the living room. This makes bathroom safety one of the top concerns for older adults who choose to age in place. Investing in a walk-in tub can be an effective way to prevent falls while getting into and out of the shower or tub. If a walk-in-tub renovation isn't in your budget, there are other more affordable options to provide additional safety and comfort.

This includes adding nonslip gripping material to the shower or tub floor and installing grab bars near the toilet and in the shower or tub to help you remain stable. Rugs are great for catching water around the bathing area, but make sure you're using nonslip mats, so they won't bunch up when you walk on them.

Tip list:

Install grab bars near the toilet and in the shower or tub area

Add gripping to the bottom of the tub or shower

Insert a shower chair or bench

Replace low toilets with higher ones, or add a raised toilet seat

Secure nonslip bath mats or rugs to the floor

Install durable and easy-to-use faucets (consider using a single-handle faucet)

Bedroom

Keeping the bedroom free from clutter is a good practice for anyone looking for restful and better quality sleep. Remove any excess furniture and items that interfere with walking through the room or serve no general purpose in the bedroom. When it comes to sleeping, you should make sure the bed is a good height for you or your loved one to easily get in and out of. The Americans with Disabilities Act (ADA) National Network advised a bed height of 20-23 inches is ideal for optimal accessibility. If you're unable to adjust the bed to this height, keeping a safe step stool nearby can help make getting into and out of bed easier. If it's in your budget, consider investing in an adjustable bed, which can be set in customized positions for reading, watching television, and, of course, sleeping. If you sleep with monitoring devices, medical alert devices, or a phone, keep them charged and nearby so they're ready for bedtime.

Tip list:

Make sure the bed is easy to get into and out of (keep a step stool nearby for bed access)

Keep the room clutter-free for more restful sleep

Charge devices needed for monitoring sleep and health before bed

Keep a phone nearby in case an emergency occurs at night

Consider purchasing an adjustable bed for increased sleeping comfort (if needed)

Products to help older adults age in place

Properly fitting nonslip footwear, easy-to-open pill dispensers, and appropriate eyewear are just a few everyday items you can purchase to make independent living safer and more comfortable. Additionally, there are certain devices and products specifically created to help older adults age in place.

Medical alert systems

A medical alert system is a device that allows you to connect with a 24/7 monitoring center at the push of a button. With some medical alert systems, like HandsFree Health, you can customize it, so your caregiver receives your emergency alerts when you push the button for help. Other systems can give you the benefit of automatic fall detection, so if you fall, the system will automatically contact a monitoring center staff member, who can call for help. A variety of systems are available for in-home or on-the-go lifestyles, so you can find one to fit your needs.

GPS trackers

GPS trackers are small devices that can help track someone's location. These work using a Global Position System (GPS), so a connection to the internet or other wireless service isn't required. You can purchase GPS trackers separately, like as a watch, or many medical alert systems come with GPS already installed and a corresponding caregiver app, which allows you to track someone when they're on the move. The Alzheimer's Association reported six in 10 people living with dementia will wander at least once. A GPS can help locate a lost person and reduce their exposure to danger. These devices are generally discreet and can easily be tucked away in a bag.

Hearing aids

It's important to be aware of your surroundings when living independently. If you or someone in your care has been having trouble hearing, consider taking an online hearing test or seeing an audiologist for a more in-depth hearing test to discuss hearing aids.

Cellphones

If you don't already own a cellphone and regularly leave the home, consider getting a cellphone, so you can easily reach someone in the event of an emergency. Some mobile phones, like Jitterbug, also double as a medical alert system and come with access to a monitoring system, so all you need to do is press a button to summon help if you fall or are in an accident.

Walk-in tubs

Walk-in tubs offer a safe, comfortable, and convenient way to bathe, especially if you experience mobility issues. The door on a walk-in tub swings either out or in and has a low threshold, making it easier to step over. Plus, walk-in tubs often come with jet features, which can help ease sore joints. Walk-in tubs come in many models, with some including a shower combination. The cost to install a walk-in tub ranges from $5,000-$20,000, depending on the size, features, and renovation required to install.

In-home consultations

If you want extra guidance when making a home safer, consider using a home safety specialist. These professionals will perform an in-home consultation, make suggestions about how to make the environment safer, and will even install equipment or make modifications based on their suggestions. This can help take the pressure off of you to find all potential hazards and leave it to a person who specializes in home safety. These professionals include occupational and physical therapists and certified aging in place specialists.

Home safety for aging adults checklist

Use our room-by-room checklist below as you walk through your home and note potential safety hazards and modifications you should make.

Click here for the PDF printable checklist.

Exterior

Lighting

Motion detection lighting for use at night

Overhead lighting to illuminate the entryway

Security system to prevent home intrusion

Ramp installation (if needed)

Handrails along all steps

Clear walkway from the parking area to home entry

Front door and storm door is lightweight and easy to open

Mats should be low-profile and not create a fall risk

Doorknob is easy to turn

Interior

Hallways

Motion detection lights to illuminate hall

Handrailing throughout walkways (if needed)

No throw rugs that create fall hazards (replace with vinyl rugs if needed)

No wiring or cords crossing high-traffic areas

Stairways

Stair lift (if needed)

Nonslip stair treads

Motion detection lights on steps

Handrailing

Kitchen

Smoke and carbon monoxide detectors work and are present in kitchen (and throughout the home)

Appliances are working correctly (no frayed wires or error codes)

The phone number for poison control is accessible

Appropriate clothing is worn when cooking (short sleeves and fire-resistant material)

Cut-resistant protective gloves and rubberized cutting boards

Living areas

Walkways are clear

No low-level tables or furniture that can cause tripping

Landline or cellphone charging station is next to the sitting area

Bedroom

Bed is easy to get into and out of (keep a step stool nearby for bed access)

The room is clutter-free for more restful sleep

Charging station for devices near bed

Bathroom

Mount grab bars near the toilet and in the shower or tub area

Install walk-in-tub/shower (if needed)

Add a nonslip mat on the tub or shower floor

Use nonslip mats around the bathing area

Replace faucet handles with ones that are easy to use

Replace low toilets or toilet seats with higher ones to make it easier to get on and off

How to pay for home safety modifications

If you need financial assistance for home safety modifications, there are several options available, including home improvement grants, long-term material loans, and certain Medicare plans.

Home improvement grants are generally offered on a one-time basis for a single specific home modification project. They do not need to be repaid.

Some organizations offer long-term loans for certain kinds of home modification materials, such as portable wheelchair ramps. These may be borrowed until they are no longer needed.

While original Medicare usually does not cover the cost of home modifications, there are several exceptions. Medicare might pay for assistive technology devices, which can be part of a home modification project, if they're considered medically necessary and prescribed by a doctor. Medicare may also offer assistance in determining which home modifications can be considered a medical requirement. Medicare Part B will cover the costs of a home evaluation from an occupational therapist to determine necessary changes. In certain instances, Medicare will also pay for bathroom modifications, including walk-in tubs, although this is rare. Generally, Medicare assistance is limited to any hardware associated with a home modification but not for construction costs.

If you have a Medicare Advantage plan, you may have more coverage for home modifications. These plans tend to offer additional benefits, which may include home modifications that are considered medically necessary. Keep in mind that Medicare Advantage plans vary from one state to another, so you should check the supplemental benefits offered where you live.

Printable home safety checklist

Bottom line

Home safety should be at the top of the list when choosing to age in place. If you want to assess the overall safety of your home, print out our Reviews Team's home safety checklist and walk through each room of your house and take notes. This will make you more aware of potential hazards and how they can be removed or modified.

Frequently asked questions

Have questions about this review? Email us at reviewsteam@ncoa.org.

Sources

1. Centers for Disease Control and Prevention. Falls and Fall Injuries Among Adults Aged ≥65 Years. Sept. 23, 2016. Found on the internet at https://www.cdc.gov/mmwr/volumes/65/wr/mm6537a2.htm

2. Hospital for Special Surgery (HSS). Addressing Falls Prevention Among Older Adults, Part I: Understanding Why Falls Happen. March 29, 2011. Found on the internet at https://www.hss.edu/conditions_addressing-falls-prevention-older-adults-understanding.asp

3. U.S. Department of Justice. Special Report. Crimes Against the Elderly, 2003-2013. November 2014. Found on the internet at https://bjs.ojp.gov/content/pub/pdf/cae0313.pdf

4. Stokke, R. The Personal Emergency Response System as a Technology Innovation in Primary Health Care Services: An Integrative Review. Journal of Medical Internet Research. July 14, 2016. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4965612/

5. Department of Justice. Elder abuse statistics. Found on the internet at https://www.justice.gov/file/1098056/download

6. Centers for Disease Control and Prevention. Nonfatal Fall-Related Injuries Associated with Dogs and Cats - United States, 2001-2006. March 27, 2009. Found on the internet at https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5811a1.htm

7. National Fire Protection Association. Installing and maintaining smoke alarms. Found on the internet at https://www.nfpa.org/Public-Education/Staying-safe/Safety-equipment/Smoke-alarms/Installing-and-maintaining-smoke-alarms

8. American Burn Association. Cooking Safety for Older Adults. Found on the internet at https://ameriburn.org/wp-content/uploads/2018/12/cobranded_aba119_burnprevention-cookingolderadults_113018-1.pdf

9. Injury Epidemiology. Circumstances and outcomes of falls among high risk community-dwelling older adults. March 20, 2014. Found on the internet at https://injepijournal.biomedcentral.com/articles/10.1186/2197-1714-1-5

10. ADA National Network. Accessible Lodging. February 2017. Found on the internet at https://adata.org/factsheet/accessible-lodging

11. Alzheimer's Association. Wandering. Retrieved June 7, 2023. Found on the internet at https://www.alz.org/help-support/caregiving/stages-behaviors/wandering

# data[].attributes.attachment_link.title
Home Safety for Older Adults: A Comprehensive Guide 2024

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Wondering how to make the home safer for older adults? This guide and printable checklist gives helpful safety tips to help adults age in place.

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Needs of Client

adequate nutrition

support system

Ability to perfom ADL's

Clients safety

Long term planning support

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resources for caregivers

counseling

respicare

aging at home as long as possible

long-term care planning

modification resources

medication compliance/teaching

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anticipatory grief

loss of independence

disbelief

confusion

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power of attorney

ethical - the best time to transition to long term care

DNR/ Living Will

State planning

medical power of attorney

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Call bell

grab bars on showers

fall risk preventions

medications in a safe place

smoke detectors

assistive devises

walker

safety with food prep.

locks on doors

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encourage problem solving

long term planning

educating patients family (home care)

medication side effects

abnormalities to report

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Balanced nutrient diet, high in protein.

Fluid intake to be adequate.

Daily weight to monitor I&O's.

Rest in between activities.

Family support, Monitoring patient changes.

Monitor sodium intake so we don't see third spacing.

Monitor labs and vitals, report any changes.

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family support to help monitor I&O's, weight, (AMS) and physical changes and emotional changes.

Avoid smoking and drinking alcohol.

Treatment/ Care plan between what patient wants as well as family.

Living situation, is the patient safe at home?

Transportation, does the family or the patient have transportation to get to app.

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Support groups for patient as well as family.

Education to help family or patient understand why the loss or disease is happening.

Mental health, due to the loss or anticipation of loss of a loved one.

Limited mobility due to aging can cause grief.

Secondary loss or mass grief due to multiple losses in a close time frame or due to new onset of a disease.

Family could be having anticipatory grief because of the new onset of a disease.

Loss of freedom for patient and family.

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Is the patient a DNR or a full code?

Does the patient have a living will?

Is the family aware of the patients wishes?

Who is the POA?

Get hospice involved.

Does the patient want to die at home or is it best to put patient in a skilled facility.

Get palliative care involved.

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How does the patient transfer or are the bed bound?

ADL'S can patient help or do the need full care?

Bed alarms, chair alarms, fall mats and assistive devices.

Home health care or skilled if patient needs help with ADL's.

Spiritual care for family and patient.

Well lit lighting.

clear path if patient is mobile to get to where they need to be.

Monitor for changes in patient baseline.

If new medication is started educate patient and family on what to look for in changes in the patient and report and changes to the provider.

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Treatment plans

PT/OT

Support groups

Exercise plans

Follow up appts

Monitor vital signs and I+O

Avoiding alcohol

Eating a healthy diet

Take medications as prescribed

Stop smoking

Parameters for medications

Daily weights

Lab work

Proper nutrition

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Healthy diet

hydration

Exercise

Assistance with medication

Assist with ADLS

Incontinence care

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Respite care

Case worker

Support groups

Home health aid

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Loss of independence

Anticipatory grief/for both

Loss of control

Isolation

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POA

Living will

DNR/Full code

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Walker

Shower chair

Grab bars

Wheel chair

Meal prep

Medication organizer

Medical alert bracelet

Good lighting

Clutter free environment

1 story home

BSC

Home aid

Aspiration precautions

Fall risk precaution

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Provide client with auditory videos

Speak to client/family

Teach back method

Alexa reminders