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Assessing and Addressing Fall Risk in a Geriatric Patient Using the Fulmer SPICES

Assessment

Student name

Institution

Course

Date
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Introduction

The ageing population is increasing rapidly at the moment, and as a nurse, I am aware of the

specialized care that these individuals require. E.G. is a 78-year-old patient whom I was assigned

and who will be assessed and discussed in this paper. E.G. will be the centre of this discussion

for this paper because of her history of falls and general fragility, which made her more

susceptible to other disorders that lower her quality of life. Diagnosis of the patient points out

that the patient has a complex medical history including; prior stroke, aneurism, breast cancer,

radiation, hypertension (HTN), hyperlipidemia, and seizure on set. According to the Fulmer

SPICES assessment results, falls resulting from altered spinal curvature and decreased mobility

are a significant issue. Generally, I will discuss the evaluation results, provide a detailed analysis

of fall syndrome, and provide a summary of the EBP-based strategies that might be implemented

to reduce the impact of falls on E.G.

SPICES Assessment Findings

I was able to systematically evaluate E.G. in several important areas using the Fulmer SPICES

tool: Sleep disorders, Problems with eating, Incontinence, episodes of seizure, Evidence of falls,

and Skin breakdown. The normal spinal curvature changes were evident during the assessment;

this can make her more likely to fall because they impact her posture and balance. For example,

during the assessment, E.G. mentioned that she occasionally feels weak while getting out of bed

to sit. Additionally, I saw minor issues with hailing and sleeping at night, which may also be

related to her fall risk. In particular, it is evident that it was challenging to get accurate

information when evaluating E.G. due to her incomplete recollection of her prior fall history. To

gain a better grasp of the problem, I spoke with my shadow nurse and inquired about her medical
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history. The evaluation supported my decision to address her fall risk because the fall had a

detrimental impact on her functional independence and quality of life.

Discussion of Fall Syndrome

One of the most prevalent problems that older patients face is falling, which can lead to injuries,

limited movement, and a loss of autonomy. I chose this syndrome because it poses the greatest

threat to EG and frequently results in physical impairment and compromised social interaction.

The concept of Aging-Related Cognitive and Emotional Susceptibility (ACES) highlights the

need to maintain a patient's mobility and independence, both of which are impacted by falls

(Wexler, 2023). Fall-related risks include diminished muscle strength and range of motion in the

joints, and changes in gait and posture.

Xing et al, (2023) stress that elderly people are more susceptible to falls due to aging-related

conditions such as muscle loss, bone density decrease, and altered balance reflexes. For instance,

EG's altered spinal curvature impacts her center of gravity which has altered her posture. Her

fear of falling also prevents her from participating in activities or going to social gatherings that

she used to attend. This leads to a decrease in functional ability and disengagement, which

highlights the need for specialized care in order to prevent falls and enhance this person's quality

of life.

However, falls impact not only physical health requirements but also emotional and social-

personal life. E.G. has been observed to withdraw from various activities she used to participate

in since she is confined to a wheelchair. She also suffers from a loss of mental and emotional

equilibrium because she is unable to leave the house to engage with others due to fear of falling,
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which leads to a cycle of inactivity that increases her risk of falling. Because fall risk can

exacerbate physical and mental health issues, it is important to concentrate on strategies to

reduce it.

Problem-Based Nursing Interventions

To prevent falls I looked into several of the evidence-based interventions which would help in

improving E.G.’s safety and mobility. Research emphasizes the importance of physical mobility

programs, specifically activities that involve exercising muscles in the core and lower body

which play a critical role in preventing falls (Izquierdo et al, 2021). In E.g.’s case, I would advise

the help of a physical therapist to develop a Range of Motion (ROM) exercise program that seeks

to strengthen muscles and create flexibility as well. Such exercises can be done in her room with

the help of a physical therapist to avoid any accidents or inefficiency.

Bradshaw, (2021) highlights that another operational essential intervention is ensuring a fall-

prevention environment. For instance, I would ensure that her bed is at the lowest position and

that all the sides of the bed are guarded especially the rails to prevent serious harm in case of a

fall. Further, there is a need for bed pads to fold on the rails and also seizure pads to be attached

to the sides. This adds some form of protection. Perhaps having clear pathways with appropriate

lighting; during night-time when she mostly gets confused, could also enhance her safety.

Research evidence also indicates walkers can be an aid when getting out of bed, provide

assistance when walking to the bathroom or walk around the unit (Thies et al, 2020). However,

E.G. should ensure that she does not over-depend on these devices so that her balance does not

become worse in the future. It will help her to have proper guidance on how she can move more

freely. Moreover, the enrollment of a regular program of visits by the nursing staff will ensure
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observation and modification of her condition from time to time. These interventions not only

will protect E.G.’s physical well-being but also promote her self-determination and assertiveness.

This may reduce her fall risk over time and enhance her feeling of self-sufficiency.

Reflection

This assignment has helped me to understand geriatric care as well as the significance of

individual approaches. By carrying out the SPICES evaluation and developing a plan of care

based on the SPICES tool for the E.G. patient, the practical aspects of the care of the elderly

were made clear. In my future practice, I will apply the tool of SPICES and follow every

segment while assessing my patients to identify and address all of the unique patient’s

vulnerabilities. It is through this assignment that I understood that some of the geriatric

syndromes like falls have a significant impact on the patient’s quality of life and therefore I

suggest adopting multidimensional approaches including physical aspects of care, and emotional

and social dimensions. It has also pointed out the need to work with the interprofessional

healthcare team in elder care. Services from the physical therapist and the nurse as sources of

information can enhance the outcome of the patient. Research emphasizes the importance of

physical mobility programs, specifically activities that involve exercising muscles in the core and

lower body which play a critical role in preventing falls. Additionally, another operational

essential intervention for my patient is ensuring a fall-prevention environment. Research

evidence also indicates walkers can be an aid when getting out of bed, and provide assistance

when walking to the bathroom or walking around the unit. In the future, I will pay more attention

to the patient-centric/adherent models and try to involve patients in decisions because of their
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concerns and preferences. Thus, attempted prevention of geriatric syndromes shall help me

constructively advance the culture of care that does not demean or infantilize its elderly patients.

References

Bradshaw, D. C. (2021). Healthy Work Environments: Skilled Communication in Daily Patient

Safety Briefings Impacts Fall Prevention (Doctoral dissertation, Grand Canyon

University).

Izquierdo, M., Merchant, R. A., Morley, J. E., Anker, S. D., Aprahamian, I., Arai, H., ... &

Singh, M. F. (2021). International exercise recommendations in older adults (ICFSR):

expert consensus guidelines. The journal of nutrition, health & aging, 25(7), 824-853.

Thies, S. B., Russell, R., Al-Ani, A., Belet, T., Bates, A., Costamagna, E., ... & Howard, D.

(2020). An investigation of the effects of walking frame height and width on walking

stability. Gait & Posture, 82, 248-253.

Wexler, S. S. (2023). A comparison of nurse sensitive outcomes of an acute care for the elderly

(ACE) unit and a regular inpatient medical unit.

Xing, L., Bao, Y., Wang, B., Shi, M., Wei, Y., Huang, X., ... & Qin, D. (2023). Falls caused by

balance disorders in the elderly with multiple systems involved: Pathogenic mechanisms

and treatment strategies. Frontiers in neurology, 14, 1128092.