Chapter 9: Meeting Safety Needs of Older Adults

Safety risks are categorized into internal factors specific to the individual and external environmental hazards. Internal factors include normal age-related physiologic changes such as diminished visual and auditory acuity, which increase risks for accidents and medication errors, and reduced mobility, muscle strength, and slowed reaction time, which dramatically increase fall risk. Chronic conditions affecting the cardiovascular and neurological systems, like orthostatic hypotension or Parkinson disease, also predispose older adults to dizziness (vertigo) and fainting (syncope), further increasing danger. A primary focus is fall prevention, detailed through initiatives like the CDC's STEADI program and the Joint Commission’s efforts, which emphasize systematic assessment for risks like gait impairment, medication review, and using assistive devices. The concept of thermoregulation is deeply explored, as older adults are highly susceptible to imbalances such as hypothermia (core temperature 95 ∘ F or lower) and hyperthermia (including heatstroke, 104 ∘ F or higher) due to slower metabolism, reduced subcutaneous fat, and diminished perception of temperature extremes. Environmental interventions, both in clinical settings and the home, are key safety strategies, addressing hazards such as poor lighting, clutter, electrical safety, and fire prevention (where older adults face a significantly higher risk of fire death). The chapter also addresses complex topics like safe driving practices and the strict guidelines governing the use of protective devices (formerly restraints), which must only be utilized as a last resort under specific medical necessity criteria. Ultimately, recognizing and modifying these internal and external risks is essential to promote independence and prevent the cycle of injury, fear of falling, and subsequent decline in physical function.