Falls among community-dwelling older adults are common and dangerous, often leading to traumatic brain injury, cervical fractures, and spinal cord injury. Physical and physiologic changes with aging, preexisting diseases, and treatments result in increased morbidity and mortality for this population. Trauma critical care nurses can expect to see increasing numbers of older adults in intensive care units as the US population of those older than 65 years increases to 53 million by 2020. Older adults pose additional dilemmas in care. This article reviews falls, mechanism of injury, and nursing care issues of particular significance to this vulnerable population in the critical care setting.
Critical care and acute care nurses must determine ways to deliver optimal patient care without the use of physical restraints. This article explores the application of the clinical decision analysis model to the challenge of finding nonrestraint approaches to care. Clinical decision analysis is a structured, quantified approach for choosing an optimal course of action in a situation that involves trade-offs among risks and preferences and when outcomes are uncertain. Decision analysis provides a graphic representation of the decision situation that facilitates evaluation of factors relevant to the situation and evaluation of the potential events and outcomes following a chosen strategy. The decision analysis model can be useful for determining guidelines for clinical practices, facilitating discussions among health care providers and patients, and determining areas in need of additional research.