This document discusses falls in older adults. It notes that falls are the primary cause of fatal and nonfatal injuries in older individuals. Frailty and limited physiologic reserve among the elderly lead to higher rates of morbidity and mortality from falls in those over 75. Falls can cause injuries like hip fractures and brain injuries. As a result of fear of falling, many older adults limit their activities and social engagements. The document discusses risk factors for falls like polypharmacy, antipsychotic drugs, visual deficits, and cognitive impairment. It provides nursing strategies to reduce falls like using call lights, alarms, slip-resistant footwear, and monitoring high-risk patients. Fall prevention is important for older adults to maintain quality of life and reduce

1. Increased Risk of Falls
Everyone strives to feel safe and comfortable in their
living surroundings. With age comes the necessity to keep one's
mind at ease while going about one's everyday tasks. In older
individuals, falls are the primary cause of fatal and nonfatal
injuries. Because of the increasing incidence of frailty and a
limited physiologic reserve among the aging population, fatal
falls occur in persons of all ages, but those over 75 experience
higher rates of morbidity and mortality. Falls are the primary
cause of injury-related emergency room visits, especially among
the elderly. Falls can cause injuries such as hip fractures, brain
injuries, and rib fractures. Depression, social isolation, and
limitations in their other activities are some of the additional
drawbacks. Falls, whether they cause harm, have a significant
influence on one's quality of life, especially for the elderly. As
a result of their fear of falling, an increasing number of older
adults are limiting their activities and social engagements.
Therefore, as nurses, ensure assess fall risks and prevent falls in
older adults.
I. Falls are a frequent clinical condition that affects
approximately half of all Americans over the age of 65.
A. An older adult is treated in the emergency room after a fall
every 11 seconds.
1. Because of the higher incidence of frailty and a limited
physiologic reserve among the elderly, falling causes higher
rates of morbidity and mortality among individuals over 75.
a. It is typical for elderly adults to have multiple chronic health
conditions, as well as a loss of physical strength and bone
density. Those are the ones who induce them to fall and easily
fracture their bones.
b. Muscle strength, balance, and reaction time all decline as we
age which put older adults at a significant risk of falling.
II. There are many risk factors of fall in elderly.
A. Polypharmacy, antipsychotic drugs, visual deficit, and

2. cognitive impairment can cause falls in older adults.
1. Many older adults take multiple drugs daily and receive
treatment from different physicians. As well as they tend to take
antipsychotic drugs for depression or other mental illnesses.
a. For instance, many elderlies have hypertension, and
sometimes they take both diuretics and antihypertensive
medication for it. These combined medications may cause
severe hypotension and risk for falls.
b. Many older adults must depend on other people with ADLs,
lost their loved ones, lonely, and depressed, so they take
antipsychotic drugs to minimize these conditions. Antipsychotic
medications might cause drowsiness and risk for falls.
III. Nursing management of falls
A. Management of fall is challenge for nurses, but there are
several ways to reduce falls.
1. Encourage fall risk clients to wear slip resistant socks or
shoes, reinforce to use call light before getting up, rise and
reposition slowly, use walker, stay within arm’s reach, use bed
alarm or chair alarm, and answer call lights promptly. These
interventions produced a 30% reduction in falls in an Australian
subacute hospital.
a. Some facilities use video monitor or one to one sitter to
prevent falls in high-risk older adults.
b. Wear a high-risk fall bracelet to alert all staffs that the
patient requires assistance with ambulation.
c. Keep high fall-risk patients closer to nursing stations so that
staffs can get to them faster.
In conclusion, falling is becoming more common among
older adults, and it is not a natural part of the aging process.
Fall prevention is particularly important in older adults because
falls are the leading cause of fatal and nonfatal injuries in this
age group. Because falls in the elderly have such serious
effects, it's vital to watch for signs and symptoms, as well as
risk factors. Patients over 65 who have fallen should be
thoroughly assessed. By detecting and treating the underlying
cause of a fall, patients can regain baseline function and reduce

3. the risk of recurrent falls. These methods help to reduce the
morbidity and mortality associated with falls. If left untreated,
it can result in serious harm and even death. As competent
nurses, we strive to protect our patients from falling and
provide them with the highest quality of life possible.
References:
Hoffmann, V. S., Neumann, L., Golgert, S., & von Renteln-
Kruse, W. (2015). Pro-active fall-risk
management is mandatory to sustain in hospital-fall
prevention in older patients-
validation of the Lucas fall-risk screening in 2,337
patients. The Journal of Nutrition,
Health & Aging, 19(10),1012-1018.
http://dx.doi.org/10.1007/s12603-015-0662-1
Meiner, S. E. ([Insert Year of Publication]). Gerontologic
Nursing (6th Edition). Elsevier Health
Sciences (US).
https://ambassadored.vitalsource.com/books/9780323498111
Please Reply to the following 2 Discussion posts:
Requirement
APA format with intext citation
Word count minimum of 150 words per post
References at least one high-level scholarly reference per post
within the last 5 years in APA format.

4. Plagiarism free.
Turnitin receipt.
DISCUSSION POST # 1 Reesha
Telemedicine can be defined as using technological equipment
as an avenue in which providers can meet with their patients.
Usually done through online video calls–whether through phone
or computers, telemedicine has created a new outlet for primary
healthcare providers to evaluate, diagnose and treat patients
remotely. The popularity and need for telemedicine arose during
the COVID-19 pandemic, serving as a way for the less acutely
ill patients to receive health care effectively and safely. When it
comes to discussing how the United States government
reimburses advanced practice nurses or physicians alike for
services like telemedicine, depends on each state and their laws
put in place by legislature.
According to the Department of HealthCare Services (DHCS)
telehealth is considered a cost-effective alternative to health
care provided in-person, particularly to underserved areas.
Telehealth is not a distinct service, but a way that providers
deliver health care to their patients that approximates in-person
care. “DHCS’s coverage and reimbursement policies for
telehealth align with the California Telehealth Advancement
Act of 2011 and federal regulations. State law defines telehealth
as “the mode of delivering health care services and public
health via information and communication technologies to
facilitate the diagnosis, consultation, treatment, education, care
management, and self-management of a patient's health care
while the patient is at the originating site and the health care
provider is at a distant site.” (DHCS, 2021).
Furthermore, the details and guidelines of reimbursements in
California can differ from the type of insurance the patient is
under ie. Medi-Cal and Medicare. To illustrate, Medi-Cal will
reimburse for telemedicine services provided through means of
live video. Services must be billed with either a GT or 95

5. modifiers. Under both insurances Advanced Practices Nurse are
eligible for Medi-Cal and Medicare reimbursements so that they
meet the guidelines and regulations approval. Telemedicine,
while cost effective for patients, is still revenue building for
primary care providers.
DISCUSSION POST #2 Kathleen
Telehealth and Telemedicine are one of the products of
Information and Communication Technology (ICT) revolution
that provides health services to patient remotely. According to
Gogia (2020), Telehealth is a process of delivering patient-
centered care healthcare services at a distance. It covers a wider
range of healthcare services besides the healthcare provider -
patient relationship. It also reduces the cost and discomfort
associated with patients traveling and promotes easy access to
specialties that can attend to timely urgent care. Telehealth
promotes connection to the healthcare team that results in
harmonious continuity of care. In addition to that, Telehealth
incorporates the store and a forward system where patients in
rural areas can have access to a radiologist, especially during
non-office hours. CT scans and MRIs interpretations can be
done through teleradiology companies that have an available
board-certified radiologist that can interpret an image in a
matter of minutes. Another positive impact of telehealth is the
association with social media where patients and relatives
become involved such as “Patients like me” where people of the
same chronic condition can share their experiences with one
another.
On the other hand, Telemedicine is the provision of clinical care
rendered by a healthcare provider using clinical processes such
as teleconsultation and telediagnosis (Gogia, 2020). Telestroke
is a subsystem of telemedicine and can be used when a patient
comes to the emergency department (ED) and can be seen by a
neurologist virtually when there is no neurologist present by
using two-way audio and video connection. Wound care
management is another clinical skill that can be done through

6. telemedicine by transferring images and video using
telemonitoring and video conference. Moreover, the Telehealth
Extension and Evaluation Act extended Medicare pandemic
health waivers for two years and will allow practitioners to
prescribe controlled substances via telehealth (Smith, 2022).
The challenge for Telehealth and Telemedicine is the constant
participation of older adults as they face a challenge in
participation having limited knowledge and skills in technology.
Technology training programs can increase the adoption of
older adults to telehealth and telemedicine in order to manage
chronic diseases (Goldberg et al., 2021). Teaching them and
their caregivers how to use the internet by starting them through
a telephone call and guiding their way in navigating their
smartphones and laptop will eventually increase their
knowledge and participation in telehealth.
Running head: ANNOTATED BIBLIOGRAPHY 1
ANNOTATED BIBLIOGRAPHY 2
Hypertension
Annotation Bibliography
Burnier, M., & Egan, B. M. (2019). Adherence in hypertension:
a review of prevalence, risk factors, impact, and
management. Circulation Research, 124(7), 1124-1140.
This study indicates that cardiovascular diseases are the main
killers. Risk factors for these occurrences include hypertension

7. and complications from diabetes. If the condition is
aggressively treated and kept under control, cardiovascular
mortality can be avoided. Contrary to popular belief, the high
prevalence of pulmonary hypertension among those who have
tried to take medication is significantly influenced by poor
medication adherence. When pharmacotherapy is not started, is
not taken as frequently as advised, or is stopped before
achieving therapeutic goals, there is suboptimal adherence. The
most frequent causes of hypertension risk factors were being
overweight and obese. Deaths from cardiovascular causes are on
the rise in relation to hypertension. Anyone can develop
hypertension (high blood pressure), regardless of their age,
gender, or nationality. The heart, arteries, brain, kidneys, and/or
eyes are just a few of the various organs that can be impacted
by the potentially fatal condition of hypertension. The systolic
and diastolic blood pressures for stage 1 hypertension are 140–
159 mmHg and 90–99 mmHg, respectively. Systolic blood
pressure of 160 mmHg or higher and diastolic blood pressure of
100 mmHg or higher are considered to be stage 2 hypertension.
I found this article to be helpful because it had a lot of the
content and information I needed.
I will use this source because of the valuable information that
the author elaborates in the journal. This will assist me in
educating both the female and male population on how to
modify their lifestyle, which will reduce the increase in
cardiovascular death that is associated with hypertension.
Musameh, M. D., Tomaszewski, M., & Williams, B. (2013).
Hypertension--a clinical update for physicians. Clinical
Medicine, 13(2), 182-184.
The British Hypertension Society and Royal College of
Physicians have published a clinical report. The update states
that over one billion people worldwide suffer from hypertension
and that efforts to lower hypertension in the population should
focus on early diagnosis and effective blood pressure control.

8. Valid issues regarding diagnosing hypertension, secondary
hypertension, managing hypertension, resistant hypertension,
and novel therapies were covered in this report. Information is
given that highlights the significance of early detection and
blood pressure control for each of these categories. Moreover,
the update mentioned the pressure that hypertension places on
the artery walls can cause a wide range of issues. Although
there are numerous risk factors for hypertension, the root cause
is frequently unknown. In the sense that a person may not be
aware they have a medical condition, which results in a lack of
treatment, hypertension can be silent. For the majority of
patients, hypertension is easily diagnosed and generally
manageable.
I find this article to be beneficial due to the extent of the
content. This article covers all aspects of therapy, including
medications, lifestyle changes, risk factors, and other concerns.
An individual must be attentive and conscious of their present
and past health state.
References
Burnier, M., & Egan, B. M. (2019). Adherence in hypertension:
a review of prevalence, risk factors, impact, and
management. Circulation Research, 124(7), 1124-1140.
Musameh, M. D., Tomaszewski, M., & Williams, B. (2013).
Hypertension--a clinical update for physicians. Clinical
Medicine, 13(2), 182-184.