Clinical Psychology and Gerontology

Unintentional falls among the aged remains of the challenging safety issues facing healthcare specialists around the world. This paper involves my assessment process with a client Mr. Peter. Peter is 82 years old married to Irene. He presented to the emergency department in Monash Medical center, where I work as a gerontology nurse.

Running head: CLINICAL PSYCHOLOGE AND GERONTOLOGY 1
Clinical Psychology and Gerontology
 Introduction
Unintentional falls among the aged remains of the challenging safety issues facing
healthcare specialists around the world. It is the most common cause of accidental death and
injury (Fulmer, Greenberg & Wallace, 2012). To lower the risk of injury and accident from falls,
interviewing strategies that make the use of SPICES tool can be used to identify the risks and
provide a further evaluation. Fulmer SPICES remains as one of the crucial frameworks that are
used to assess older adults. It focuses on 6 common conditions referred to as “marker
conditions.” These marker conditions include Sleep diseases, Problems with eating and feeding,
Incontinence, confusion, evidence of falls, and skin breakdown. These marker conditions provide
the image of the overall health conditions of the aged and provide the guidelines on health care
services that they need (Fulmer et al., 2012). The assessment can be done regularly to prevent
and treat these common markers.
This paper involves my assessment process with a client Mr. Peter. Peter is 82 years old
married to Irene. He presented to the emergency department in Monash Medical center, where I
work as a gerontology nurse. The client looked old and weak, and one could tell he was in a poor
state of his health. The nurse took him to the gerontology department, where I provide
assessment for older clients who visit the hospital while in the poor state of their health.
. He had a complicated medical history, including frequent falls and Stroke.

CLINICAL PSYCHOLOGE AND GERONTOLOGY 2
Interview Process
After the patient recovered, I introduced myself, welcomed him, and ordered him for an
interview. The interview aimed to assess the six conditions that are included in Fulmer SPICES
(Fulmer et al., 2012). The first question that I asked him is whether he slept well last night. With
signs of confusion, he said he had slept well. The next question was whether he had had any
issue with eating, chewing, or swallowing. While struggling to answer me, he said that he always
enjoys eating but sometimes feels nausea and vomiting after eating. While answering my
questions, I could see he was trembling and had difficulties in understanding my question. I
could see his trouble in seeing in one on one with both eyes. I asked him to stand to relax and
feel at home. His legs and arms were trembling and noticed his left leg had pain which he could
not withstand. He told me his leg had injured because of his last fall, which happened last night
at home. I asked him whether he had problems with his skin and said yes. His arms had reddened
skin and could see his sudden numbness on his arms, legs, and his face.
After the interviewing process, I could summarize the results based on Fulmer SPICES
assessment. The results of the client’s risk factors to falls after Fulmer SPICES assessment
include:
-Weak muscles in arms and in legs due to low blood pressure and dehydration
-Poor balance as a result of pain, impaired mobility and unstable gait
-Fainting and dizziness as a result of slow and irregular heart rate
-Vision and hearing problems as a result of glaucoma and depth perception
-Memory loss and confusion

CLINICAL PSYCHOLOGE AND GERONTOLOGY 3
Problem Identification
From the interviewing process, I could understand that he had no issue with the sleep
disorder, no problem with eating and chewing, but sometimes he could be disturbed with
vomiting after immediately after eating. With the use of Fulmer SPICES, I could identify that the
client had skin breakdown, evidence of falls, and sometimes was confused (Fulmer et al., 2012).
After looking at these signs and symptoms, I would guess that Mr. Peter could be suffering from
Stroke. I allowed the client to for MRI checkup, which confirmed the patient indeed was
suffering from a stroke.
Stroke is one of the common disorders in older adults. Its signs and symptoms include a
weak muscle that leads to issues difficult in walking, instability, paralysis in one side, and issues
with coordination. Other signs and symptoms include visual problems like sudden visual loss,
double vision, and blurred vision (Fulmer, 2007). The whole body may look frail, difficulty in
speaking, numbness, and difficulty in swallowing, which might be as a result of nausea and
vomiting.
After identification, I knew what next is to develop a care plan that can help him recover the
issues of eating, confusion, skin breakdown, falls, and from a stroke. Besides, I could understand
that if these conditions are not intervened, the client can develop other problems such as
problems of sleeping, Incontinence issues, among other conditions that are common to geriatric
patients. The experience that I had with the SPICES was amazing since it helped me to be able to
identify the problems that My Peter had. After appreciating the results that I got from SPICES
assessment, next was to develop a care plan that would focus on the daily assessment of these
acute and chronic conditions (Fulmer, 2007).

CLINICAL PSYCHOLOGE AND GERONTOLOGY 4
Research and Interventions
Some of the best practices that I can consider for the care plan for falls is vitamin D
supplementation, recommend the client to have balanced training using mechanical apparatus
and multifactorial interventions (Fulmer, 2007). Other best practices which are geared towards
the prevention of falls include providing physiotherapy in sub-acute wards, educating the client
to be aware of his falls risk and teaching him some of the risk reduction strategies that he may
take to reduce the risk of falling. There are various research studies that have provided solid
evidence that Vitamin D supplementation, balanced training, provision of physiotherapy,
education, multifactorial programs and multifactorial interventions as effective in reducing the
rate of falls (Datan & Lohmann, 2013).
Nursing intervention to risk factors that are linked to falls will be geared towards restoring as
much blood flow as possible. Restoring more blood flow will minimize cellular death or cellular
damage (Brown, 2013). The management measures will include controlling the blood pressure,
regulating intracranial pressure, doing invasive procedures, and reversing anticoagulants.
Physical, occupational, and speech therapy will also be crucial in reducing the risk factors of
falls (Fulmer, 2007).
Evidence for physical interventions linked to walking is increasingly being used in the stroke
recovery process. Such interventions are mostly linked to physical therapy and fitness
interventions. Mixed training is understood to improve walking ability and balance. Besides,
cardiovascular fitness training involving walking improves exercise ability, particularly after
stroke (Borenstein et al., 2016).

CLINICAL PSYCHOLOGE AND GERONTOLOGY 5
A study was carried out that involved 17 trials of 1297 patients who had risks of falls (Datan
& Lohmann, 2013). The main aim of the study was to find out the effectiveness and safety of
Circuit class therapy in prevention of risk factors that are associated with falls. The study
demonstrated that CCT was superior and had significant benefits in reducing the risks of falls.
This indicates that CCT is effective in improving and reducing the risk factors that are linked to
falls like in the case of Mr. Peter.
Conclusion
Falls by older people in nursing care facilities and hospitals are common events that are
linked with considerable mortality and morbidity. The incidences of falls in nursing health care
settings are reported to be about four times that in the community. Some of the common risk
factors of falls include weak muscles, foot problems, vision and hearing problems, confusion and
memory loss. This demonstrates the need for early identification and on admission for these risk
factors before they intensify. SPICES are an essential tool that can guide a care nurse in
providing and improving care for older patients (Aronow et al., 2014). It guides and focuses on
the daily assessment of acute and chronic conditions that are affecting older people. Besides, it
assesses the risk factors for falls and provides the way forward for nursing intervention.

CLINICAL PSYCHOLOGE AND GERONTOLOGY 6
References
Aronow, H. U., Borenstein, J., Haus, F., Braunstein, G. D., & Bolton, L. B. (2014). Validating
SPICES as a screening tool for frailty risks among hospitalized older adults. Nursing
research and practice, 2014.
Borenstein, J. E., Aronow, H. U., Bolton, L. B., Dimalanta, M. I., Chan, E., Palmer, K., ... &
Braunstein, G. D. (2016). Identification and team-based interprofessional management of
hospitalized vulnerable older adults. Nursing outlook, 64(2), 137-145.
Brown-O'Hara, T. (2013). Geriatric syndromes and their implications for
nursing. Nursing2018, 43(1), 1-3.
Datan, N., & Lohmann, N. (Eds.). (2013). Transitions of aging. Elsevier.
Fulmer, T., 2007. How to try this: Fulmer SPICES. AJN The American Journal of
Nursing, 107(10), pp.40-48.
Fulmer, T., Greenberg, S. A., & Wallace, M. (2012). Fulmer SPICES: An overall assessment
tool for older adults. Nursing, 102, 62.

CLINICAL PSYCHOLOGE AND GERONTOLOGY 7
Appendix
Interview Questions
ME: Mr. Peter, Did you sleep well last night?
Client: Yes I did, I always enjoy sleeping very much.
Me: Okay, have you had issues with eating, chewing or swallowing
Client: Yes, sometimes I do, but I think the problem is as a result of nausea and vomiting
Me: It seems you can’t walk straight, are you having pain
Client: Yes, my left leg is in deep pain
Me: How often do you experience fall
Client: Frequently, most when I am going to toilet or bathroom.
Me: Any other issue that you might be having
Client: I always feel very weak
Me: Okay, we will care for these risks factors of fall. We will intervene on your health situations
before it becomes severe.
Client: I will appreciate for your help
Me: It is our responsibility to ensure every patient with risks of falls like you is provided with
care.