Geriatric considerations - Safe and secure environments: Nursing

Safe and secure environments can improve the health and well-being of older adults while providing an opportunity to age in place and live independently, safely, and comfortably.

As the nurse, you'll identify risks to safe and secure environments and promote safety for older adults by addressing risks associated with fires, firearms, transportation, and heat- and cold-related injuries.

First let’s discuss fires, which can cause burns and smoke inhalation injuries.

For older adults, there are several factors that can increase the risk of injury during a fire, including impaired mobility, sensory impairments, slower decision-making or response time, and certain preexisting health conditions.

Now, fires can be caused by factors that include inadequate home repairs or maintenance, use of space heaters, and smoking materials, like cigarettes.

For example, a fire can originate from a poorly maintained fireplace, a space heater placed next to flammable materials, or from falling asleep while smoking in bed.

As the nurse, you’ll promote fire safety by ensuring your patient has well-maintained smoke alarms in every room.

They should also have access to a fire extinguisher and know how to use it.

If your patient smokes, instruct them to avoid smoking in bed or in a chair when there’s a possibility of falling asleep; to avoid smoking after taking medications that may cause drowsiness; and to dispose of all cigarette butts in a nonflammable container away from other items.

Lastly, you can help your patient develop and practice a fire escape plan.

Now, firearms are a significant cause of injury and death in older adults. Gun ownership is typically higher in older adults when compared to other populations. At the same time, older adults experience a higher rate of altered mood, memory, cognition, and function. These factors greatly increase the risk of unintentional firearm injuries which can occur from improper firearm care or handling; and intentional firearm injuries and suicide due to depression.

As the nurse, you can use the 5 Ls of firearm safety to evaluate your patient’s gun safety practices: Locked, Loaded, Little children, feeling Low, and Learned owner.

Locked refers to whether a firearm is present in the home and if it’s kept in a locked and secure place; Loaded refers to whether the firearm is loaded with ammunition;

Little children refers to whether there are young children in the home that could access the firearm;

and feeling Low refers to the presence of mood changes like feeling depressed or having thoughts of self-harm.

Lastly, Learned owner refers to whether the firearm owner has had formal firearm safety training.

Based on your assessment, you can promote firearm safety by providing information on proper firearm storage, like keeping the firearm unloaded in a locked cabinet or gun safe where young children can’t access it.

If your patient has signs or symptoms of a mood change, collaborate with the healthcare provider and social worker for referral for counseling services, as indicated.