Background of the Study
Individuals aged 65 years and over exhibit a greater prevalence of the problem of falls that mostly result in injuries. The combination of healthcare needs and risks involved in elderly falls often increases the complexity of the problem in this special patient population in primary nursing care. This phenomenon has been the focus of a significant number of qualitative clinical research studies. Two studies conducted a qualitative study to investigate this clinical problem as well as its underlying mechanisms; (Bunn, Dickinson, Simpson, Narayanan, Humphrey, Griffiths, and Victor, 2014) and (Chan, Yeung, Wong, Lam, Chung, Luk, and Law, 2015). The significance of the research entails the costs of treatment and the number of people affected.
Three million older adults are treated in emergency units for fall injuries each year where one in five falls causes hazardous injuries such as broken bones and head injury. In 2015, medical costs associated with elderly falls exceeded $50 billion where 75% of the costs were borne by Medicare and Medicaid. The fear of falling also affects older people’s quality of life as they shun being physically active since the chances of falling again doubles after the first fall. The research by (Bunn et al, 2014) aimed at a qualitative exploration of nurse’s perspectives concerning elderly falls in adults with mental health problems and the effectiveness of fall prevention interventions. The study by (Chan et al, 2015) explored the prevention methods in cognitively impaired people such as physical exercise. The research questions explored by the study include; What is the prevalence of falls in elderly persons? What are the clinical ramifications falling? How best can the problem be reduced?
Evidence of Support to the PICOT Question
The PICOT question entails how the use of patient-centered intervention techniques can lead to the reduction of elderly falls. According to (Bunn et al, 2014), mentally impaired patients require enhanced patient care to improve results. The implementation of the method in elderly patients will thus focus on guiding older adults on the indicators of falls to curb the prevalence of falls before they happen. Identification of the indicators of falls would improve the patient’s outcome since the nurses approach the condition with a personalized solution.
In the research study by (Chan et al, 2015), older adults with cognitive impairment are guided on the use of physical exercises as an intervention to prevent falls. Physical exercise intervention is conducted in a controlled environment to reduce the risk of aggravated muscle contractions. The physical therapist thus uses a patient-centered approach through effective communication to assess the health conditions and recommend specific exercises. The interventions in the articles and PICOT question are similar. The interventions used in the articles reflect on a patient-centered approach since the medical assessment and prognosis are personalized to conform to each patient’s needs. The comparison groups in the articles include elderly patients with mental issues and cognitive impairments. However, there is a difference between the comparison groups where the PICOT question generalizes the population and the research articles differentiate the population into smaller units.
Methods of Study
Qualitative research methods were used as they help in understanding causes, opinions, trends, and developing a hypothesis regarding the issue of older adults falling. In the study by (Bunn et al, 2014), the authors used phenomenological research through semi-structured qualitative interviews to investigate the concern of elderly falls. The focus was on the population of patients in nursing and residential homes through 14 studies to explore the opinions of medical practitioners. The research employed the use of electronic data on falls and related injuries. In the research study by (Chan et al, 2015), the authors used grounded theory research through qualitative and quantitative studies from the literature that were relevant to their study and the focus of the research on elderly falling. The research setting was a health care institution. The study interviewed 781 elderly participants affected by the issue of falling. The study sought to obtain their experiences regarding their daily work and how their work could have affected their personal lives. That would partially provide data establishing the cause and solution to the problem.
The literature used is largely based on peer-reviewed journal articles that are accessible in public databases such as PubMed and Google Scholar. There were no date restrictions, a criterion accepted within the qualitative criterion article currency. However, the articles used relied on research conducted in 2011 and updated in the two consecutive years, 2012 and 2013. The chosen articles are notably relevant to the topic of research. Although the authors referenced a wide scope of relevant peer-reviewed articles, there is no indication of the prospective limitations of the studies used. The articles’ literature review relied upon adequate data and information on the subject of falling and its consequences on the elderly population to build logical intervention and prevention techniques. The phenomenological research advantage is its richness in natural data but also its research has low credibility. The grounded theory research method’s benefit is that the researcher’s bias does not affect the outcome of the study, however, it uses large data which is difficult to manage.
Results of the Study
The result of the research by (Bunn et al, 2014) shows that multifactorial interventions reduce the susceptibility of falling. The interventions include sensory stimulation through exercises, provision of medications, and supervision. Increased awareness of the potential symptoms of falls also reduces the risk of falls as the older adults inform caregivers of changes in their health. The evidence provided shows that falls in older adults are multifactorial where several factors contribute to the risk of falling. For the implementation of the interventions, a list of triggers and practical strategies to address the issue is initiated to reduce the frequency of falling.
The result of the research by (Chan et al, 2015), reveals that physical exercise is a precursor to stronger postures which reduces the risk of falls among elderly adults. However, the possibility of falls is not entirely scrapped, thus the exercises focus on the balance and strength of the individual. Physical exercises are used to improve balance, gait, and coordination (Cadore, Rodríguez-Mañas, Sinclair, and Izquierdo, 2013). The findings however do not explain the frequency and number of exercises needed to effectively prevent falls. The implications of the studies to nursing practice entail the need to understand the interventions relating to each type of risk including health-based risks and environmental risks and their interventions. Health-based risks include chronic illness-specific to an individual while environmental risks include improper use of canes. The interventions used should match the exposure to the specific type of risk.
The studies used qualitative research through the use of human participants to collect data. The usage of human participants brings forth various domains of ethical considerations through the Institutional Review Board IRB. IRB reviews research proposals to ensure federal guidelines are followed. The studies were approved by the IRB. The primary ethical considerations include; privacy, informed consent, protection from harm, and withdrawal from research. In both studies, the participants were provided with written information and consented to participate in the research. Patient privacy is ensured by having no specific institutions indicated that leave a trail tracing back to the participants. The research ensured participant privacy as they withheld names and institutions used. However, there is little information revealing the withdrawal of participants from the research.
Bunn, F., Dickinson, A., Simpson, C., Narayanan, V., Humphrey, D., Griffiths, C., … & Victor, C. (2014). Preventing falls among older people with mental health problems: a systematic review. BMC nursing, 13(1), 4.
Cadore, E. L., Rodríguez-Mañas, L., Sinclair, A., & Izquierdo, M. (2013). Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review. Rejuvenation Research, 16(2), 105-114.
Chan, W. C., Yeung, J. W. F., Wong, C. S. M., Lam, L. C. W., Chung, K. F., Luk, J. K. H., … & Law, A. C. K. (2015). Efficacy of physical exercise in preventing falls in older adults with cognitive impairment: a systematic review and meta-analysis. Journal of the American Medical Directors Association, 16(2), 149-154.
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