Background of the Study
The elderly population, particularly individuals aged 65 and above, exhibit a greater prevalence of falls compared to other age groups. Three million older adults are treated for falls in emergency units annually, depicting the issue’s gravity in healthcare settings. Two qualitative research studies dedicated to investigating this healthcare issue include; Davenport, Cameron, Samson, Sri-On, and Liu (2020) and Najafpour, Godarzi, Arab, and Yaseri (2019). The complexity of healthcare needs in geriatric care increases the prevalence of the issue in primary nursing care; thus, there is a need to integrate specific fall risk interventions.
In 2015, medical costs associated with elderly patient fall exceeded $50 billion, where the largest portion was used to cater for expenses related to fall injuries. According to research, 20% of older adult falls result in serious injuries such as head injuries and broken bones. Older adults’ falls affect their quality of life, such as lack of outdoor exploration due to the risk of repeated falls. The research by Davenport et al. (2020) aimed to scrutinize the degree of knowledge in emergency departments regarding fall prevention interventions among elderly patients. The study research question includes the difference between the level of knowledge and implementation of geriatric emergency department guidelines designed to reduce the frequency of falls among the older adult population. Najafpour et al. (2019) explored the risk factors for falls in a hospital setting. The study research question examines the association between risk factors among fallers in comparison to non-fallers.
Evaluation of PICOT Question
The PICOT question explores the efficacy level of patient-centered intervention methods in reducing the rate of geriatric patient fall. According to Davenport et al. (2020), the reduction in fall rates should focus on prevention techniques aimed at determining the risk of falls in older adults. The geriatric fall prevention guidelines should entail the regular screening of patients to ensure a personalized driven approach. In addition, the fall prevention knowledge in the emergency departments is crucial in determining the prevalence of falls among elderly patients due to the frequency of geriatric patients in the department.
The research study by (Najafpour et al. (2019) explores the correlation between risk factors and the prevalence of falls among elderly patients. The risk factors analyzed include both intrinsic factors such as gender, age, and musculoskeletal and extrinsic factors such as the health system’s failure. In addition, the prevalence of falls is attributed to the history of medication and modifiable clinical characteristics of patients. The comparison groups in Davenport et al. (2020) article include older adults aged 65 and above. In contrast, Najafpour et al. (2019) generalized the comparison groups since the controls comprised adults with higher fall risk.
Methods of Study
Qualitative research methods were utilized since their findings are easily applicable to nursing care practices. The study by Davenport et al. (2020) used phenomenological research through a semi-structured qualitative survey regarding the knowledge, attitudes, and behaviors of emergency department providers regarding the issue of elderly falls. The study was conducted anonymously among emergency providers, including residents and physicians at a tertiary center in the U.S. The tertiary center was chosen due to its high attendance of geriatric patients, where 25% are aged 65 and above. The research also entailed the use of Redcap, which is an electronic data capture tool. The research study by Najafpour (2019) used a systematic review and metaanalysis through cases and control groups to determine the fall risk factors among elderly patients. The research involved the investigation of 24,000 patients. There were 185 cases recruited into the study, all of who had a falling incident at the hospital. In addition, the control group consisted of 1141 patients who had a high risk of falling according to the Morse Fall Scale.
The literature is based on peer-reviewed journal articles accessible through PubMed and National Center for Biotechnology Information sites. The reports relied on research conducted between 2016 and 2017. The research article by Davenport et al. (2020) states its limitation since its study was done in only one emergency department setting; thus, the results cannot be generalized. In addition, the response rate was 75% indicating loss of opinion and input. However, the article by Najafpour et al. (2019) does not indicate its limitations but implies the authors have no competing interests. The phonological research advantage is its abundance of data, but the data is limited due to its low credibility. The benefit of a systematic review and metaanalysis is its increased number of observations and its unbiased findings. The disadvantages of systematic review and metaanalysis include selecting studies, loss of information, and inappropriate subgroup analyses.
Results of the Study
The results of the research by Davenport et al. (2020) reveal that emergency department providers lack adequate knowledge regarding the interventions to prevent future falls among older adults. However, the providers understand the importance of fall prevention in the geriatric population, but the gap between knowledge and practice affects the prevalence of falls. The results also reveal low compliance with the geriatric emergency department guidelines since there is a lack of information regarding fall epidemiology. The lack of sufficient knowledge is mainly due to inconsistency in residency training leading to failure of fall interventions among the older adults population. In addition, there is a lack of standardization regarding the most appropriate screening tool to use in the emergency department. There is no single screening tool certified for use based on ease of usage. The study recommends improving residency training among the providers to determine the elderly population that would benefit the most from screening interventions. In addition, more research is required to limit the disconnection between medical practice and what providers regard as critical assessment among the patients.
The research by Najafpour et al. (2019) indicates patient-related factors and hospital settings that increase fall prevalence. The patient-related fall risk factors include prolonged stay, visual impairment, and balance difficulties due to musculoskeletal dysfunction. However, the study indicated no correlation between the prevalence of falling and the demographic variables such as age and gender. Patients’ fall history also determines the level of risk regarding repeated falls. The primary activities that aggravate the risk of older adults falling are walking and bathroom use. The study recommends interventions such as scheduled toilet visits and frequent nurse visitation to older adult wards. Medications such as sedatives, anticonvulsants, and diabetic medication increased the risk of patient falls. The study recommends patient monitoring after treatment and modification of terms and time of dosage.
Ethical Considerations
The research study participants comprised of humans thus are subject to ethical considerations through the Institutional Review Board (IRB). The IRB reviews research studies to ensure conformity to federal guidelines. The IRB approved both studies. The central ethical considerations include; informed consent, conditions for withdrawal from the research, privacy concerns, and protection of the patients. Both study groups provided participants with written consent papers, and no participant was coerced to participate in the study. Patient privacy was ensured through the absence of a paper trail since no names were included in the research.
