The Strategy Of The Prevention Of Falls Among Older Patients Research Essay

The Strategy Of The Prevention Of Falls Among Older Patients Research Essay

Prevention of Falls among Elderly Patients
Every year one of the three adults aged 65 years and above falls. Majority of these falls result in moderate to severe injuries leading to the emergency department (ED) visits and hospitalizations. The falls have led to rising of the death rate at an alarming rate for the past decade. In the United States, falls present a substantial economic burden to the country’s healthcare services. In 2013, Medicare incurred $34 billion direct medical costs for the incidents directly related to falls. These costs are predicted to inflate due to the increase in fall-related injuries and boomers age. There are numerous strategies for reducing falls including risk assessment, exercise, hip protectors, mineral enhancing agents, physical modifications, and risk factor screening among others. The paper comprehensively describes the evidence-based strategies for preventing falls among older adults.The Strategy Of The Prevention Of Falls Among Older Patients Research Essay

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Summary of Fall-Prevention in Adults
Prospective studies conducted on community-dwelling adults have established that more than 30% of the older adults fall at least once every year and the likelihood of falling increases steeply with age (Crandall et al., 2016). Around 10% of adults who fall sustain serious injuries like femur fracture associated with numerous adverse effects including reductions in mobility, decreased physical fitness, and increased risk of early death, limited social interactions, and lower quality of life. The available statistics show that 2.5 million non-fatal falls were treated in the ED in 2013 and more than 734, 000 of the patients were admitted in hospitals (Crandall et al., 2016). Falls result in prohibitive spending with fatal and non-fatal fall-related costs summing up to $ 23.3 billion in 2008 and $34 billion in 2013 (Crandall et al., 2016).
One of the most critical issues of global concern is the prevention of falls. There exist various fall-prevention strategies such as risk assessment, exercise, hip protectors, mineral enhancing agents, physical modifications, and risk factor screening among others (Crandall et al., 2016). Only a few of the above evidence-based strategies have been adopted owing to lack of data translating these techniques from research to practice and gaps in the current guidelines concerning methods of prescribing appropriate interventions or integrating and implementing them into daily clinical and community practices (Li et al., 2016).
Identification and Significance of the Problem
The problem identified in this case is the occurrence of patient falls among older adults. The problem is significant in healthcare settings due to some reasons. First, falls present one of the leading causes of morbidity and disability among older adults. Approximately 12-42% of the clients who fall will suffer from a fall-related injury with around 20% demanding for medical attention and 10% nursing a fracture that is secondary to osteoporosis (Kwan & Straus, 2014). Second, falls are associated with significant costs including increased patient care costs, length of hospital stay, and liability. Research shows that a patient nursing serious fall-related injury will spend an additional average of 6-12 days in the hospital and will incur higher healthcare costs amounting $13, 316 as compared to their counterparts after adjusting for non-clinical and clinical confounders. Also, patient falls result in increased spending for Medicaid and Medicare. For instance, these organizations incurred a cost of $ 23.3 billion in 2008 with this amount increasing to $34 billion in 2013 (Crandall et al., 2016). These costs are incredibly high forcing insurance companies to raise their premiums to cater to the rising costs of healthcare.The Strategy Of The Prevention Of Falls Among Older Patients Research Essay

PICO Questions
The PICO questions are the driving force for evidence-based practice (EBP). EBP would be meaningless were there no questions. The main focus of EBP questions is on practical, real-world problem and issues. For instance, the PICO questions in this context will center on fall-prevention strategies among elderly patients. Some of the PICO questions formulated in this research are:
1. In fall-prone patients aged 65 years and above, what is the effect of mineral-enhancing agents in preventing fall-related injuries?
2. In fall-prone patients aged 65 years and above, what is the impact of using hip protectors in the prevention of falls?
3. In fall-prone patients aged 65 years and above, what is the effect of implementing physical exercise programs in the prevention of falls?
4. In fall-prone patients aged 65 years and above, what is the impact of physical environment modifications in the prevention of falls?
5. In fall-prone patients aged 65 years and above, what is the effect of risk factor screening in the prevention of falls?
The research questions were analyzed for feasibility using a variety of methods. For instance, a pilot or proof of concept was employed in assessing the feasibility of the PICO questions which significantly assisted in determining the viability and avoiding the waste of intellectual energy and resources. These strategies were initially pilot tested using a small population size, and a biostatistician was consulted who significantly helped in selecting a less costly approach.The Strategy Of The Prevention Of Falls Among Older Patients Research Essay

Preliminary PICO Question
Using the pilot testing and consultations from the biostatistician, the most feasible strategy were found to be physical exercise programs. As a result, the preliminary PICO question is “In fall-prone patients aged 65 years and above, what is the effect of implementing physical exercise programs in the prevention of falls?” PICO is an acronym for the patient/problem, intervention, comparison, and outcome. In the above question:
Patient- fall-prone patients aged 65 years and above
Intervention- implementation of physical exercise programs
Comparison- patients who have not undergone through physical exercise programs.
Outcome- is the decrease in fall-related injuries.
Keywords for Literature Search
The data used for the research was searched from widely recognized databases that include Medline, Google Scholar, and EMBASE. Some of the keywords used for the search include exercise, falls, evidence-based practice, older adults, fall-risk assessment, seniors, resistance training, postural stability, Tai Chi, Taiji, and accidental falls.The Strategy Of The Prevention Of Falls Among Older Patients Research Essay
Literature Review
Detection of the risk factors for falls significantly assists in implementing effective and specifically tailored interventions for preventing falls (Gschwind et al., 2013). Regularly conducted objective, valid, and reliable risk assessment protocols for falls help in the identification of people at risk hence recommending and optimizing prevention strategies. The most common modifiable intrinsic risk factors for falls are gait instabilities, muscle weakness, and balance deficits. These factors can be modified by exercise programs (Gschwind et al., 2013).
Tai Chi is a slow motion, a low-impact exercise which is a perfect addition to the daily routines of older adults. According to Hu et al. (2016), Tai Chi is a suitable exercise for preventing accidental falls among elderly patients. The practice includes strengthening exercises, a walking program, and standing balance exercises (Suttanon et al., 2013).
Inconsistencies and Contradictions in the Literature
Many of the fall prevention strategies including exercises have been shown to produce positive effects in decreasing the incidences of falls among older adults. However, some of the studies fail to document how the fall prevention strategies can be incorporated in the community services. In the systematic review of Tai Chi, numerous studies were found to document the usefulness of Tai Chi on preventing falls, but some studies reported negative feelings producing contradicting results.
Preliminary Conclusion
The evidence on the effectiveness of exercise programs provides strong support for a change in practice. The exercise programs incorporating strength, endurance, and balance helps in reducing falls among the elderly population with some studies reporting as high as 32% reduction in incidences of falls. Some physical exercises such as the limb strength exercises substantially enhance flexor muscle and knee extensor strength, ankle dorsiflexion and bone mineral density reducing the risk of falling.The Strategy Of The Prevention Of Falls Among Older Patients Research Essay

Literature Review Summary Table
Citation Objectives of the study Study Design Study Setting and study population Data Collection Methods Study Findings
Gschwind, Y. J., Kressig, R. W., Lacroix, A., Muehlbauer, T., Pfenninger, B., & Granacher, U. (2013). A best practice fall prevention exercise program to improve balance, strength/power, and psychosocial health in older adults: study protocol for a randomized controlled trial. BMC Geriatrics, 13(1), 105. To examine the effects of the fall prevention program developed by an interdisciplinary panel on measuring balance, body composition, psychosocial well-being, power/strength, cognition, and falls self-efficacy in older adults. Randomized Controlled Trial (RCT) University of Potsdam, Germany
The study population consists of older adults aged 65-80 years Data collected using bioelectrical impedance analysis system and through questionnaires. Home-based exercises and multiple-component group exercises reduce the rate of falls and fall risks.
Shier, V., Trieu, E., & Ganz, D. A. (2016). Implementing exercise programs to prevent falls: A
Systematic descriptive review. Injury epidemiology, 3(1), 16. To detail findings from various reviews and then concentrate on the impacts of integrating exercise programs for the prevention of falls Systematic descriptive review Literature search from Web of Science and Google Scholar The findings from the reviews showed that exercise programs are useful in decreasing falls among community-dwelling elders.The Strategy Of The Prevention Of Falls Among Older Patients Research Essay
Hu, Y. N., Chung, Y. J., Yu, H. K., Chen, Y. C., Tsai, C. T., & Hu, G. C. (2016). Effect of Tai Chi exercise on fall prevention in older adults: systematic review and meta-analysis of randomized controlled trials. International Journal of Gerontology, 10(3), 131-136. To investigate the current evidence on the effectiveness of the Tai Chi intervention on preventing falls Meta-analysis and systematic review Literature search from Medline, EMBASE, PubMed, and Cochrane Library. Tai Chi was found effective in reducing fall incidences in older adults
Burton, E., Cavalheri, V., Adams, R., Browne, C. O., Bovery-Spencer, P., Fenton, A. M., … & Hill, K. D. (2015). Effectiveness of exercise programs to reduce falls in older people with dementia living in the community: a systematic review and meta-analysis. Clinical interventions in aging, 10, 421. To examine the effectiveness of fall programs in reducing falls in elderly patients with dementia. Systematic review and meta-analysis Literature search from widely recognized databases such as Medline, PubMed, EMBASE, CINAHL, Psych Info, and Scopus. The results of the study suggested that exercise programs significantly assists in reducing falls among older people with dementia residing in a community.The Strategy Of The Prevention Of Falls Among Older Patients Research Essay
Lach, H. W., Harrison, B. E., & Phongphanngam, S. (2016). Falls and fall prevention in older adults with early-stage dementia: an integrative review. Research in gerontological nursing, 10(3), 139-148. To present a literature review on the risk factors for falls and interventions that help in the prevention of dementia or mild and cognitive impairment (MCI), and examine the implications for future research and practice. An integrative review Literature search from CINAHL, OVID, EMBASE, SCOPUS, Medline, and Psych Info The experimental group that received cognitive training with exercise recorded significant improvements in gait speed and balance.

Restating the PICO question
What are the impacts of using physical exercise programs in the reduction of incidences of falls among elderly patients aged 65 years and above?
Summary of Findings from Articles used for Literature Review
The study by Gschwind et al. (2013) found that home-based and multiple-component exercises significantly reduces the rate of falls and fall risks. The study found that muscle power exercises coupled with lower loads and faster movement velocities enhance the activities of daily living (ADL) and produce superior effects as compared to traditional progressive resistance training (Gschwind et al., 2013). According to the results of the study by Gschwind et al. (2013), balance exercises are more suitable for adults who have experienced a fall in the past. The study by Hu et al. (2016) established that Tai Chi potentially reduces the risks of falls among the elderly population. However, training variables may significantly affect the effectiveness of the Tai Chi intervention (Hu et al., 2016). Suttanon et al., 2013) established that exercise programs are feasible and aid in improving balance and mobility performance in older adults living with Alzheimer’s disease. The Strategy Of The Prevention Of Falls Among Older Patients Research Essay
The above studies support the effectiveness of exercise programs in decreasing the incidences of falls in the older people. This is because some physical exercises such as Tai Chi have the capability of enhancing flexor muscle and knee extensor strength and bone mineral density making a person healthy and consequently eliminating the risks of falls (Hu et al., 2016). Also, Suttanon et al. (2013) assert that exercises improve the balance and mobility of older adults which eliminates the likelihood of falling.
How exercise programs contribute to better outcomes and the adverse outcomes that might arise from failing to use the EBP
Exercise programs such as Tai Chi, step, strength, and stretching among others have proved useful in eliminating the risks of falls among community-based older adults. These programs improve coordination, balance, muscular strength, agility, mobility, and flexibility, therefore, making the client strong and healthy (Tiedemann et al., 2013). Furthermore, these strategies enhance weight-wearing bones and substantially improve functionality which decreases falls by lowering the mortality rates. The exercise techniques improve the quality of life through reducing falls and their consequences. Additionally, these methods are also useful in lowering the cost of healthcare. Exercise programs increase the degree of independence and the capacity to perform ADL through the elimination of falls (Tiedemann et al., 2013). Failure to implement exercise programs is associated with numerous adverse effects such as increased risk of falls which lead to increase in morbidity and mortality rates, increased healthcare costs, limitation in the ADLs, and increased dependency.The Strategy Of The Prevention Of Falls Among Older Patients Research Essay
Strategy for Disseminating the EBP
There are numerous ways of disseminating the information on the benefits of exercise programs in alleviating falls among the elderly population. Some of these include using social media groups such as Facebook, Twitter, WhatsApp, and Linked In (Eccles et al., 2018). The advantage of using these channels lies in the fact that the information can reach a large number of people at once. Besides, one can also print and distribute health circulars among healthcare professionals in the clinical setting.The Strategy Of The Prevention Of Falls Among Older Patients Research Essay
Implementing the Evidence-Based Practice
The healthcare professionals have a role to play in implementing exercise programs among older adults. To encourage patients to participate in exercise programs I would highlight a range of benefits associated with the strategies in addition to prevention of falls. Some of these include improving the quality of life, participation in ADLs, physical functioning, decrease in healthcare costs, and the decrease in morbidity and mortality rates (Uusi-Rasi et al., 2015). I will tout these advantages to the patients because they are motivated to participate in EBP by a wide range of perceived benefits such as improved health, independence, mood, and enjoyment. The exercise programs can be implemented in both home-based and class-based settings. I will consider tradeoffs between patient adherence and program intensity when implementing the exercises. This is because longer duration and more frequent exercises are essential in decreasing fall rates but have the potential to reduce the adherence and willingness to participate.The Strategy Of The Prevention Of Falls Among Older Patients Research Essay
Conclusion
There are various strategies for reducing falls. Some of these are a risk assessment, exercise, hip protectors, mineral enhancing agents, physical modifications, and risk factor screening. Feasibility analysis shows that the use of exercises are viable and do not lead to the waste of resources and intellectual energy as compared to the other techniques. The exercise programs can either be implemented in home-based or class-based settings. Physical exercises such as Tai Chi improve flexor muscle and knee extensor strength and bone mineral density hence assisting in fall prevention. Moreover, exercise programs like Tai Chi, step, strength, and stretching improve coordination, balance, muscular strength, agility, mobility, and flexibility, therefore, making the patient regain energy and health. Healthcare professionals are thus encouraged to implement the exercise programs since they are useful in decreasing falls which subsequently leads to increase in morbidity and mortality rates, increased independence and ADLs, and lower cost of the healthcare.The Strategy Of The Prevention Of Falls Among Older Patients Research Essay

Reasons Why the Study Was Conducted
The purpose of the study was to establish which evidence-based fall prevention practices are suitable for adoption in Primary Care for older adults between 65-95 years.
Sample Size
The study sample subjects were outpatients who were aged between 65-95 years of age, who had a documented history of a fall within a period of 12 months and needed medical treatment. The sample size was 116 patients who also met the eligibility criteria in terms of age and a previous history of a fall.
Whether the instruments of the Study Variables are Reliable and Defined Clearly
The independent variable for the study were clearly defined that is; falls and fall-related injuries within the last 12 months, patients who attended primary care clinic visits within the last 12 months with fall related injuries and the existence of co-morbidities which served as risk factors for experiencing falls or fall-related injuries. The Strategy Of The Prevention Of Falls Among Older Patients Research Essay
How Data was analyzed
Data analysis was done through the use of chi-square and independent t-tests and later by the use of SPSS software version 22.0.
Presence of Any Unusual Events during the Study
During the study, since data was collected by the use of medical records, a total of 256 patients were identified. However, 140 were ineligible for various reasons. Firs, 99 patients had no visits to the clinic within 3 months after their fall, 37 were documented to have dementia and 4 were non-ambulatory. For these reasons, the ineligibility of the 140 subjects left the study with only 116 as the sample size.
How the Results Fit In With Previous Research in This Area
In reference to previous observational research of the management of falls in the primary care practice, two studies use physician self-reports and two others use medical reviews. The performance of conducting risk assessments and familiarizing those at risk with the environment was 50% or less. This study found out that some risk factors associated with falls such as gait and balance visual acuity and postural hypotension were assessed more than twice with health providers prescribing the intervention of familiarizing the patient with the environment more frequently for the fall risks that were identified.The Strategy Of The Prevention Of Falls Among Older Patients Research Essay
The present study also demonstrates much frequent interventions in comparison to prior studies due to the inclusion of geriatric specialists in the study sample of primary care providers and the presence of the geriatric specialists in the clinical settings and nursing homes. In this study, Geriatric specialists performed risk assessments and emphasized on familiarizing patients with the environment more often in comparison to nurses and general internists. However, this is not a surprising observation since geriatric specialists undergo training to address multifactorial issues in health and falls are a well-recognized geriatric syndrome.
The Implications of the Research for Clinical Practice
This study emphasizes on the use of various evidence, based practices the prevention of falls among older adults aged 65-95 years. The most initial approach by nurses, geriatric specialists, general internists and other healthcare providers should be to conduct as risk assessment before prescribing a suitable intervention measure depending on patient’s social, physical, emotional, and environmental aspects. Key attention should be given to increasing messaging on public health on falls and their preventability, increasing attention to high risk medications, performing home safety evaluations and the use of structured visit note templates since it captures detailed information.The Strategy Of The Prevention Of Falls Among Older Patients Research Essay

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The problem of falls among older patients is one of the most important issues in the contemporary health care setting because patients at the old age face the high risk of falls, while effects of falls are extremely dangerous for the older population. In such a situation, the elaboration of effective strategies aiming at the prevention of falls among older patients is essential for the maintenance of health of patients and the improvement of the quality of services delivered by the nursing staff to older patients. The project reveals the fact that there are multiple causes of falls among older patients, which may be divided into two groups: external and internal factors that cause falls among older patients. External factors include the health care facilities and environment, including poor lighting, slippery falls and other factors. Internal factors raise the high risk of falls among the older population include the physical condition of patients, history of falls, and other factors that affect the older population. The current project focuses on the elaboration of recommendations that can help to improve the quality of nursing care and prevent the risk of falls among older patients. In this regard, the core of the strategy of falls prevention among older patients is the creation of comfortable health care environment, close work with patients and the implementation of the falls prevention plan, which involves the communication of the plan to patients and their family members. At the same time, the project suggests the detailed evaluation of the proposed strategy to assess its effectiveness and, in case of the high effectiveness of the strategy, introduce it en mass.The Strategy Of The Prevention Of Falls Among Older Patients Research Essay

Today, the problem of falls among older patients is one of the most important issues in the contemporary health care setting because patients at the old age face the high risk of falls, while effects of falls are extremely dangerous for the older population. In such a situation, the elaboration of effective strategies aiming at the prevention of falls among older patients is essential for the maintenance of health of patients and the improvement of the quality of services delivered by the nursing staff to older patients. The Strategy Of The Prevention Of Falls Among Older Patients Research Essay

Existing studies () reveal the fact that older patients are vulnerable to the high risk of falls, especially patients with falls history. The awareness of nurses of the risk of falls among older patients is particularly important because nurses work closely with clients and spend more time with patients than other health care professionals. The involvement of nurses in the provision of nursing care implies their responsibility for the prevention of falls among older patients. They should be aware of risks, which their patients face and, thus, they can help to prevent falls among their patients. Current studies () reveal the considerable, negative impact of falls on the health of patients because older patients are more vulnerable to the risk of fractures and severe injuries caused by falls, including morbidity and mortality of patients.The Strategy Of The Prevention Of Falls Among Older Patients Research Essay

The project reveals the fact that there are multiple causes of falls among older patients, which may be divided into two groups: external and internal factors that cause falls among older patients. External factors include the health care facilities and environment, including poor lighting, slippery falls and other factors. The poor health care setting increases the risk of falls but, at this point, the high risk emerges, when nurses are unaware of the risk of falls among older patients and their consequences. For example, a slippery floor can be a cause of falls among patients and it is within the scope of nurses’ responsibility to minimize such risks and prevent threats of falls. However, many researchers () insist that nurses often remain unaware of or underestimate the risk of falls among older patients.The Strategy Of The Prevention Of Falls Among Older Patients Research Essay

Internal factors raise the high risk of falls among the older population include the physical condition of patients, history of falls, and other factors that affect the older population. Internal factors can have a considerable impact on older patients and increase the risk of falls among older patients. For example, many patients suffer from visual impairment and other health problems that increase the risk of falls. In such a way, the risk of falls is driven by the physical condition of patients. Moreover, many patients suffer from the lack of awareness of the risk of falls, as is the case of many nurses. In such a way, the elimination of internal factors that cause falls among patients will help to decrease the risk of falls.The Strategy Of The Prevention Of Falls Among Older Patients Research Essay

The core of the strategy of falls prevention among older patients is the creation of comfortable health care environment, close work with patients and the implementation of the falls prevention plan, which involves the communication of the plan to patients and their family members. The prevention of the risk of falls through the increase of awareness of patients and communication of the importance of falls prevention is an essential element of the fall prevention strategy. The prevention of falls among older patients involves the awareness of key stakeholders of the risk of falls that means that health care professionals and nurses are not the only stakeholders, who should be aware of the risk of falls, but also patients and their family members. The support of family members is very important for older patients because they are not always under the supervision of health care professionals. This is why their family members should also be aware of the risk of falls and know how to prevent falls among older patients not only in the health care environment but also and mainly at home, where patients cannot always count on the support of nurses. The proposed strategy involves the communication of falls prevention plan to patients and their family members, while nurses should make the proposed strategy a part of their regular, professional performance.The Strategy Of The Prevention Of Falls Among Older Patients Research Essay

At the same time, the project suggests the detailed evaluation of the proposed strategy to assess its effectiveness and, in case of the high effectiveness of the strategy, introduce it en mass. The evaluation of the proposed strategy is essential to determine whether the strategy is effective or not. Therefore, the effective implementation of the strategy opens the way to the further implementation of the strategy in the contemporary health care setting. On the other hand, the failure or drawbacks of the proposed strategy imply that the strategy needs changes. The Strategy Of The Prevention Of Falls Among Older Patients Research Essay

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