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Research Critiques and PICOT Question: Final Draft
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Introduction
The literature reviewed shows there is an increasing trend in falls and fall-related injuries
among the elderly, which has a significant impact on nursing practice. The morbidity data
confirms an increasing case among the elderly which is a domain in nursing practice. The higher-
risk group in fall injuries is the older population and the most affected are the ones living
independently in the community which is a significant public health problem (Wellecke
et al.,
2022). Falls cause serious injuries, decreased quality of life, higher healthcare expenditures, and
even death in this vulnerable group. Older persons in the community have an increased risk of
falls due to many circumstances. Aging-related changes in balance and gait, chronic health
disorders (such as osteoporosis and cardiovascular disease), polypharmacy, environmental risks,
and cognitive impairments are also contributors (Zhang
et al.,
2022). Therefore, healthcare
providers such as nurses play a key role in the prevention, diagnosis, treatment, or rehabilitative
care of the vulnerable older population.
The provision of care to older patients with fall injuries is multi-disciplinary. Healthcare
practitioners, community groups, and family caregivers must all work together to find a solution
to this problem. However, the literature reviewed, places nurses as the essential primary,
secondary, and tertiary care providers in the management of falls and fall-related injuries among
elderly individuals. The nurses are charged with identifying older persons at risk for falls by
conducting thorough evaluations and implementing treatments supported by scientific evidence.
All possible therapies include exercise programs to boost strength and balance, medication
evaluations to reduce polypharmacy, environmental adjustments, and patient education on fall
prevention methods (Zhang et al., 2022).
However, among the nurses, the assessment,
evaluation, and implementation of the interventions for fall injuries among the elderly in the
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community setting is still not clear. Therefore, it is important to implement effective fall
prevention strategies. The paper aims to critically assess the danger of falls and fall-related
injuries among older adults aged 65 years and above and review research studies that address the
nursing practice problem.
PICOT Question
In
(P)
community-dwelling adults aged 65 years and above
(I),
does the implementation
of a fall prevention program that includes exercise, home safety assessments, and educational
sessions better strategy, when
(C)
compared to no structured fall prevention program (O) result
in a reduction in the rate of falls and fall-related injuries
(T)?
The PICOT question investigates
the effectiveness of implementing a comprehensive fall prevention program or no structured fall
prevention program in reducing falls and injuries among older adults.
Background Of the Studies
In the paper, four peer-reviewed studies Lurie
et al.
(2020), Sturnieks
et al.
(2023), Zhang
et al
. (2022) and Wellecke
et al.
(2022) were reviewed which proved relevant and reliable in fall
and fall-related injuries among the elderly adults. Lurie
et al.
(2020) investigated the rising cases
of falls and fall-related injuries among the elderly, particularly the ones living independently in
the community. The researchers examined the efficiency of Surface Perturbation Training (SPT)
and traditional exercise programs in the prevention of falls and fall-related injuries among older
adults. The researchers evaluated the SPT's impact on postural control and balance in the elderly
population. The study identified effective strategies for stopping falls among older individuals
who live independently (Lurie
et al.
, 2020).
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Sturnieks
et al.
(2023) investigated fall prevention among community-dwelling older
individuals by combining exergaming with seated computer brain training exercises. It aimed to
reduce fall rates and examine the impact on cognitive function, physical abilities, fear of falling,
and quality of life.
Sturnieks
et al.
(2023) provided potential interventions for preventing falls
among elderly individuals living independently at home. Both studies have provided valuable
insights into fall prevention strategies explicitly tailored to older adults' needs while residing in
the community setting.
Zhang
et al
. (2022) and Wellecke
et al.
(2022) studies pinpoint the increasing cases of
falls and fall-related injuries among the aging population. Wellecke
et al.
(2022) investigated the
effectiveness of the housing accessibility design features, while Zhang
et al
. (2022) examined
through meta-analysis and systematic review the effectiveness of the programs preventing falls
for 10 years.
Support
The reviewed articles, provide relevant and reliable information on the effectiveness of
different interventions in preventing falls among older adults living in communities. Lurie
et al.
(2020) and Sturnieks
et al.
(2023) carried out their study in the same target group aged 65+ years
and who were living in the community The articles are relevant to the nursing practice problem
domain and can help understand how specific interventions impacted falls and fall-related
injuries. Sturnieks
et al.
(2023) explored combining exergame with settled computer brain
exercise to prevent falls among homes older individuals. Sturnieks
et al.
(2023) answer the
PICOT question by comparing this particular intervention to a no-structured fall prevention
program in reducing falls and related injury rates.
5
The research by Zhang
et al
. (2022) and Wellecke
et al.
(2022) verifies the impact of fall
prevention initiatives on reducing fall risk among elderly people in community settings. The
approaches adopted in the two research aligned with the PICOT framework. Remarkably, every
investigation confirmed a substantial decrease in the possibility of incidents within the
intervention firms. The results substantiate the potency of fall prevention programs in
minimizing the likelihood of mishaps due to falls in the elderly community.
Overall, these four articles provided research evidence on different interventions to
prevent falls among community-dwelling older individuals, contributing valuable information
towards addressing the PICOT question.
Interventions
The interventions and comparison groups used in the articles align closely with the
PICOT question. Lurie et al. (2020) and Sturnieks
et al.
(2023) carried out their study in the
same target group aged 65+ years and who were living in the community. However, the other
interventions to reduce the incidences of falls and related injuries differed among the scholars.
Lurie
et al.
(2020) compared Surface Perturbation Training (SPT) to traditional exercise
programs for fall prevention among older adults while Sturnieks
et al.
(2023) compared
combined exergame with seated computer brain training exercises to no structured fall
prevention program, similar to the examination of a fall prevention program versus no program.
Both studies provided relevant comparisons to address the PICOT question and explore the
effectiveness of different interventions compared to no structured fall prevention programs in
dropping falls and related damages among homes with older adults.
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The findings of Zhang
et al
. (2022) recommended the introduction of elements such as
level and even walking routes and less hazardous environments by removing elements such as
garbage. Zhang
et al
. (2022) demonstrate how vital it is for older people who live in cities with
many people to pay attention to the structured surroundings and the strategies and routines
individuals use to reduce their risk of falling. On the other hand, Wellecke
et al.
(2022)
highlighted the importance of preemptively making ready-for-domestic adjustments, such as
bolstering bathroom partitions to accommodate the integration of grab bars post-construction
Methods of the Studies
The paper presents the methods used for the qualitative articles reviewed. Zhang
et al.
(2022) interviewed fifty area adults in-depth and face-to-face in semi-structured interviews. The
conversations were transcribed word for word, and a theme analysis was done on them. The
findings fell into five main groups: fall risks and situations, fall results, fear of falling and its
effects, neighborhood setting, and fall avoidance practices and attitudes.
Wellecke
et al.
(2022) used a mixed-method approach in their research.
The survey
focused on a cross-sectional online survey to gather data from occupational therapists from
Australia over six weeks. During a six-week time frame, the survey measures demographic and
professional details, housing design elements, and home changes through three separate sections.
People can join through social media platforms or electronic messages from professional
networks. Besides, the employed approach offered several advantages, including gathering
information directly from participants and performing statistical analysis. Normalized questions
streamline the process of comparing and identifying consistent patterns and trends. This
technique's shortcoming stems from its dependence on participant-provided information, which
might contain mistakes or be influenced by personal perspectives.
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The quantitative studies employed the same technique for the randomization of the study
participants. The study by Lurie
et al.
(2020) used a rational, randomized, controlled trial design
with participants randomly assigned to the Surface Perturbation Training (SPT) group or the
control group receiving traditional exercise programs for fall prevention. During balance
exercises, SPT involved unpredictable movements on an unstable surface, while the control
group received standard practices. This intervention method provided a thorough experimental
design that minimized bias and increased internal validity. However, it could only partially
capture real-life situations as participants are trained on specific apparatuses rather than in their
usual environments. Furthermore, Sturnieks et al. (2023) conducted a 12-month study comparing
exergaming combined with seated computer brain training exercises to standard care for fall
prevention in older individuals. They collected multiple measures at different time points to
assess various outcomes, but this approach could only be possible for some participants due to
resource requirements.
Results
Compared to traditional exercise programs, Lurie
et al
. (2020) conducted a study to
assess the effectiveness of Surface Perturbation Training (SPT) in reducing falls among older
adults. The findings revealed that individuals who underwent SPT exhibited notable
improvements in postural control and balance, surpassing the results achieved by those who
followed conventional exercise routines.
The findings of Zhang
et al.
(2022) demonstrated how vital it is to make communities
safer (by introducing elements such as level and even walking routes) and less hazardous (by
removing elements such as garbage). The most recent research demonstrates how vital it is for
older people who live in cities with many people to pay attention to the structured surroundings
8
and the strategies and routines individuals use to reduce their risk of falling. On the other hand,
Wellecke
et al
. (2022) verified that the intervention corporations experienced a notably
diminished opportunity of falls compared to their manipulated organization's opposite numbers.
The quantitative results of the investigation highlighted the importance of preemptively making
ready-for-domestic adjustments, such as bolstering bathroom partitions to accommodate the
integration of grab bars post-construction
Implications for Nursing Practice
The implications of these studies are important for nursing practice It is evident in the
literature that nurses reduce falls and injuries by improving postural control and balance through
targeted exercises like SPT. Collaboration among various stakeholders, such as healthcare
professionals, community groups, family caregivers, and older individuals, was crucial for
successfully implementing fall prevention programs. Nurses were vital in facilitating this
collaboration and coordinating efforts to address falls among community-dwelling older adults.
Lastly, these studies emphasized the importance of evidence-based practice in fall prevention for
this population, emphasizing how incorporating these findings into nursing practice could
significantly reduce falls and improve overall well-being.
Ethical implication
The researchers demonstrated ethical practices by considering informed consent and
confidentiality. Informed consent ensures that individuals understand the study's purpose,
procedures, risks, and benefits before participating or declining (Xu et al., 2020). Confidentiality
protects participants' trust by ensuring their identities are not revealed or linked to their
responses. Lurie
et al.
(2020) obtained IRB approval before data collection, provided informed
9
consent information to participants, used de-identified data for analysis purposes, and
implemented strict protocols for data management. Similarly, Sturnieks
et al.
(2023) obtained
written informed consent following IRB guidelines and protected participant privacy through
secure storage on secured computers with no access granted to legal personnel involved in the
research activities. Both studies adhered to ethical principles by obtaining informed consent and
maintaining confidentiality throughout their trials.
Outcomes Comparison
The outcomes expected in the evidence-based practice change are in line with the
findings recommended by studies by Lurie
et al.
(2020), Sturnieks
et al.
(2023), Zhang
et al
.
(2022), and Wellecke
et al.
(2022). It is evident that implementing education sessions, home
safety assessments, and exercise correspondingly reduces falls and fall-related injuries among
community-dwelling older adults.
The research outcomes support the effectiveness of these
interventions in achieving the reduction of the danger of falls and fall-related injuries among
older adults aged 65 years and above.
Proposed Evidence-Based Practice Change
The final analysis has shown the link between fall and fall-related injuries among adults
above 60 years, the PICOT question, and the articles reviewed. Bolstering bathroom partitions,
removing hazardous elements, and incorporating Surface Perturbation Training (SPT) were
found to be vital in fall inhibition interventions for older adults living in the community The
review outcomes suggest that SPT could effectively enhance balance and reduce fall risks among
older individuals residing within their communities. Studies showed that incorporating specific
postural control and balance exercises and combining exergame with seated computer brain
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training exercises could significantly decrease fall rates among older individuals. This
intervention also improved cognitive functioning and overall quality of life.
Conclusion
The studies addressed the nursing practice problem of falls among older individuals in
communities. The studies evaluated different interventions for fall prevention and provided
valuable insights into participant experiences and engagement factors. These findings help
design practical strategies for preventing falls in older adults living independently at home.
Moreover, considering patients' perspectives was crucial when implementing interventions like
SPT or combined exergame/seated computer brain training programs for fall prevention in older
individuals. The studies help in understanding the experiences of community-dwelling older
adults concerned about maintaining independence and reducing risks associated with aging-
related changes in balance/gait or chronic health disorders. Besides, nurses could facilitate
collaboration to implement evidence-based approaches through evaluations, treatment plans,
medication assessments, environmental adjustments, and patient education on fall prevention
strategies.
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References
Lurie, J. D., Zagaria, A. B., Ellis, L., Pidgeon, D., Gill-Body, K. M., Burke, C., ... &
McDonough, C. M. (2020). Surface Perturbation Training to Prevent Falls in Older
Adults: A Highly Pragmatic, Randomized Controlled Trial. Physical Therapy, 100(7),
1153-1162.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7498164/#:~:text=At
%203%20months%2C%20the%20perturbation,0.78)%20compared%20with%20usual
%20treatment
.
Sturnieks, D. L., Hicks, C., Smith, N., Ratanapongleka, M., Menant, J. C., Turner, J., ... &
LORD, S. (2023). Smart±Step Exergame and Seated Computer Brain Training for
Preventing Falls in Community-Dwelling Older People: A 12-Month Randomized
Controlled Trial
https://www.researchgate.net/publication/370741235_smartstep_exergame_and_seated_c
omputer_brain_training_for_preventing_falls_in_community-
dwelling_older_people_a_12-month_randomised_controlled_trial
Wellecke, I., de Bruin, E. D., van der Hooft, T., & Zwakhalen, S. G. (2022). Effectiveness of fall
prevention programs for community-dwelling older adults: A systematic review and
meta-analysis. Journal of the American Geriatrics Society, 70(1), 191-202.
https://pubmed.ncbi.nlm.nih.gov/35292211/
Xu, A., Baysari, M. T., Stocker, S. L., Leow, L. J., Day, R. O., & Carland, J. E. (2020).
Researchers’ views on, and experiences with, the requirement to obtain informed consent
in research involving human participants: a qualitative study.
BMC Medical Ethics
,
21
(1),
1-11.
https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-020-00538-7
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Zhang, A., Zhou, Y., Li, C., Shi, Y., & He, Y. (2022). Effectiveness of fall prevention programs
for community-dwelling older adults: A systematic review and meta-analysis. Journal of
the American Medical Directors Association, 23(2), 252–263.
https://www.cambridge.org/core/journals/ageing-and-society/article/abs/qualitative
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