Falls in the Elderly
As individuals become older, they become more vulnerable and susceptible to diseases, illnesses, and chronic conditions. The body undergoes numerous changes that affect the ability of the body to defend and protect itself from multiple causes of harm. In the United States, one of the health problems affecting the majority of the elderly population is falling. It is approximated that more than 30 per cent of the elderly population experiences at least one incidence of falling each year (Ozen & Demir, 2020). Minor injuries, which are non-fatal, caused by falls, include cuts, bruises, and fractures. Major injuries that prove to fatal include brain and spinal injuries (Abraham & Cimino-Fiallos, 2019). This capstone project aims at studying falls among the elderly population and identifying the most effective intervention to reduce and prevent falls in the same patient population.
The incidence of falls, especially multiple falls, increases both the physical and social needs required by the elderly population. Chronic illnesses and conditions increase the risk of falls among this population as they act as mediating factors. They increase the frequency of incidence of the falls. For example, arthritis is one of the major factors that increase the risk of falls in an elderly patient. Arthritis affects individuals walking and makes standing very strenuous (Abraham & Cimino-Fiallos, 2019). Other chronic conditions and medical history that increase the risk of falls include diabetes, stroke, chronic kidney disease (CKD), vitamin D deficiency, and depression (Florence et al., 2018). These chronic conditions contribute to first-time falling and recurrent incidences of falling. Risk factors associated with falls include age above 65 years, being male compared to being female, belonging to the white race/ethnicity, and a history of falls or various health conditions as mentioned above (Abraham & Cimino-Fiallos, 2019). Other medical diagnoses that contribute to falls in the elderly include higher body mass index (BMI), anemia, dementia, impaired hearing or vision, neuropathy, and recent hospital discharge (Florence et al., 2018). Alcohol use and abuse also increase the risk of falls in the specific patient population. Moreover, the most important factors when considering falls in the elderly is their overall health status which determines their quality of life.
The Spirit of Inquiry Ignited
Falls in the elderly threatens the independence and safety of the affected individuals. According to the U.S. Centers for Disease Control and Prevention (CDC), more than 2.8 million injuries treated in emergency departments annually are caused by falls (“Falls prevention facts,” 2018). These include about 900,000 hospitalizations and nearly 30,000 deaths every year (“Falls prevention facts,” 2018). The CDC also records that one in every four Americans 65 years and above falls each year (“Falls prevention facts,” 2018). When these statistics are broken down, it translates to an older adult being treated in the emergency room every 11 seconds and an older adult dying as a result of a falls every 19 minutes (“Falls prevention facts,” 2018). Falls, whether they cause injuries or not, have a huge impact on the life led by these individuals. Elderly individuals develop a severe fear of falling, and this results in reduced activities and social engagements, all of which are important for their health and well-being. Additionally, lack of/reduced activities and social engagements cause depression, feelings of loneliness and helplessness, and social isolation (Abraham & Cimino-Fiallos, 2019).
Economically, falls generate huge health and personal costs. In the year 2015 alone, the total cost of treating and managing injuries caused by falls was an estimated 50 billion U.S. dollars (Florence et al., 2018). As much as Medicaid and Medicare took care of 75 per cent of these costs (9 billion and 29 billion respectively), it is still an enormous amount of health care costs (Florence et al., 2018). These costs could be significantly reduced as invested in another health care crisis/issue that needs more resources. Worse still, the costs associated with falls in the elderly patient population was expected to go over 65 billion U.S. dollars by this year (Florence et al., 2018). The elderly population in America is growing larger by the day, especially with the aging of the “boomer” generation (Abraham & Cimino-Fiallos, 2019). The incidence of falls in the elderly can be reduced and prevented with the early implementation of effective interventions. Effective interventions include clinical-community partnerships, evidence-based falls prevention programs, and lifestyle modifications.
PICOT Question
In elderly patients above 65 years old experiencing falls (P), what is the effectiveness of exercise therapy (I) compared to no use of exercise therapy (C) in prevention and reduction of the rates of injuries resulted by falls (O) in a period of six months (T)?
Search Strategy
As health care providers, it is essential to not only apply evidence-based practices but to be equipped with the necessary research skills. In total, six databases were used to find the available articles on the effectiveness of exercises and exercise therapy as an intervention for reducing and preventing falls in the elderly. The South University Library was the most user-friendly and resourceful compared to the other search databases. It was easy to modify and narrow down the searches both at basic and advanced levels. The information and search results were readily available—the S.U. Library allowed the option of searching using the specific PICO question and yielded precise results. This was a feature that most of the other databases lacked. The TRIP database was the other search database that also offered the option of searching using the PICO question. This database was also very user-friendly apart from the fact that a “Pro” membership was required to access parts of the search options and features. The Dynamed database was simply structured, making it very easy to use. The data and information provided were comprehensive and broad. However, it was limited in the modification features that could be applied. The keywords used to search included “falls in the elderly/ elderly patients” “elderly patients, exercise therapy or no exercise therapy” and “reducing and preventing injuries from falls.” [AND] and [OR] were used to improve the searches conducted.
Critical Appraisal of the Evidence Performed
Many researchers have conducted research studies conducted to determine the efficacy of exercise therapy in reducing and preventing falls in the elderly. For one, Gawler et al. (2016) conducted a study to explore how effective exercise programs that are home-based were in minimizing and preventing falls in the elderly. The researchers compared home-based exercise programs with those that are group-based. The sample comprised of older adults 65 years and above (Gawler et al., 2016). As a person grows old, the body ages and becomes frail. The body also becomes more susceptible to chronic diseases and conditions, has reduced mobility and balance. These factors predispose the older adults to the incidence of at least one fall, with most experiencing multiple falls. This research observed and recorded that there was a considerable alleviation of the incidence of falls in both the intervention and comparison groups. The exercise programs caused improvement in balance, increased blood flow throughout the body, and strengthened muscles and bones in the participants (Gawler et al., 2016).
Liu et al. (2017) analyzed 23 randomized controlled trials (RCTs) that used either resistance strength exercises or multimodal exercises to reduce falls in the elderly. The RCTs underwent both meta-analysis and systematic review as the primary research designs. The findings of the research show that both of the exercises are effective in reducing falls in the elderly population. This is especially for adults 75 years and above (Liu et al., 2017). Both exercise improve muscle strength and balance when standing still. Additionally, the researchers found that multimodal exercises improved dynamic standing balance, gait speed, and chair stand (Liu et al., 2017). Problems with balance, mobility, and reduced muscle strength significantly increase the risk of falling. Improving these aspects not only reduces the risk of falls but promotes the health status and well-being of the patient.
Evidence Integrated with Clinical Expertise and Patient Preferences to Inform a Decision and Practice Change Implemented
Research Design and Sample Size
The primary research designs that will be used in this project were systematic review and meta-analysis. A total of four articles will be reviewed to determine the efficacy of exercise therapy and exercise programs in reducing and preventing the incidence of falls in the patient population in focus (Burton et al., 2015). Three of the four articles to be used will use Random Controlled Trials. The other one will be a pilot study that utilized a pre-test/post-test design.
Sample Strategy
The four articles will be screened through three stages. The first stage will be through the inclusion and exclusion criteria. The second stage will involve full screening based on the article’s abstract and a full article screening. The last stage will involve an assessment of the quality of the methodology used through the risk of bias tool, the Cochrane Collaboration’s (Burton et al., 2015).
Stakeholders
Key stakeholders in this project will include nurses who will assist with the monitoring and evaluation of the patients, and physiotherapists who will help in implementing the exercise therapy. The educators, instructors, and administrators of the learning and health care institution will also be key stakeholders in various engagements. Additionally, as the project will be requiring the participation of elderly patients, their families will be instrumental stakeholders.
Limitations
The major limitation identified for this project is the risk of bias unaccounted for in the articles selected. All necessary measures will be taken to prevent this. They include a three-stage screening and use of Cochrane Collaboration tool.
Measuring Tools and Instruments
Cochrane Collaboration, a tool used to check the risk of bias, will be utilized. During data collection, a PRISMA checklist will be used to ensure that the findings will be reported systematically.
Data Analysis
The studies will be categorized and described according to the type of intervention used, compliance to the intervention in terms of participation, the features and appropriateness of the study/research design used, the efficacy of the interventions applied, and the overall quality of the study conducted (Burton et al., 2015).
Outcome Evaluated
This capstone project will find exercise therapy as an effective intervention in reducing the risk of falls in the elderly (Burton et al., 2015). The baseline data will focus on different physical activities and programs and how they minimize the occurrence of falls. The project will also ascertain that exercise programs, like evidence-based prevention programs, are critical in preventing the risk of falls in older adults 65 years and above. As subsequent objectives, the project will show that exercising, as an intervention activity, increases blood flow in the body, improves balance and posture, and improves the overall quality of life. Moreover, exercise therapy delays and prevents the onset and incidence of other ailments and chronic conditions that come with aging.
Project Dissemination
The process of disseminating this project will require the participation and collaboration of all key stakeholders. The purpose of the dissemination process will be to determine whether or not the purpose, objectives, and goals of the project will have been achieved. Additionally, the dissemination process will determine the extent to which the project’s purpose and objectives will have been achieved. Stakeholders will come together and engage in a process where they will identify further opportunities presented in this project. They will determine the importance of the project to the clinical practice and offer opportunities for improvement. The strengths and limitations of the current project will also be identified. Finally, the project will be documented and submitted to be published, shared, and stored.
Conclusion
In the U.S. today, the population of the elderly continues to swell up at an increasing rate. With the increase in this population, the incidence and frequency of falls are expected to more than triple. There is an urgent need to come up with interventions that will ensure that they remain healthy for a long while. Effective interventions will also ensure that the health care cost associated with falls in the elderly is reduced and controlled. Falls in the elderly is a burden to not only the patients, but also their family members, as caregivers, and the health care system. Exercise programs and exercise therapy as interventions are effective ways of reducing and preventing falls among this vulnerable population.
References
Abraham, M. K., & Cimino-Fiallos, N. (2019, December 16). Falls in the elderly: Causes, injuries, and management. Retrieved from https://reference.medscape.com/slideshow/falls-in-the-elderly-6012395
Burton, E., Cavalheri, V., Adams, R., Oakley Browne, C., Bovery-Spencer, P., Fenton, A., … Hill, K. (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, 421. doi:10.2147/cia.s71691
Falls prevention facts. (2018, June 4). Retrieved from https://www.ncoa.org/news/resources-for-reporters/get-the-facts/falls-prevention-facts/
Florence, C. S., Bergen, G., Atherly, A., Burns, E., Stevens, J., & Drake, C. (2018). Medical costs of fatal and Non-fatal falls in older adults. Journal of the American Geriatrics Society, 66(4), 693-698. doi:10.1111/jgs.15304
Gawler, S., Skelton, D., Dinan-Young, S., Masud, T., Morris, R., Griffin, M., … Iliffe, S. (2016). Reducing falls among older people in general practice: The ProAct65+ exercise intervention trial. Archives of Gerontology and Geriatrics, 67, 46-54. doi:10.1016/j.archger.2016.06.019
Jin, J. (2018). Prevention of falls in older adults. Jama, 319(16), 1734-1734. Doi:10.1001/jama.2018
Liu, C., Chang, W., Araujo de Carvalho, I., Savage, K. E., Radford, L. W., & Amuthavalli Thiyagarajan, J. (2017). Effects of physical exercise in older adults with reduced physical capacity. International Journal of Rehabilitation Research, 40(4), 303-314. doi:10.1097/mrr.0000000000000249
Ozen, B., & Demir, G. (2020). A Determinant for Falls and Risk Factors in the Elderly: Daytime Sleepiness. International Journal of Caring Sciences, 13(1), 732–737.