Prevention of Falls among the Elderly.

Posted: November 2nd, 2022

Prevention of Falls among the Elderly.

Levels of evidence are classified into five hierarchical divisions. Evidence in each level is dependent on the applicability, validity and quality of the methodological design as applied to patient care. The strength of the recommendations made by a research study is given by the above decisions. The Canadian Task Force on the Periodic Health Examination described these levels through a 1979 report which sought to develop recommendations based on medical literature evidence. According to the report, the effectiveness of an intervention is determined by the system of rating developed by the authors. This paper seeks to examine three research articles on fall prevention among the elderly and discuss their levels of evidence.Prevention of Falls among the Elderly.

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Article One
Cruz, S., Carvalho, L., & Lopes, E. (2016). Improving the evaluation of risk of fall through clinical supervision: an evidence. Procedia-Social and Behavioral Sciences, 217, 382-388.
This article presents a quantitative research on the fall risks. It seeks to provide evidence on the quality and safety of nursing through the improvement of provider skills and implementation of clinical supervision. The research was conducted between March and May 2014wit a convenient participating sample of 132 participants. The research is guided by nursing evaluation perimeters and concludes that prioritization of hospital fall prevention is essential in reducing safety risks. Moreover, Cruz, Carvalho and Lopes (2016) note that clinical supervision supports the nursing team, raises awareness and reflection and also ensures the safety and quality of patient care.This quantitative research is an original study by Cruz, Carvalho and Lopes conducted in 2016. It focuses on determining the impact of the implementation of healthcare quality indicator and clinical supervision model on hospital fall prevention.Prevention of Falls among the Elderly.
The level of evidence presented in this article is Level III. This is because; it is a quantitative, descriptive and correlational study that uses questionnaires from the convenient samples. The samples were also not randomly selected but instead were selected based on the presence of a patient within the site of study. As such, this is a controlled trial with no randomization that falls under the level III evidence category. Level III evidence contains evidences acquired from well-designed controlled trials without randomization that is quasi-experimental. Cruz, Carvalho and Lopes (2016) selected the convenience sample of 132 participants who were admitted within the study period. The research also sought to determine whether there was a statistically significant relationship between age,sex, physical restraint and interventionswith fall risks in hospitalized patients and the results were quantitatively presented.Prevention of Falls among the Elderly.
Article 2
Ott, L. D. (2018). The impact of implementing a fall prevention educational session for community‐dwelling physical therapy patients. Nursing open, 5(4), 567-574.
This article by Ott provide a research about the implementation of education session interventions as an intervention for fall prevention among the community dwelling individuals undergoing physical therapy. The aim of the study is to evaluate the impact of educational settings on use of fall prevention interventions, fall risk knowledge and the number of falls experienced in the community among the physical therapy geriatrics.
The study evidence falls under Level III evidence. This is because; it is a characteristic of both qualitative and quantitative research employing a mixed method study design. The pilot study is a well-designed controlled trial without randomization. It is a pretest–posttest quasi‐experimental research design that uses questionnaires to evaluate the outcome measures of the number of falls sustained for 60 days post the educational sessions, number of participants implementing fall prevention techniques and fall risk knowledge (Ott, 2018). Moreover the sampling was convenient and non-random based on the geriatric attending physical therapy at the time of study.Prevention of Falls among the Elderly.
Article 3
Lee, H. H., & Jung, S. H. (2017). Prediction of post-stroke falls by quantitative assessment of balance. Annals of rehabilitation medicine, 41(3), 339.
This article presents an examination an evaluation of characteristics of the postural instability in stroke patients and alsogives a prediction model of post-stroke falls.The research uses participants with first eve stroke cases and postural instability parameters such as postural sway velocity (PSV) and the weight bearing asymmetry (WBA). Lee and Jung (2017), statistically assesses the participants using fall related questionnaires and telephone interviews to obtain the results.
The level of evidence in this quantitative study is Level II. The research is a controlled trial employing convenient sample of 71 participants derived from the 231 individuals who had experienced first time stroke cases. The participants are selected based on a designed criterion that ensured that they all were first time stroke patients admitted for rehabilitation therapy between August 2011 and December 2015 in the Boramae Medical Center (Lee & Jung, 2017).The results present statistical evidence that the participants of the study increase the postural sway and weight bearing asymmetry. The research is analyzed though multivariable logistic regression analysis and Statistical Package for the Social Sciences (SPSS) and presented in graph form for the tests conducted (Lee & Jung, 2017). As such, the research study uses a pretest–posttest quasi‐experimental research design.Prevention of Falls among the Elderly.

Levels of Evidence

Levels of evidence are classified into five hierarchical divisions. Evidence in each level is dependent on the applicability, validity and quality of the methodological design as applied to patient care. The strength of the recommendations made by a research study is given by the above decisions. The Canadian Task Force on the Periodic Health Examination described these levels through a 1979 report which sought to develop recommendations based on medical literature evidence. According to the report, the effectiveness of an intervention is determined by the system of rating developed by the authors. This paper seeks to examine three research articles on fall prevention among the elderly and discuss their levels of evidence.

Article One

Choi, S. D., Guo, L., Kang, D., & Xiong, S. (2017). Exergame technology and interactive interventions for elderly fall prevention: a systematic literature review. Applied ergonomics, 65, 570-581.

This article presents a systematic review of literature materials regarding exergaming and its applications for elderly fall prevention. The study sought to determine the cognitive and physical function impacts of exergame interventions on the elderly population. According to the study, Nintendo Wii is the most common device for exergaming while Xbox Kinect is reported to be the second during the prevention of falls (Choi, Guo, Kang & Xiong, 2017). Consequently, it concludes that fall prevention exergame-based interventions improve the cognitive and physical functions of the elderly compared to conventional physical therapy.Prevention of Falls among the Elderly.

The level of evidence in this article is Level III. This level of evidence contains data collected from quasi-experimental, the well-designed controlled trials without randomization. Quasi experimental research is dependent on the manipulation of independent variables without the assignment of random order of conditions or conditions to participants. They have experimental units, treatments outcomes and measures even though they lack randomization. In this case, the article is based on multiple literature sources which are selected according to their relevance to the study and not randomized selection. Most of the articles used employ the quasi-experimental design and pre-post control group design as well as mixed methods. These designs have been employed in the research to study the impacts of exergames on the prevention of falls among the elderly and hence the use of quasi experimental design makes the article fall under level III of evidence (Choi, Guo, Kang & Xiong, 2017).

Article 2

Carande-Kulis, V., Stevens, J. A., Florence, C. S., Beattie, B. L., & Arias, I. (2015). A cost–benefit analysis of three older adult fall prevention interventions. Journal of safety research, 52, 65-70.

This article is about the cost benefits associated with fall prevention in adults. It examines three older adults and seeks to identify the effective, feasible community-based fall interventions with a positive return on investment. The results of the study concluded that fall interventions have positive net benefits.In general, the paper recommendsthe use of the Otago Exercise Program, Tai chi: Moving for Better Balance and stepping on interventions for prevention of falls in older adults (Carande-Kulis et al., 2015).Prevention of Falls among the Elderly.

The evidence of the study falls under the level I class according to John Hopkins Nursing evidence-based practice levels of evidence. This level is characterized by experimental studies, randomized controlled trial (RCT),and systematic review of RCTs, with or without meta-analysis. The study is experimental inthat it follows three adults wo are highly vulnerable to frequent falls and analysis the effects of interventions employed in their cases with regard to the economic value. On the other hand, it employs a randomized control trial .On the effectiveness of intervention results. A comparison of the national data estimates helped determine the medical cost of using the interventions.

Article 3

Tricco, A. C., Thomas, S. M., Veroniki, A. A., Hamid, J. S., Cogo, E., Strifler, L., … & Riva, J. J. (2017). Comparisons of interventions for preventing falls in older adults: a systematic review and meta-analysis. Jama, 318(17), 1687-1699.

This article compares the usual care of older adults to the integration of combined exercise and vision assessment and treatment;exercise; environmental assessment and modification, vision assessment and treatment and combined exercise; combined clinic-level quality improvement strategies, calcium supplementation, and vitamin D supplementation (Tricco et al., 2017). The results of the study conclude that the use of interventions in healthcare reduces the risks of injurious falls when compared to the usual care. However, the choices of interventions rely on the patient and the values of the caregiver as well as preferences.Prevention of Falls among the Elderly.

The article provides level III evidence. This is because; it is a non-experimental study that employs a combination of randomized clinical trials (RCTs) and systematic reviews with meta-analysis. RCTs were used to examine fall prevention interventions for the geriatric population aged 65 years and above in acute care and community settings (Tricco et al., 2017). The comparison measures included placebo, fall prevention interventions and usual care. The systematic review followed a guidance statement developed by the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) (Tricco et al., 2017). The results were briefly described and extended through a network meta-analysis that ranked all the available interventions for fall prevention and their combinations.Prevention of Falls among the Elderly.