Elderly Fall Risks and Prevention

Introduction

The elderly individuals are those who are over the age of 60-65 years and as a result of their natural ageing process, it is seen that they have increased risk of experiencing falls in the community as well as in hospital settings. The key reason responsible for the elderly to experience falls is their chronic health condition such as dementia, heart diseases, low blood pressure and others. This is evident as patients with heart disease and low blood pressure experiences sudden dizziness, blackout or unconsciousness which makes them hard to get up while lying or sit properly in turn leading them prone to fall (Sammy et al. 2016; NHS, 2019). The inner ear health problem such as labyrinthitis or vertigo attack leads elderly individuals to experience falls as in this condition the vestibular system present in the inner part of the ear which acts to allow individuals to properly balance the body is damaged (Kamil et al. 2016). In addition, the study by Pi et al. (2015) informs that as a result of falls the elderly individuals experience hip injury and fractures in different parts of the body. This contributes to reduce their mobility and in some cases makes them bedridden. Thus, to avoid such consequences the study is being developed to understand the way effective strategies and actions, to those found in healthcare dissertation help, that are to be taken to reduce risk of falls in elderly individuals and promote their well-being.

Rationale of the study

The experience of falls and fractures are seen to be a common as well as serious health problem experienced by older individuals. In between 2017 to 2018 the Public Health Outcomes Framework informed that nearly 220, 1060 emergency hospital admission are made related to falls among elderly individuals who are above the age of 65 years. In addition, out of them the 146, 665 which are 66.6% of the total falls reported were elderly individuals who are above the age of 80 (GOV, 2019). Thus, the figures indicate that there is high risk of falls among elderly individuals with progress in age that is making them experience urgent hospital admissions. This issue of increased falls among the elderly is seen to be regarded as the 9th highest cause for disability-adjusted life years in 2013 in England (HCPA, 2018). Thus, the question has been asked so that the issue of disability and negative health condition experienced by adults as a result of falls can be avoided to ensure their well-being. Moreover, the unaddressed hazards of falls for the elderly in the home area have caused NHS England to bear the expense of £435 million. In addition, the fragility fracture among the elderly that is caused due to falls has led the NHS, UK to spend £4.4 billion in total (GOV, 2019). Thus, the question to understand ways for reducing falls among the elderly individuals have been asked so that effective precaution and strategies can be implemented to reduce the expenditure of NHS for the purpose. This is required so that the funds can be saved to be spent for treatment of more complex health condition.

Framing of Research Question

The PICO tool is to be used in the study to develop the research question. As asserted by Eriksen and Frandsen (2018), PICO tool informs a pattern that is to be followed for framing a proper research question so that it can help in developing answer for health-related query in executing an evidence-based study. The tool is frequently used for performing systematic review studies. As commented by Palumbo et al. (2015), the framing of a proper research question is essential which is directly relevant to the identified research problem and need to be phrased properly. This is because it would help the researcher to gather effective information based on the question to resolve the raised issue in the research. Thus, in this research, a proper research question is being framed with the help of PICO tool. The PICO stands for problem, intervention, control and outcome (Eriksen and Frandsen, 2018). In this study, the problem that is the main issue in the study is the risk of falls for elderly. The intervention which is the action to be taken in this study is ways of reducing the risk of falls for elderly individuals. There is no control group considered in the study and the study outcome which is the result for the research is reduced risk of falls for the elderly individuals to ensure their well-being. Therefore, the formulated research question for the study is: What are the ways of reducing risks of falls among elderly individuals to ensure their well-being? (Refer to Appendix 1)

Aim of the review

The review aims to identify ways of reducing falls for elderly individuals.

Objective of the review

To evaluate the ways of reducing risk of falls for the elderly individuals

Methodology

Research Strategy

The search strategy that is to be used for executing this study is systematic review. As mentioned by Tsuda (2017), systematic review includes synthesis and appraisal of information from research papers by using a clear and rigours method to summarise the information so that it assists to provide improved evidence which is important for effective clinical intervention. This informs that judgements are developed based on the collected evidence to inform recommendation and ways of resolving the raised problem in healthcare. As commented by López-Soto et al. (2015), benefit of using systematic review is that the conclusion developed for the study based on the evidence is reliable. This is because researchers select scientifically approved studies and previous evidence-based studies for collecting information that helps them to reduce error and biases in results that may be developed by them while personally executing the study. Moreover, systematic review helps the healthcare professional and clinical to have high-quality evidence for resolving a certain issue. As argued by Tricco et al. (2017), literature review strategy provides summarised general information regarding a topic. Thus, the strategy is not to be used as it does not provide detailed information required to resolve a raised problem in the topic.

Database and Search Terms

The electronic database is to be used in the review to gather evidence because online search of articles and journals helps the researcher to have opportunity of analysing and synthesising wide range of complex and updated data that are helpful in executing an enriched review (Lukaszyk et al. 2016). The databases which are to be used for the study include PubMed, CINAHL, Google Scholar, MEDLINE, etc. The keywords to search for data online are needed to be properly framed so that relevant articles, as well as journals, can be identified in executing the study. The search terms to be used in this review includes "elderly individuals", "reduce risk of falls of elderly at the hospital", "strategies to reduce fall risk for elderly in community settings” and others. In addition, the offline books and articles available in the library are to be examined for collecting information regarding the topic.

Inclusion and Exclusion Criteria

The inclusion criteria in a study mention the factors that are to be considered regarding the topic to execute the study whereas the exclusion criteria are the factors that are the be avoided in executing the study (Lusardi et al. 2017). In this review, the articles which are written in English, fully accessible, published after 2013, academic and contain information regarding the way to reduce risk of falls for elderly individuals are to be included in the study. However, the articles that are written in other languages except for English, only abstract available, non-academic and contains information for reducing falls among patients of all age groups are to be excluded. The articles written in English are to be included and others are excluded because the researcher has only knowledge about English language and thus the information written in other languages may not be understood by the person to be used in the study. The fully accessible articles are to be included because they would help the researcher to collect the detailed and relevant information required for executing this review. The articles after 2013 are to be selected because they are going to provide most current information avoid gathering of backdated information which may lower the validity of the study. The non-academic articles are to be included so that scientific and experiment based information can be used for executing the review in a proper way. (Refer to Appendix 2)

Results of Research Strategy

The study of Luk et al. (2015) informs that modification in the environment around the elderly is required in which the heights of beds are to be reduced and implementation of proper bed exist alarms and sensors are required. This is because lower height of bed would make elderly individual be in adequate range within the floor to stand properly reducing chances of falls due to their inability to stand on the floor that is not within their reach of bed after sitting up (Luk et al. 2015). The installation of bed alarms would indicate nurses and carers that the elderly are leaving their bed which would lead them to immediately go for assistance to ensure the elderly does not experience any falls (Luk et al. 2015). The fact is supported by the study of Lee et al. (2018) where it is mentioned that lower bed heights along with bed railings are appropriate to reduce risk of falls among the elderly. This is because it makes the elderly individuals stand properly on the floor.

In the study by de Andrade Mesquita et al. (2015), it is mentioned that involvement of the elderly in the exercise programs is effective to create reduction of falls as it leads the individuals to develop better balance. This is evident as in the study it is mentioned that 58 elderly women out of total 63 participants who were involved in exercise for neuromuscular facilitation and pilates exercise were found to show better balancing score compared to the individuals who were not involved in any exercise. Since exercise improves the muscle control efficiency of the elderly individuals it leads them to avoid falls due to lack of balance. In comparison, the study by Zhang et al. (2015), informs that improvement of vision of elderly by using improved lights in the surrounding with removal of floor mats, painting steps to make them vivid and installation of handle on the wall for holding is effective to reduce risk of falls. This is because providing better lights and painting of vivid steps would make elders aware of any hazard or obstacles in the surrounding making them avoid falls due to toppling down. In addition, removal of floor mats would help the elderly avoid fall due to slipping along with the installation of handle on the wall would make them use it for support, in turn, avoiding fall due to loss of balance (Luk et al. 2015).

The study by VAN and Mire (2017) highlighted multi-factorial intervention is required for reducing the risk of falls among elderly patients. According to the researcher, multi-factorial intervention would include exercise programs for the elderly to strength their gait, vitamin D supplements, proper medication, resolving vision problem and foot issues, improvement of surrounding environment and management of postural hypotension. Therefore, the facts presented by Luk et al. (2015), Lee et al. (2018) and de Andrade Mesquita et al. (2015) is mentioned by the VAN and Mire (2017) to be followed together to ensure proper reduction of falls among the elderly. The facts presented by the study is supported by Khalifa (2019) where the researcher mentioned that exercise therapy and development of surrounding environment (lower beds, rails and arms support, better flooring and passages) is required to reduce risk of falls for elderly in hospitals. However, in addition the study by Khalifa (2019) informed that medical condition of elderly (vision, balance, musculoskeletal) are to be treated properly, better education regarding way to reduce falls are to be provided to nurses and carers and technological interventions such as wearable devices, floor and room sensors are to be used for reducing risk of falls among the individuals. This is because in the study it is highlighted that vision problem makes the elderly unable to identify hazards and obstacles while walking or moving making them experience falls. The study mentioned that improvement of musculoskeletal features improves muscle coordination along with treatment of vestibular balance improves the balance of the body, vision and proprioception improves awareness of elderly about obstacles while walking, in turn, leading them to avoid falls.

The study Khalifa (2019) mentioned wearable technologies to be used to monitor patients for reducing falls. This is because monitoring the elderly patient's movement makes the carers or nurse become aware about when to provide assistance to the elderly so that the risk of falls can be prevented within the hospital. In comparison, the study of Bayen et al. (2017) informs that video monitoring of elderly patients in the hospital through installed cameras is effective to reduce incidences of falls. This is because in video monitoring the captured videos of patients are analysed to understand the nature of change in the surrounding environment and assistance to be provided to the elderly patients. Thus, accordingly changes are made in the hospital to reduce falls and it was seen that reduction in fall rates were captured with the change through the process in the hospital chosen in the study.

Quality Appraisal

The CASP tool is the commonly used quality appraisal tool for analysing different studies with the aim to help the researcher find and gather meaningful evidence which is to be applied in their clinical practice (Bourne et al. 2018). In this review, the CASP tool is to be used for quality appraisal of the articles selected to gather evidence regarding the topic. (Refer to Appendix 3)

Summary of findings

The main points from the papers reviewed in relation to the research question is that to reduce risk of falls among the elderly individuals they are to be provided low bed for sleeping and bed alarms are to be installed along with railings. This is because it would lead them be in reach within the floor to stand as well as call for help when required rather than personally moving which may make them prone to fall out of balance. The other papers indicated that vision improvement, treatment of vestibule balance and musculoskeletal issues, removal of floor mats, installation of handles on walls for support, video monitoring through cameras, wearable devices and others are to be implemented and used to reduce risk of falls for elderly. The theme which can be developed from the evidence collected is strategies for reduction of risk of falls among the elderly mainly in hospital settings.

Issues of Implementation

The PARIHS (Promotion Action on Research Implementation) framework informs that successfully implement the developed evidence in the practice is related with the nature of evidence, the context in which the change is to be implemented and mechanism through which the evidence is to be implemented for making change (Harvey and Kitson, 2015). Thus, the three factors to be considered are evidence, context and facilitation of mechanism to create change. The evidence indicates to examine the nature as well as the strength of evidence and its efficiency to be implemented (Pfadenhauer et al. 2015). The evidence collected from the studies informs that improvement of surroundings (low beds, removal of mats, installation of handles), resolving health issues (vestibule balance, vision, musculoskeletal), monitoring of patients (wearable devices, video-monitoring) and education of nurses is to be made to reduce risk of falls among the elderly. The evidence is easy to be adapted as changes in surroundings in hospital as well as in homes as suggested in not difficulty as lower beds can be easily bought and handles can be installed easily on the walls with immediate effect.

The evidence collected is strong and valid as each of the information is provided through experiment and research executed by the researcher of the studies while developing them. In order to implement the evidence in hospital settings for fall reduction among elderly, the healthcare professionals, nurses and carers are to be included. This is because healthcare professionals identify and treat health issues of elderly individuals whereas nurses have the role to provide appropriate services to elderly patients to ensure their well-being (Gustavsson et al. 2018). Thus, both of their contributions are required as they help each other to ensure well-being o elderly by reducing falls. The context in which the evidence is to be implemented is hospital surrounding where the elderly are being admitted to be treated for different health issue. The context is divided into three parts that are determining the prevailing culture, leadership roles and approach of organisation (Lewis et al. 2015). In hospital settings for the elderly where the evidence is planned to be implemented, it is seen that there is good culture and intended approach from the organisation to ensuring implementing steps for better care of elderly. This is evident as hospitals are developed with the intention to treat the elderly and others to ensure them live a better life (Cartagena et al. 2017). Therefore, implementation of the evidence would create any issue in the context it is been tried to be established.

In hospital setting, transformation leadership is being commonly used. The transformation leaders encourage staffs to make innovate and new changes to ensure better services to service users (Tanniru et al. 2018). Since the evidence ensures better care delivery to elderly patients thus its implementation would not create any issue. The facilitation indicates nature of support required for implementing change (Harvey and Kitson, 2015). In order to implement the mentioned evidence, the education and training programs as a support are to be developed so that nurses and others are informed regarding the ways they are to follow to reduce fall of elderly in the setting. For this purpose, money is required to be spent as arranging training and support programs requires the involvement of different experts. In addition, to implement video cameras for monitoring elderly to prevent falls adequate finances is to be required. The installation of handles and buying beds that are lower in height also need adequate finances. Thus, in implementing the mentioned evidence the issues that could be experienced is lack of enough finances. In addition, time constraint could act as issue as implementation of the evidence to create reduction of falls would require enough time and participation from nurses and health practitioners to learn and get trained which they may not have due to increased workload to care for increased number of patients.

Conclusion

The above discussion informs that elderly experiences risk of falls due to their health issues and ageing which makes them unable to properly balance their body. In order to understand the ways in which the risk of falls can be reduced for them, the systematic review research strategy is followed. The findings inform that multivariate approaches such as resolving health issues, low beds, vision improvement and others are to be done to reduce falls. In addition, technology and video monitoring are to be used to create the change of reducing fall risk for the elderly. The PARIHS framework is implemented in the review to identify issues of implementing the evidence and it is found that time and money constraints are the main issues to be faced.

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