Nursing Research and Clinical Practice

Introduction

Nursing research can be referred as the important analytical process that is used to make the perfect answers to the different clinical questions in the nursing practices. Evidence Based Practice. Evidence Based Practice (EBP) is one of the important process in the nursing process in terms of conducting proper research on the different nursing aspects and clinical process in terms of getting the proper result and the outcomes. Nursing and Midwifery Council, has set the guidelines for the EBP, in which it is stated that, nurses would practice in accordance to the best as well as relevant available evidences, in terms of delivering the best care and safety to the service providers. According to Bauman et al. (2016), if the clinical and nursing practice is performed on basis of the evidence-based practice, then it improves the outcomes of the ensure clinical process in line with improvement of the health and wellbeing of the service users. Moreover, Nursing and Midwifery Council also stated that problem solving approach in the nursing practice is important in terms of incorporating the conscientious use of the different current best practices. Hoffman et al. (2013), has mentioned that, through conducting the EBP, nurses and the clinicians can integrate different evidences, research papers and relevant information, which assist them to improve the overall outcomes of the clinical researches in order to improve the treatment process and health care methods. This assignment is going to identify the gaps in the current nursing practices by developing the relevant questions using the PICO (Patient, intervention, comparison and outcome). A proper search strategy is going to be conducted through thein terms finding the relevant research papers in terms of formulating the relevant research questions, followed by the proper application of the Critical Appraisal Skill Programme Tool (CASP, 2013). The perfect evaluation of the findings would be undertaken to identify the suitable recommendation in terms of conducting the best clinical practice. it is also possible that different barriers and difficulties such as limited fund, lack of time and poor governmental assistance can affect the overall outcomes of the research. Take a deeper dive into Collaboration in Childcare Settings with our additional resources.

Justification of the choice of topic and the search strategy:

The topic of this essay is “ways of reducing the falls in case of elderly patients”. This study is going to use the relevant evidence-based practices, in terms of using the accurate information for addressing the topic. Fall is considered as one of the most common health concerns as well as threats in aged people (Bauman et al. 2016). In the UK, about 30-40% of community-dwelling elder people experience falls in every year. Fall is one of the most common outcomes of restricted mobility that is associated with the inability of people to carry out every day functions such as bathing, housekeeping, shopping and dressing. This essay is going to review the selected literature by using critical appraisal tool, the Caldwell’s Mixed Model, which demonstrates different research question for critically analyse the effectiveness of the selected articles in terms of meeting these research questions (Caldwell et al. 2014). It is high time to analyse the different ways of reducing the falls in case of elderly patient, through conducting the research-based studies and evidence-based practices. This essay, would use the EBP in order to highlight the issues related ton the elderly falls, and its adverse outcomes on et health and wellbeing of the older people. in todays, fast-paced life, the recurrent falls in case of the older patient is common which not only affect their physical health but also affect their psychological strength (Davies and O'mahony, 2015). In this context, selection of this topic is justified, through which this essay, would use the evidences, and research-based information which can represent the possible ways that are important in reducing the risk of the elderly falls.

Search Strategy:

In this essay a search has been carried out by using the online database such as MEDLINE, CINHAL, British Nursing Index. This search strategy is carried out through using the Boolean Operator ‘OR’ for the keywords that is used for describing the actual intervention. The key words are, ‘high risk falls’, ‘falls in elder people’, ‘recurrent falls’, ‘clinical support’ healthcare needs and old age health. Research articles of the last five years (from2014) are selected for this essay. During the search process, initially 458 articles are selected. In addition to this, additional records from the other sources are 18. Then the duplicates are removed during the further selection and 241 articles are selected for the essay. Then the screening process is carried out, in which 161 articles are removed and 70 articles are selected for the essay. Then the eligibility test of the articles is carried out and finally, 12 relevant and highly appropriate articles are selected for the essay.

PICO Tool:

This essay will use PICO (Problem Intervention Comparison Outcomes) model to frame and answer clinical questions about eliminating the risk of falls in elderly patients. By using PICO Model (Problem Intervention Comparison Outcomes), this assignment will frame well-focused questions that will assist researchers to analyse the four important aspects including Patient problem, Intervention, comparison and Outcomes. Moreover, this essay will also use PARIHS (Promoting Action on Research Implementation in Health Services) for implementing the research outcomes as well as evidence into practice. Through using the PARIHS framework, this essay is going highlight the implementation of research into clinical practice by incorporating the research evidence

PICO tool:

PICO framework is used in this essay to define the key aspects such as Population, Intervention, comparison and outcomes of the selected research papers by forming relevant questions. It helps to formulate the clear research questions in assisting researchers to clarify the Search terms.

Research questions using the search terms in PICO tool:

By using the aforementioned PICO tool, appropriate research question is formulated which is as follows:

What are the possible ways to reduce the risks of falls in elderly patient in community settings?

The topic of this essay highlights the appropriate ways in reducing the risk of falls in elderly patients belonging to an age group of 65-75 years. According to Gawler et al. (2016), here are different preliminary studies regarding the prevention measures regarding the reduction of falls in the case of elder people. This topic is important for the learners as well as for future researchers to get proper knowledge regarding the associated factors of falls, clinical settings to protect older people from recurrent falls and roles of health providers to improve the mental as well as physical health of the patient. As stated by Ku et al. (2013), in today’s fast-paced life, most of the older people experience recurrent falls, which not only damage their physical strength but also affect their psychological stability. Therefore, selection of this topic will highlight the factors associated with of recurrent falls in elderly patients and also the possible ways for assessing the as well as managing the fall risk by implementing relevant clinical settings.

Critical analysis of the selected research papers:

CASP Tool:

CASP Tool or Critical Appraisal Skill Programme tool is designed to assist the learners to make proper sense of evidence from the research papers (Munthe-Kaas et al. 2018). CASP tool is used to understand the purpose, important points and the outcomes of the different research paper. It consists of 11 questions, which are used to analyse and assess the validity, applicability and result of different types of researchers such as random controlling trial, or qualitative study or meta-analysis.

Critical analysis:

This study has selected 11 UK based research papers on elderly falls in UK and ways of reducing the risk of falls at this age. critical analysis of each research paper is discussed one after one in the following paragraphs.

A.

“Abbott, J., Tomassen, S., Lane, L., Bishop, K. and Thomas, N., 2016. Assessment for benign paroxysmal positional vertigo in medical patients admitted with falls in a district general hospital. Clinical Medicine, 16(4), pp.335-338”

1.Title and Year of Publication:

Title: “Assessment for benign paroxysmal positional vertigo in medical patients admitted with falls in a district general hospital”

Year: 2016

2.Purpose:

This research aims to highlight the fact that, older people in the UK who are suffering from benign paroxysmal positional vertigo (BPPV), are more prevalent of the risk of falling as compared to people who do not have this disease.

3. Methods used:

For conducting this research, the researcher has used the randomise controlling trial process. In this clinical trial, 111 patients, who are suffering from dizziness, falls and off leg, have been initially selected from the UK based hospitals (Abbott et al. 2016). Confirmation has taken from all the patients who are willing to participate in this research. All the patients were tested by using Dix-Hallpike manoeuvre in order to diagnose BPPV (benign paroxysmal positional vertigo). The medical team, the inpatient and the patient's GP are informed about the participation of the patient in this study.

4. Results:

During this study, total of 5081 patients had been admitted in the NHS hospitals, UK, among which 111 patients were considered as suitable for the assessment. Out of the 111 selected patients, 18 had declined to participate in the study, 49 were considered as unsuitable for the study and 7 were discharged prior to the assessment process (Abbott et al. 2016. Finally, only 37 patients participated in the assessment process and had completed the overall study. These patients were tested with Dix-Hallpike manoeuvre for determining the presence of BPPV. as a result of this assessment, 20 patients (54%) were positive for BPPV and 17 were negative. Patients who were tested positive were recommended for better treatment, care and psychotherapist team in order to protect them from the falling risk.

5. How this helps to answer the questions:

This research paper assists this study to identify potential causing factors for falling risk in elderly people in the UK. Benign paroxysmal positional vertigo (BPPV), is a type of dizziness that is caused due to the abnormal reaction of the inner ear balance system, which is associated with controlling body movement (Abbott et al. 2016). Majority of older people in the UK, who are admitted in NHS hospitals with recurrent falls and leg off, have been diagnosed with BPPV. this research paper thus assists this study to answer the research questions by mentioning that, one of the important ways to reduce falls in elderly people in the UK is to provide an effective treatment process for eliminating the risk of BPPV.

6. One strength:

One strength of this research paper is it has represented the strong association of BPPV in the elderly patient in the UK and the rising risk of the recurrent falls (Abbott et al. 2016). Through analysing this research paper, it is possible to understand the majority of the elderly people in the UK who experience the recurrent falls, can have huge chances of having BPPV. From this research, it has been proved that the majority of the elderly people who are admitted to NHS hospitals have been diagnosed with BPPV. Therefore, using this research paper is helpful in terms of understanding the prevalence of elderly people suffering from BPPV to the risks of recurrent falls.

7. One limitation

One of the potential limitation or drawbacks of this research paper is it has focused on only one particular physiological condition (BPPV), as the potential causative factor for the risk of falls in elder patient, rather than representing other important biological and psychological factors. This confined this study into some limited outcomes and study that are unable to provide the clear concept of possible ways in reducing the risk of fall in the elderly patient. As stated by Al‐Sari et al. (2017), sometimes, most of the aged people suffers from recurrent falls due to some other mental and physical issues such as depression, anxiety, loss of hearing and arthritis. these factors are not described in this research paper.

8. Overall quality of evidence presented:

Although there are both the strength and limitations associated with the research per, the overall quality of evidence used in this research paper is highly appreciable, the evidence is based on the proper clinical study by selecting the patient from the NHS hospitals. Moreover, the assessment is done under the surveillance of the medical team and physiotherapist, in order to assure the accuracy and authentication of the research.

B.

“Gawler, S., Skelton, D.A., Dinan-Young, S., Masud, T., Morris, R.W., Griffin, M., Kendrick, D. and Iliffe, S., 2016. Reducing falls among older people in general practice: The ProAct65+ exercise intervention trial. Archives of gerontology and geriatrics, 67, pp.46-54.”

1.Title and Year of Publication:

Title: “Reducing falls among older people in general practice: The ProAct65+ exercise intervention trial.”

Year: 2016

2.Purpose:

This research aims to prove that a group-based exercise programme (Falls Management Exercise (FaME) and a home-based exercise programme ((Otago Exercise Programme (OEP)) are more effective in order to reduce the risk of falls in the elderly patient as compared to the usual care (UC) (Gawler et al. 2016).

3. Methods used:

A randomised control trial has been conducted by selecting 1256 community-dwelling older people (aged 65+). In this assessment process, the selected participants are recruited through GP practices in two sites London and Nottingham. Baseline assessment had been conducted before the randomisation (Gawler et al. 2016). The intervention period was of 24 weeks and then there was the immediate post-intervention assessment process. Participants were followed in every six months for 24 months. Then the fall database had been collected and analysed.

4. Results:

294 participants (24%) falls in one or two times in a year. In two groups which have been passed through the above-mentioned exercises are reported to have no increase of falls as compared to the group that is under the UC process during the assessment. The group that has been passed the FaME exercise is reported to have significant reduction injurious falls as compared to the UC group.

5. How this helps to answer the questions:

This research paper assists the study to represent that, one of the most effective ways to reduce the falls in an elderly patient in the UK is to offer the elderly people two types of exercise programme. These are a group-based exercise programme (Falls Management Exercise (FaME) and a home-based exercise programme ((Otago Exercise Programme (OEP)) (Gawler et al. 2016). Through this research paper, this study can recommend this two-programme ass important ways which would increase moderate to vigorous physical activity (MVPA) in older people which is associated with a reduction of falls.

6. One strength:

One of the strengths of this research paper is it has assisted this study to fund out one of the most important ways in order to reduce the falls in the elderly patient. In this research paper (Gawler et al. 2016), has mentioned that the two-group based and home-based exercises FaME and OEP are more effective as compared to UC in term of increasing the moderate to vigorous physical activity (MVPA) in older people (above 65). MPVA is important in the older age to main the proper balance and reduces the falls.

7. One limitation:

One of the drawbacks of this research paper is it does not make any information regarding the other important ways except these two exercises in order to reduce the risk of recurrent falls in elderly people in the UK. In this aspect Abbott et al. ( 2016) stated that, this research paper has presented effectiveness of these two exercises in case of a patient in London and Nottingham, which is unable to predict whether the two exercises can be effective in other places, especially in the rural and suburban region in the UK. Moreover, for the older adults residing in the poor community in the UK, it is quite impossible to attend these two types of exercises. In that case, which ways or physical treatment cab be effusive in reducing falling risk, this research paper cannot explain.

8. Overall quality of evidence presented:

This research has used the accurate and authentic evidence that are gained through proper analysis and evaluation of database collected during the assessment process.

C.

“Al‐Sari, U.A., Tobias, J.H., Archer, H. and Clark, E.M., 2017. Do subjective memory complaints predict falls, fractures and healthcare utilization? A two‐year prospective study based on a cohort of older women recruited from primary care. International journal of geriatric psychiatry, 32(9), pp.968-976.”

1.Title and Year of Publication:

Title: “Do subjective memory complaints predict falls, fractures and healthcare utilization? “

Year: 2017

2.Purpose:

This research paper aims to highlight the strong association of the subjective memory complaints (SMC) with cognitive impairment, recurrent falls and fractures in older people (Al‐Sari et al. 2017).

3. Methods used:

In this research, the researcher has done the prospective analysis of the cohort study, in which 3184 older women are selected from the Bristol and Avon in the UK. In the population based cohort is recruited from primary care (Al‐Sari et al. 2017). data are collected by using the self-completion questionnaires and the baseline and 2 years.

4. Results:

Out of 3184 participants, 350 participants were reported to have SMC. They were between the age of 70-74 years. They were less mobile and physically week as compared to the other participants who were not reported to have SMC (Al‐Sari et al. 2017).

5. How this helps to answer the questions:

This research paper assists this study by providing evidence-based information about the strong association of the recurrent falls in older people and SMC. In this research appear ()n mentioned that memory loss or subjective memory complaints (SMC) is one of the sign that act as a market for detecting the risk of falls, cognitive impairment and health issues in older people (Al‐Sari et al. 2017).

6. One strength:

Strength on this research paper is it highlights the importance of neuropsychological testing in term detecting whether the older adults are suffering from subjective memory complaints (SMC). If the individual has SMC, then he or she is highly prevalent towards the risk of falls. As stead by Al‐Sari et al. (2017), older people with SMC are more; likely to fall and get injured as compared to the people who do not have SMC.

7. One limitation:

One of the important drawbacks of this research paper is, although it has successfully explained the more risk of falls in older people with SMC, it is unable to highlight the proper treatment process or physical as well as psychological support that needs to be conducted for these patients in order to protect them from falls and injuries.

8. Overall quality of evidence presented:

This research has used the accurate and authentic evidence that are gained through proper analysis and evaluation of database collected during the assessment process.

D.

“Booth, V., Logan, P., Harwood, R. and Hood, V., 2015. Falls prevention interventions in older adults with cognitive impairment: a systematic review of reviews. International Journal of Therapy and Rehabilitation, 22(6), pp.289-296.”

1.Title and Year of Publication:

Title: “Falls prevention interventions in older adults with cognitive impairment: a systematic review of reviews”

Year: 2015

2.Purpose:

Purpose of this research is to highlight the prevalence of risk of falls in an elderly patient who suffer from cognitive impairment (Booth et al. 2015).

3. Methods used:

In this research, the researcher has done the secondary research by electronic database from MEDLINE, AMED, CINAHL Cochrane electronic library and EMBASE. Keywords that are used to search the relevant evidence are falls, fall prevention, cognitive impairment, rehabilitation and ‘Alzheimer’s disease (Booth et al. 2015).

4. Results:

By analysing the result Booth et al. (2015). mentioned that older people who suffer from cognitive impairment are more prevalent to the risk of falls.

5. How this helps to answer the questions:

Although these research papers have used relevant evidence in order to highlight the reduction of recurrent falls in the patient suffering from cognitive impairment, it is unable to assist this study to make appropriate answer to the research question. This is because this research paper has highlighted the association of cognitive impairment with recurrent falls in older people, but it is unable to represent any possible ways to reduce the risk of falls in these patients.

6. One strength:

On strength of this research paper, it highlights how cognitive impairment acts as a potential causative factor in leading to recurrent falls in older people (Booth et al. 2015).

7. One limitation

It is unable to highlight any possible ways that can be implemented into the practical field to reduce the cognitive impairment and recurrent falls in older people.

8. Overall quality of evidence presented:

This research is secondary research which is based on collecting the electronic database from the online sites and libraries. By using the PRISMA tool it has selected only relevant papers to achieve the quality of this research.

E.

“Gardiner, S., Glogowska, M., Stoddart, C., Pendlebury, S., Lasserson, D. and Jackson, D., 2017. Older people's experiences of falling and perceived risk of falls in the community: a narrative synthesis of qualitative research. International journal of older people nursing, 12(4), p.e12151.”

1.Title and Year of Publication:

Title: “Older people's experiences of falling and perceived risk of falls in the community: a narrative synthesis of qualitative research.”

Year: 2017

2.Purpose:

Purpose of this research is to examine the experience of falls in older people and the perceived risk of falling (Gardiner et al. 2017).

3. Methods used:

Qualitative secondary research has been considered in which database are collected through the articles and journals selected from Medline, EMBASE, CINAHL, Medline and BNI (Gardiner et al. 2017).

4. Results:

Through using the PRISMA tool, 11 papers are selected as relevant and appropriate for this study.

5. How this helps to answer the questions:

The evidence of this research assists this study to understand how older people are more prevalent to normal people. Moreover, this research has presented the fact that at an old age, people are more dependent onthe other people (Gardiner et al. 2017). Majority of the older adult who has experience falls can develop trauma and threats of recurrent falls. In this aspect, this research paper has recommended providing the mental and physical support to each older patient in order to reduce the risk of falling

6. One strength:

It assists the study to get proper information about the prevalence of older people towards the recurrent falling.

7. One limitation:

This research does not highlight the factors that are associated with the increased risk of fall in an elderly patient.

8. Overall quality of evidence presented:

All the database that is selected through PRISMA tools is relevant to meet the research objectives. The research is able to maintain its quality.

H.

“Hawley, C., Sakr, M., Scapinello, S., Salvo, J. and Wrenn, P., 2017. Traumatic brain injuries in older adults—6 years of data for one UK trauma centre: a retrospective analysis of prospectively collected data. Emerg Med J, 34(8), pp.509-516.”

1.Title and Year of Publication:

Title: “Traumatic brain injuries in older adults—6 years of data for one UK trauma centre:”

Year: 2017

2.Purpose:

This research aims to highlight the incidence of traumatic brain injuries (TBI) in older adults (Hawley et al. 2017).

3. Methods used:

Retrospective analysis has been done by selecting 4413 patients who were admitted with TBI in UK hospitals.

4. Results:

Among the 4413 patients, 1389 were more than 65 years and 45 % of them were reported to have TBI. Falls accounted for 85% of the patient who suffers from TBI (Hawley et al. 2017).

5. How this helps to answer the questions:

This research paper is unable to provide proper information regarding the ways of reducing falls in elderly patients. It has emphasized on TBI in older patients and the association of TBI with falls in older adults (Hawley et al. 2017).

6. One strength:

This study has successfully represented how the older patient with TBI are prevalent to recurrent falls

7. One limitation

It is unable to shed light on the possible ways to reduce falls in older people

8. Overall quality of evidence presented:

Through using relevant and highly appropriate database this research paper has maintained its quality in a well-organised manner.

I.

“Papoutsi, C., Poots, A., Clements, J., Wyrko, Z., Offord, N. and Reed, J.E., 2018. Improving patient safety for older people in acute admissions: implementation of the Failsafe checklist in 12 hospitals across the UK. Age and Ageing, 47(2), pp.311-317.”

1.Title and Year of Publication:

Year: 2018

Title: “Improving patient safety for older people in acute admissions: implementation of the Frailsafe checklist in 12 hospitals across the UK”

2.Purpose:

to examine the usefulness of Frailsafe Checklist, in order to increase safety and quality of healthcare in the older patient (Papoutsi et al. 2018).

3. Methods used:

110 qualitative interviews and group discussion have been conducted to get the appropriate database.

4. Results:

Through using a checklist, it is possible to determine the drawback of hospitals assessment. Moreover, the checklist assists health professionals to set proper treatment process for the patients.

5. How this helps to answer the questions:

This research paper assists this study to recommend this using of Frail safe checklist in order t determine the falling risk and health issues in older people.

6. One strength:

This research paper highlights the effectiveness of using the Frailsafe Checklist in order to determine the health and quality of care in older patients

7. One limitation

Does not highlight the causative factors of fall risk in the case of older patients. Moreover, it is unable to highlight how frailsafe checklist would be used to reduce the fall risk in elderly patients.

8. Overall quality of evidence presented:

Through using relevant and highly appropriate database this research paper has maintained its quality in a well-organised manner.

J.

“Parry, S.W., Bamford, C., Deary, V., Finch, T.L., Gray, J., MacDonald, C., McMeekin, P., Sabin, N.J., Steen, I.N., Whitney, S.L. and McColl, E.M., 2016. Cognitive–behavioural therapy-based intervention to reduce the fear of falling in older people: therapy development and randomised controlled trial–the Strategies for Increasing Independence, Confidence and Energy (STRIDE) study”

1.Title and Year of Publication:

Year: 2016

Title: “Cognitive–behavioural therapy-based intervention to reduce the fear of falling in older people: therapy development and randomised controlled trial–the Strategies for Increasing Independence,”

2.Purpose:

To examine how effective is the cognitive behavioural therapy to reducing the risk of fall in an elderly patient (Parry et al. 2016)

3. Methods used:

Randomised controlled trial has been conducted by selected patients with experience of recurrent falls, who have age group for more than 60 years.

4. Results:

It has shed light on cognitive behavioural therapy as an important way to reduce the risk of falls in elderly people (Parry et al. 2016).

5. How this helps to answer the questions:

It helps to answer how cognitive behavioural theory can be used in case of elderly people in order to reduce the risk of falling.

6. One strength:

It has shed light on cognitive behavioural therapy as an important way to reduce the risk of falls in elderly people.

7. One limitation

It does not highlight the proper process in which cognitive behavioural therapy assist older people to become independent and protected from recurrent falling

8. Overall quality of evidence presented:

This research has used the accurate and authentic evidence that are gained through proper analysis and evaluation of database collected during the assessment process.

Recommendation:

Chosen Question:

How does the recurrent falls can be reduced in case of the elderly patient?

From all the five mentioned themes, it can be recommended that, recurrent falls, is one of the major issues in todays health care context, in case of older patient the has reduced physical and psychological strength which not only affect their psychological strength but also affect their overall physical strength. In the nursing the health and social care professionals are bound to the NMC Codes of Conduct which assist the health and social care staffs to provide the high-quality care and support to the service user, especially to the older people, which are dependent for their regular activities in the other people. NICE guidelines make it obligatory for the nurses and health professional to conduct the evidence-based practice in which they can use the relevant and research-based information to improve the process and the overall health and wellbeing of the people. All the research papers that have been selected shows the urgent needs of the robust research and evidence based clinical practices that can be implemented to reduce the recurrent falls in case of the elderly patient. There may be some barriers regarding conducting the robust clinical research such a lack of time and efficient health professions. Therefore, it is high time to look into the matter, and appoint the high skilled clinicians and health professional who can meet the dependence needs of the older people in terms of safeguard them from any type of injuries, falls and psychological damages. Based on the evidence-based practices, health professional and the nurses can implement the therapies and the counselling process which would assist them to improve the psychological strength and the emotional ability of the service users. Through implementing the effective therapies and counselling process, health professional and the nurses can implement the evidence-based care process that not only improve the psychological strength of the service users but also improves the physical ability of the service users. Highly effective care process can be implemented through using the proper care and support. Moreover, training is one of the important process which can improve the efficiency and professional knowledge of eth nurses ands health professional. NHS guidelines for the nurses focuses on improving their knowledge and clinical perception through their self-assessment and training process. Through conducting the proper training process, it is possible to improve the knowledge and expertise of nurses in terms of dealing with the older patient. Through their professional knowledge they can provide the better safeguarding process and protection to the older people in terms of avoiding eth risks of recurrent falls in case of th older patient.

Implementation:

PARIHS framework is one of the most important tools, which is used by this assignment to implement the research evidence into practice.

PARIHS (Promoting Action on Research Implementation in Health Services) framework:

This framework is used to make perfect implementation of the research into practice. This framework is based on the three key aspects, evidence, context and facilitation. This tool also represents the changes that can be made for gaining the expected outcome. Promoting Action on Research Implementation in Health Services (PARIHS) has assisted this study to implement the findings of selected researches into the practical field in order to meet the objectives of this study. By conducting proper description of the of selected articles in terms of meeting the criteria of aforementioned three aspects, evidence, context, facilitator, this study has represented the way to implement as well as incorporate the research evidence into the practical healthcare settings. The entire tool is given in the appendix. [Refers to appendix 3]

Conclusion:

From the above discussion, it is clear that older people are more likely prevalent to recurrent falls. Older people have restricted mobility, which affects their activities of daily living such as dressing, cleaning, moving, bathing and eating. There are needed high-quality healthcare support and clinical supervision for elderly patient to avoid the risk of falls. this assignment concludes that proper care management process not only reduce the chances of falling but also improves the physical as well as the mental ability of the older patient in order to deal with the risk of falls. Different factors such as social, socio-economic, demographic, physical and psychological factors are associated with risk of falls in the older patient. Therefore, health providers need to provide all time supervision and care for these patients to avoid the risk. Moreover, the health professional would offer psychological and physical therapies to improve the ability of older people for performing their regular activities without falling.

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