Research Paper On Review Of The Literature

Bloch, F., Gautier, V., Noury, N., Lundy, J.E., Poujaud, J., Claessens, Y. E. & Rigaud, A.S. (2011). Evaluation under real-life conditions of a stand-alone fall detector for the elderly subjects (Bloch et al., 2011). Annals of Physical and Rehabilitation Medicine, 54 (2011):391–398.
This quantitative study by Bloch et al., evaluates the experience of 10 elderly adults aged 75 and above with the use of the VigiFall. The purpose of the research was to also to assess the participants’ acceptability and tolerance of the device in real-life settings. The accelerometric sensor of VigiFall was attached to the participants’ thorax and it gives out a signal when the subject is about to fall or makes sudden movements. Results show that VigiFall was effective in detecting fall events and alarm events. Participants also showed tolerance of the device even in prolonged periods of time. This study is significant to nursing care because it presents actual experience of devices that can be utilized to predict potential falls and immediately alerts medical staff of occurrence of falls.
Boele van Hensbroek, P., van Dijk, N., van Breda, G. F., Scheffer, A.C., van der Cammen, T.J., Lips, P., Goslings, J. C. & de Rooij, S. E. (2009). The CAREFALL Triage instrument identifying risk factors for recurrent falls in elderly patients. The American Journal of Emergency Medicine (1):23-26. doi.org/10.1016/j.ajem.2008.01.029.
This single-center comparison study evaluates the validity and reliability of the CAREFALL triage instrument (CTI), a 44-item self-administered questionnaire that is answered by elderly patients admitted to the emergency department of hospitals. The study was carried out in a hospital in Amsterdam from 2004 to 2006. There were three sets of patients who participated. The first set was comprised of 100 Dutch-speaking patients who volunteered for the study and 200 patients matched from the CAREFALL database. The second set was 111 patients, and the third set was 27 patients. This study measured the CTI’s construct validity, content validity, test-retest validity, and clinical validity. Research results show that CTI is valid and is a reliable instrument that identifies modifiable factors among elderly patients after a fall. This study is relevant to nursing care because an instrument, such as CTI, can contribute to the development of appropriate interventions that prevents falls among elderly patients admitted to hospitals and community-dwellings.
da Costa B.R., Rutjes, A.W.S., Mendy, A., Freund-Heritage, R. & Vieira, E.R. (2012) Can Falls Risk Prediction Tools Correctly Identify Fall-Prone Elderly Rehabilitation Inpatients? A Systematic Review and Meta-Analysis. PLoS ONE 7(7): e41061. doi:10.1371/journal.pone.0041061.
This study focussed on the assessment of fall prediction tools. The researchers began working with six databases where they were able to gather 786 studies that were potentially eligible. However, after applying their criteria they finally selected only three studies. The fall prediction tools that were discussed in these studies were STRATIFY, DOWNTOWN, and PJC-FRAT. The tool STRATIFY was discussed in all three studies. The total number of participants in the sample was 754 older persons with an average age of 79 to 81. The number of female participants was slightly higher (from 62% to 69%) in each of the studies. The number of fallers among the participants in each of the three studies ranged from 26% to 51%. A prospective cohort design was utilized by the three chosen studies. Researchers who conducted the meta-analysis realized that there are very few studies done about fall predictive tools, thus they identified the low number of available studies one of their research limitations. Another key finding highlighted by one of the studies was one author’s recommendation to identify and modify risk factors as the main strategy to prevent falls and not depend on risk prediction because such devices do not top the falling of patients.
Dykes, P., Carroll, D., McColgan, K., Hurley, A., Lipsitz, S., Colombo, L., Midleton, B. (2011). Scales for assessing self-efficacy of nurse s and assistants for preventing falls. Journal of Advanced Nursing, 67(2), 438–449. doi:10.1111/j.1365-2648.2010.05501.x.
The research was undertaken to develop and evaluate two instruments or scales that quantifies the beliefs of staffs in relation to avoiding falls of their patients. These scales are the Self-Efficacy for Preventing Falls-Nurse (SEPFN) and the Self-Efficacy for Preventing Falls-assistant. A combination of quantitative and qualitative-descriptive methods, distributed in four phases, is used in the study. Phase 1 one and Phase 3 make use of interviews and focus-group discussions, while in Phase 2, the contents of the scales were developed and finalized. The final questionnaires had 37 items in the SEPFN and 33 items in the SEPFA. Phase 4 was allotted for reliability testing and a Likert-scoring (six-point) was used with the descriptors completely confident and not at all confident located at opposite ends of the Likert scale. Participants in the study include registered nurses (RNs) and certified nursing assistant (CNAs) from four acute hospitals, two academic medical centers, and two suburban hospitals in February to December 2008. Results from the study showed that the SEPFN and SEPFA have psychometric adequacy and can therefore be used to measure the self-efficacy beliefs in preventing falls of bedside staffs. This study is particularly relevant to the nursing profession because it contributes a quantitative instrument that measures the staffs beliefs. Having such measure can assist hospital leaders in the development or identification or enhancement/education programs for their nurses and nurse assistants.
Homann B, Plaschg A, Grundner M, Haubenhofer, A., Griedl, T., Ivanic, G., Hofer, E., Fazekas, F. & Homann, C.N. (2013).The impact of neurological disorders on the risk for falls in the community dwelling elderly: case-controlled study. BMJ Open; 3(11):e003367. doi: 10.1136/bmjopen-2013-003367.
The design utilized for this research is prospective case-controlled study. The participants include 228 patients, average age of 74.5, with 61% women. The control group number 193 with average age of 71.4 and 63% are women. The research was undertaken to identify the impact of common neurological diseases on the senior citizens risk for falls. The main outcome measure of the study was the patients’ recollection of incidence of fall within the past 12 months. Additional risk factors were also measure through motor and non-motor function tests. The results of the research showed that patients with the higher proportion of fallers are those with stroke, dementia, epilepsy, and Parkinson;s disease. The strengths of the study are in the aspect of standardized outcome measures, study design, and standardized assessment of patients while the main limitation is in the aspect of memory recall of patients’ self-reporting of falls. This study is important in the nursing profession because of its use of standardized outcome and assessment measures.
Mamun, K. & Lim, JKH. (2009). Association between falls and high-risk medication use in hospitalized Asian elderly patients. Geriatrics Gerontology International, 9: 276-281. doi: 10.1111/j.1447-0594.2009.00533.x.
The purpose of this study was to identify the role of medication in causing falls among the elderly patients. There are 298 research participants and they have all been admitted to the hospitals within the past 12 months. The average age was 75.8 years old, and 60.4% male. These are all Asian elderly and 84.9% of them are Chinese. The researchers used multivariate analysis to process their data and results showed that the fallers were taking fewer medications. However, the medications they were taking in were cough medications, anti-platelet drugs, and hypnotics. The statistical analysis also showed that the fallers already had a history of falls and were likely to stay longer in the hospital. The results of the study is significant because it identifies which types of medications are associated with more incidents of falls, thus patients taking such drugs may need other drugs to prevent falls during their hospital stay.
Miller, E., Wightman, E., Rumbolt, K., McConnell, S., Berg, K., Devereaux, M. & Campbell, F. (2009). Management of fall-related injuries in the elderly: A retrospective chart review of patients presenting to the emergency department of a community-based teaching hospital. Physiotherapy Canada, 61 (1): 26-37.
This retrospective longitudinal chart review study, conducted in Canada, identifies the current procedures that hospitals in Toronto follow in handling elderly patients seeking treatment for fall-related injuries. The sample in the study is 300 persons, aged 65 years old and above. Results showed that all patients, including the elderly, only saw a physician or a nurse. Less than four percent saw other health practitioners such as physical therapist or occupational therapist. Elderly patients’ risk for falls was also not assessed all the time in the Emergency Department. A key finding was that 8.3% of elderly patients who seek treatment in the Emergency Department return within the next six months to again be treated for a fall-related incident. This study is significant because it shows the importance of fall assessments even in emergency departments in order to provide appropriate interventions for the elderly patients.
Mussi, C., Galizia, G., Abete, P., Morrione, A., Maraviglia, A., Noro, G., Cavagnaro, P., Ghirelli, L., Tava, G., Rengo, F., Masotti, G., Salvioli, G., Marchionni, N. & Ungar, A. (2013). Unexplained Falls Are Frequent in Patients with Fall-Related Injury Admitted to Orthopaedic Wards: The UFO Study (Unexplained Falls in Older Patients). Current Gerontology and Geriatrics Research,2013. Doi. org/10.1155/2013/928603.
The purpose of this study is to investigate the characteristics of unexplained falls among the elderly patients whose injuries result in fractures. The population studied are all patients who are 65 years old and above and are admitted to the orthopaedic ward. Patient data was collected and patients were also evaluated using instruments such as MMSE, GDS, BADL, IADL, and CIRS. These evaluation tools were used to evaluate the patient’s cognitive performance, presence of affective disorders, and disability. SPSS was used in the statistical analysis of data. The results show that patients who are 80 years old and above are more likely to have lower MMSE scores, have depressive symptoms. They also tend to remember the falls. As regards medications, diuretics are most likely to be taken by older patients.
The study also noted that a second hip fracture occurring within just five years from the first fracture has been experienced by 14.8% of patients admitted to the orthopaedic ward. This study is relevant to patient care because it presents the physiological conditions of elderly patients and their propensity to suffer from hip injuries when they suffer from a fall. This reality can contribute to the development of fall-prevention strategies for elderly patients.
Nabeshima, A., Hagihara, A., Hayashi, K., Nabeshima, S. & Okochi, J. (2007). Identifying interacting predictors of falling among hospitalized elderly in Japan: A signal detection approach. Geriatrics Gerontology International, 7:160-166. doi: 10.1111/j.1447-0594.2007.00391.x
The purpose of this study was to identify the interaction between different risk factors for falls of elderly patients. The research participants were 364 patients with an average age of 81 and 76.7% women. They were in hospital for more than six months in the period from April 2000 to March 2001. Research results showed that those who were not bedridden, had dementia, and received tranquilizers were the ones who experienced the most fall incidents. This study is significant because this highlights the need to revise medications to prevent falls among the elderly.
Pfortmueller, C.A., Kunz, M., Lindner, G., Zisakis, A., Puig, S. & Exadaktylos, A.K. (2014). Fall-Related Emergency Department Admission: Fall Environment and Settings and Related Injury Patterns in 6357 Patients with Special Emphasis on the Elderly. The Scientific World Journal. 2014: 256519. Doi. 10.1155/2014/256519.
Falls among the elderly translate to increasing costs. Older female patients are more likely to sustain fractures from these falls. The article provides patients characteristics and graphs on risk analysis and distribution of injuries. This study does not contain much information that can support my proposed change as it only recommends further studies that can screen elderly fall patients in the emergency department.
Quinn, P. & Horgan, F. (2013). Single- and dual-task assessments in elderly patients in a falls intervention programme. International Journal of Therapy and Rehabilitation, 20 (11): 530-535.
This article emphasizes the relationship between falls and cognitive impairment. Older people experience a decline in their executive function, and such cognitive decline has been identified as a risk factor for falls. A common result of falls is hip fracture. This condition is a major concern as treatment of hip fractures and the associated long-term care of the elderly with such ailment estimated to reach 7.6 million pounds. This article provides support for my proposed change because it discusses a practical method for identifying the elderly who are most likely to be fallers in either hospitals or in community setting.
Rhalimi, M., Helou, R. & Jaeker, P. (2009). Medication Use and Increased Risk of Falls in Hospitalized Elderly Patients: A Retrospective, Case-Control Study. Drugs Aging, 26(10): 847-852.
The falls that elderly people experience can result in serious injuries. Taking medications is a major risk factor because there are certain drugs, most commonly taken by older people suffering from chronic conditions, which can lead to falls. Half of the incidents of falls take place during the first week of the older people’s confinement in hospitals. The drugs associated with increased falls include zolpidem and meprobamate. This article provides support for my proposed change because it identifies which drugs can result in more falls.
Shimada, H., Suzukawa, M., Ishizaki, T., Kobayashi, K., Kim, H. & Suzuki, T. (2011). Relationship between subjective fall risk assessment and falls and fall-related fractures in frail elderly people BMC Geriatrics 11:40. doi:10.1186/1471-2318-11-40.
Fractures resulting from falls are common among elderly people. Those who have impaired mobility caused by disorders in balance and gait are more likely to experience falls. This article describes both objective and subjective tests that assess who are most likely to experience falls among the elderly. This study supports my proposed change because it identifies subjective methods that can be used as an assessment tool for fallers who are unable to perform the objective tests.
Sirkin, A.M. & Rosner, N.G. (2008). Hypertensive management in the elderly patient at risk for falls. Journal of the American Academy of Nurse Practitioners,21:402-408. doi:10.1111/j.1745-7599.2009.00418.x
Falls have been identified as the leading cause of injury-related deaths among the elderly. In the US, the total direct cost of injuries resulting from falls reaches 19 billion dollars in the year 2000. Since older people suffer from chronic conditions, they are most likely to take multiple medications. As they take in more kinds of drugs, their risk of falls also increases. This article supports my proposed change because it highlights the need for regular review of the medications taken, and the combinations of these drugs, among the elderly.
Vass, C.D., Sahota, O., Drummond, A., Kendrick, D., Gladman1, J., Sach, T., Avis, M. & Grainge, M.(2009). REFINE (Reducing Falls in In-patient Elderly) - a randomised controlled trial. Trials, 10:83-86. Doi.10.1186/1745-6215-10-83
The elderly in hospitals are three times most likely to experience falls than those in community dwellings. In the UK, there were more than 200,000 falls that occurred within a one year period in 2005-2006. This article supports my proposed change because it discusses REFINE (Reducing falls in In-patient Elderly), an instrument that can be used to prevent falls among the elderly patients.