Categories
Nursing

Literature Review Fall Prevention 2

Outline

Introduction

  • Conduct review by abstracting data from articles using a database format.
  • Creation of table summarizing key elements

Synthesize and write review (Summary)

  • Study 1
  • Study 11
  • Study 111

Conclusion

  • Literature Review – matic and integrated approach

Introduction

The PICO question related to this literature review seeks to answer how older adults can benefit from multifactorial based strategies in fall prevention as against when multi- component support measures are used? P/ people –Older adults; I/Intervention – multifactorial prevention strategies; C/ Comparison – None; O/Outcome – Fall Prevention

Multifactorial fall prevention strategies relate to designing care plan based on combination of factors. These include the person’s age, vision, hearing, environment, health status, muscle strength reflexes as well as underlying physical conditions affecting ability to maintain balance. A multicomponent approach relates to combining a number of strategies as fall prevention measures. These could include exercise, weight loss programs, physical therapy, installing features in a building as fall prevention facilities and nutrition programs. When a single approach is practiced just one component of fall prevention is utilize such as exercise only.

As such, this literature review entailed researching relevant documents that would answer questions applying the health sciences PICO scientific research methodology. Precisely, it is identifying elements related to P-Patient/people/ participant, I- Intervention, C- None and O-Outcome. As such, the supporting research question is:-

What are the influences of multi-factorial practices in fall prevention?

In relation to this study the PICO results were based on findings of the following key terms implicit both in the PICO as well as research questions. They are elderly/older adult; multifactorial intervention; single strategies and fall prevention.

Conduct review by abstracting data from articles using a database format

Database searched included Google Scholar, PubMed and Journal of Allied Health Sciences.  Below are the findings:-

http://google.com/scholar

Search Engine

Web

Search

#

P I C O Results Remarks
    elderly/older adult Multi

factorial

None  Fall prevention

 

   
Goggle 1   X X X 123,000  
  2 X   X X 150,000  
  3 X X   X 250,000  
  4 X X X   500,000  
               

 

http://www.pubmed.gov

Search engine Web Search

#

P I C O Results Remarks
    Elderly/older adult Multi

factorial

None Fall prevention    
PubMed 1   X X X 30,000  
  2 X   X X 23,000  
  3 X X   X 58,000  
  4 X X X   66,000  
               

 

http://ijahsp.nova.edu/

Search engine Web Search

 #

 

P I C O Results Remarks
    Elderly/older adult Multifactorial none Fall prevention    
Journal of allied health

sciences

1   X X X 2,000  
  2 X   X X 0  
  3 X X   X 0  
  4 X X X    4,000  
               

 

Summary of search results activity and selection of

Key papers according to hierarchy of evidence

As could have been observed key terms multifactorial and fall prevention were mostly found during the Google search. Generally, the Google search seemed more productive with Journal of Allied Health Sciences least effective. Studies selected as evidence based assumptions are listed in the table below:-

Table showing selection of key papers according to hierarchy of evidence

Creation of table summarizing key elements

# Citation Study Design Sam-

ple size and

Statis-tical met-

hods

Purpose/

Results/

Find-

ings

Limita-

tions

Conclusion/

Recommenda-

tions/

Nursing implications

Quality of Evidence
1. Costello, E., & Edelstein, J. (2008). Update on falls prevention for community-dwelling older

adults: Review of single and multifactorial intervention programs. Journal of            Rehabilitation Research & Development, 45(8),1135-1152

Critical analy-

sis of litera-

ture

12 pieces of litera-

Ture

No statistics quali-

tative

data analysis

Update  knowledge regarding fall prevention for community-dwelling older adults: Review of single and multifacto-

rial

intervene-

tion programs

Litera-

ture reviews are secon-dary data. As such, conclu-

sions are minted to the congre-

gate views of research

her’s work from the literature available on the subject

Multifac-

torial intervention

must embrace

assessment of

a multiple fall

prevention strategies and measures to prevent them.

 

Evidence level:-

Secondary

Evidence grade: 11

2. Lee Smith, M. Jiang, L., & Ory, M. (2012). Falls Efficacy among Older Adults Enrolled in an

Evidence-Based Program to Reduce Fall-Related Risk Sustainability of Individual Benefits

Over Time. Fam Community Health. 35(3), 256-26

Linear mixed model and multi-level

logistic

regres-

sion

2480 older adults

began the program

and

 

282 comp-

leted 6 month follow up.

 

Statis-tical

analy-

sis of vari-

ance was cond-ucted.

To evaluate the effectiveness of

‘A Matter of Balance/

Volunteer Lay Leader Model evidence-based fall risk reduction program. The program was proven to be beneficial

to older adults

The limitation regards efficacy when 9% of

Partic-

pants

comp-

leted  6 month

follow. This make concl-

usion very difficult to validate.

 

There was significant sustain-

-ability in fall prevention among the elderly

due to programs.

Recommen-

dations are that these programs should be con- tinuously evaluated for  efficacy with the aim of

making them more applicable

techniques.

Evidence level:

Primary

Evidence Grade: 1

3. Peel, M. Travers, C. Bell, R., Smith K. (2009). Evaluation of a health service delivery     intervention to promote falls prevention in older people across the care continuum. Journal

  of Evaluation in Clinical Practice, 16, 1254–1261

Quali

Tative task force evalu-ation

Six fall safety officers

making up a task force of resear

chers

 

Investi-

gates

‘the implement-

tation and evaluation of a state-wide workforce enhance-

ment

strategy to promote the uptake of evidence-based falls prevention activities for older adults’(Peel, Travers, Bell & Smith, 2009 p 1254).

Although a task force evalua-

tion is

consi-

dered primary,

a

limitation

regarding the popul-

ation sample could create some

degree internal

validity. A definite inclusion and exclusion criteria was not ment-ioned

Results showed progress in designing and preven-

ting fall programs in the

community.

Barriers were also reviewed

and  documented

The study provided strong evi-

dence supportive

for ‘implementing coordinated state-wide falls prevention

strategies for the prevention of falls in older people’ (Peel, Travers, Bell & Smith, 2009 p 1254).

Evidence level: Primary

Evidence

Grade: 1

 

Synthesize and write review

 Summary

Study 1

Update on falls prevention for community-dwelling older adults: Review of single and multifactorial intervention programs by Ellen Costello and Joan E. Edelstein presented a literature review of randomized controlled trials investigating the effectiveness of fall prevention programs in the community.

The research questions contained in this study were not obvious. As such, they were difficult to identify. However, the study guidelines embraced four assumption listed in the abstract. They implied that (1) multifactorial fall prevention programs were more effective for older individuals with a previous fall history rather than a nonselect group; (2) fall screening should include medication and vision assessment along with referreal from health practitioner;

(3)  adapting exercise strategies only is very effective fall reducing prevention strategy which should be included a comprehensive program in muscle strengthening, balance, and/or endurance training combination for at least 12 weeks; and (4) frequent home hazard assessment accompanied by modifications is essential to fall prevention, especially in high risk populations (Costello & Edelstein, 2008).   The research design embraced a critical analysis of literature.  An advantage of this design is that many studies could be reviewed in one analysis. However, a limitation is that it is secondary research material. Therefore, validity and reliability issues emerging from the individual studies reviewed could compromise conclusions. Sampling and data collection procedures entailed developing key words from which they browsed data bases such as PubMed, Medline, Proquest, CINAHL, Cochrane Controlled Trials, Science Citation Index, and ERIC for studies on the desired phenomenon during 1996-2007. Twelve multifactorial interventions were selected for review. Key words included; ‘ aging, exercise, fall prevention, falls, home hazard assessment, medication assessment, multifactorial, rehabilitation, single intervention and vision assessment’ (Costello & Edelstein, 2008, p.1135).

The instrument used to retrieve data were electronic databases containing information pertinent to the key words of interest, research questions and assumptions projected. Data analysis was through explanatory approaches and tabulation of research methodologies and findings to facilitate comparison. There were mixed results emerging from the twelve studies reviewed. They were inconclusive regarding assessment of home hazards as being a fall prevention strategies, which is applicable. Effectiveness of exercise was fully supported in the literature. The researchers, nonetheless, concluded that multifactorial falls prevention programs that do not include a comprehensive health and risk assessment should at the minimum contain a review of medications and vision assessment along with an exercise program and home hazard assessment (Costello & Edelstein, 2008).

Study 11

Efficacy among Older Adults Enrolled in an Evidence-Based Program to Reduce Fall-Related Risk Sustainability of Individual Benefits over Time by Lee Smith, Jiang & Ory (2012) examined how effective fall prevention programs can be if only measures were taken sustain them. Researchers argue that while these programs are in existence there are no evidence based studies to put them in a perspective that they can be applied across the health care disciplines within the country (Smith et.al2012).

 

A major disadvantage of their study lay in the outcome of merely 9% of participants returning for follow up 6 month assessments. In this way a true evaluation of the sustainable efficacy could not have been ascertained as in study 1 where clearly a multifocal intervention showed sustainability since there was a greater number of older adults who continued the program unto the end. Therefore, this study while attempting to provide some evidence of establishing scientific approaches towards implementing  prevention strategies it is still inconclusive(Costello & Edelstein, 2008).  .

Study 111

Evaluation of a health service delivery intervention to promote fall prevention in older people across the care continuum by Peel, Travers, Bell and Smith (2009) unlike studies 1 and 11 undertook a taskforce methodology towards evaluating fall prevention services within a given population. While this evidence was derived from primary sources researchers relied heavily upon documentation from other supporting agencies to arrive at a comprehensive analysis of services within the community (Peel et.al, 2009).

This was a twofold design. First researchers wanted to evaluate the process and procedures, which were in place. Afterwards, they conducted needs analysis interpreting the relevance of other services within target communities and how the elderly could benefit from more fall prevention programs. Unlike study 1 where an intervention applying a workable multifactorial intervention existed and the elderly were actively engaged in the process in study 11 interventions were non-existent. However, they established evidence to show where elderly are vulnerable to fall and should therefore be recipients of a cross continuum

service delivery model program (Peel et.al, 2009).

Conclusion

Overall Judgement Regarding Literature Review

Patricia Cronin (2008) and others have indicated that a literature review embodies a complex range of skills involving knowledge of defining relevant topics to be explored; literature search and retrieval; analyzing and synthesizing data as well as writing and reporting information accurately (Cronin et.al,2008).

As such, the foregoing presentation demonstrated this writer’s ability to adequately complete these duties mentioned in the previous paragraph. Three research studies were highlighted in the synthesis of relevant research literature. The overall judgment indicated that these three studies contained appropriate evidence based material indicative of preventing falls in older adults through from multifactorial intervention primarily and other incorporated evidenced based interventions. From the findings in this literature review all three studies concluded that a multifactorial model of fall prevention is very effective, but programs must be implement across communities for application of this evidence

References

Costello, E., & Edelstein, J. (2008). Update on falls prevention for community-dwelling older

adults: Review of single and multifactorial intervention programs. Journal of

               Rehabilitation Research & Development, 45(8),1135-1152

Cronin, P. Francis, R. Coughlan, M. (2008). Undertaking a Literature Review. A

Step-by- Step approach. British Journal of Nursing.17 (1), 38-43

Denzin, K., & Lincoln, S. (Eds.). (2005). The Sage Handbook of Qualitative

              Research (3rd ed.). Thousand Oaks, CA: Sage

Lee Smith, M. Jiang, L., & Ory, M. (2012). Falls Efficacy among Older Adults Enrolled in an

Evidence-Based Program to Reduce Fall-Related Risk Sustainability of Individual Benefits

Over Time. Fam Community Health. 35(3), 256-263

Peel, M. Travers, C. Bell, R., Smith K. (2009). Evaluation of a health service delivery

intervention to promote falls prevention in older people across the care continuum. Journal

          of Evaluation in Clinical Practice, 16, 1254–1261

Yin, R. (2009). Case Study Research: Design and Methods. Fourth Edition.  California SAGE

Publicaions.