Introduction
Fall prevention in geriatric patients is one of the most pressing concerns in nursing. Older adults, especially those with dementia and other cognitive impairments, are at higher risk of falling and sustaining injuries. Physical exercise is frequently proposed as an effective fall risk reduction intervention (Toots et al., 2019). However, the potential benefits of exercise as a fall prevention technique should be explored more thoroughly to make an informed conclusion on its usefulness in geriatric care. In theory, exercise programs should have a significant positive effect on fall reduction due to the improvement of patients’ stamina, gait, and balance. This paper critically evaluates two quantitative studies on fall prevention in geriatric patients to answer a related PICOT question.
PICOT Question
In geriatric patients, what is the effect of physical exercise-based interventions on fall risk prevention compared to the standard care process?
Background of Studies
The first quantitative study by Toots et al. (2019) attempted to explore the effects of a high-intensity physical exercise program on fall rates and injury incidence in geriatric patients with dementia. The researchers acknowledged existing evidence in favor of exercise-based interventions’ efficacy in fall prevention and tried to test it with additional variables, thus making a new contribution to the nursing theory. In particular, Toots et al. (2019) investigated whether the effects of an exercise program are associated with patients’ sex, dementia type, and improvement in balance. In that regard, the authors set two research questions: “Will high-intensity exercise intervention affect the number of falls?” and “Will the effects be consistent across different genders, dementia types, and improvement in patients’ balance?”
The second study had a similar purpose of exploring the impact of exercise-based interventions on fall rates and physical performance in nursing home patients with dementia. In addition, Brett et al. (2021) contributed to nursing by finding whether intervention delivery was more effective in a single long session or multiple short sessions. In that regard, the study had two research questions stemming from the corresponding objectives. The first one was: “Will exercise-based intervention improve the physical performance of nursing home residents and reduce the fall risk?” The second question was, “Will shorter-duration, high-frequency interventions produce more beneficial outcomes in patients with dementia?”
Support of the Nursing Studies Problem
Both studies are directly related to the PICOT question in terms of population group and intervention deployed to manage fall risk. Toots et al. (2019) studied the impact of high-intensity physical exercise on fall rates and injury incidence in older adults. Likewise, Brett et al. (2021) attempted to find evidence of physical exercise efficacy as a fall risk management intervention. Overall, both studies focused on the fall prevention aspect of exercise programs. In that regard, the results of these studies have a direct connection to the PICOT question, pointing at potential outcomes and providing valuable additional information.
Both articles’ intervention and comparison groups perfectly match those described in the PICOT question. In particular, Toots et al. (2019) and Brett et al. (2021) studied older adults with dementia and divided research samples into intervention and control groups. Control groups in both studies received standard care, while the intervention groups completed prescribed physical exercise programs. As such, the quantitative studies provided solid empirical evidence on whether exercise-based interventions benefit geriatric patients, the main population group in the PICOT question.
Method of Studies
Both studies utilized a common research design of randomized controlled trials (RCT) with subsequent statistical analysis. Participants were randomly assigned to the intervention and control groups to determine the exact efficacy of exercise as a fall prevention method. However, the researchers deployed RCTs in a slightly different fashion. Toots et al. (2019) divided 186 participants into control and intervention groups. In turn, each group was divided into 18 clusters of three to eight participants living together to reduce the result contamination effect. Brett et al. (2021) divided 60 participants into one control and two intervention groups consisting of 20 individuals. The researchers added the second intervention group to answer the effects of short, high-frequency exercise sessions compared to the standard intervention delivery mode.
In general, the main advantage of RCTs lies in establishing a straightforward causal relationship. Accurate statistical data allows researchers to evaluate the results of the studied intervention. In addition, the randomization element allows the researchers to control bias and obtain reliable evidence based on statistical analysis. However, standalone RCTs rarely demonstrate results that can be generalized and applied to a broad population sample. The studied patient groups frequently differ from people treated in standard settings. Therefore, multiple RCTs should be reviewed to make an informed judgment of the intervention’s efficacy.
Results of Studies
Contrary to existing evidence, Toots et al. (2019) found that fall incidents in elderly patients with dementia were not affected by a high-intensity physical exercise program. In addition, patients’ gender, dementia type, and balance improvement did not affect fall rates. However, patients in the intervention group sustained fewer fall-related injuries: 5 in 87 falls compared to 14 in 89 in the control group. These results suggest that exercise programs may produce a beneficial impact outside of fall prevention. In particular, Oliveira et al. (2019) found that physical activity significantly improves mobility goal attainment in older adults.
In contrast, Brett et al. (2021) found that exercise-based interventions significantly reduced the median number of falls in two intervention groups. The levels of improvement were comparable between the group that performed a weekly 45-minute exercise session and the group where the intervention was delivered in three 15-minute sessions per week. Additionally, participants in the intervention groups achieved statistically significant improvements in Timed Up and Go (TUG) and timed static pedaling (TSP) tests. These results aligned with Bjerk et al. (2019) and Patti et al. (2021), who confirmed the positive impact of physical exercise on older adults. In that regard, nurses should consider adding exercise-based interventions to standard care plans, even if fall reduction may be insignificant in certain patient populations.
Ethical Considerations
Both studies had similar ethical considerations and methods of addressing them. Most importantly, the researchers had to obtain informed consent from participants. Toots et al. (2019) approached all participants personally and received oral permission that was additionally confirmed by the participants’ close relatives. Brett et al. (2021) invited all potential participants and their caregivers to an information session, where participants, or people making decisions on their behalf, provided written consent. In addition, the authors had to receive special approval from controlling bodies before commencing the study. Toots et al. (2019) presented their project to the Regional Ethics Review Board in Umeå, Sweden, while Brett et al. (2021) got approval from the host organization, Macquarie University, Australia.
Conclusion
Overall, one can argue that quantitative studies confirmed the efficacy of physical exercise-based interventions in geriatric patients. At the same time, the interventions’ positive effects may not be universally related to a flat fall rate reduction. Instead, the patients may become more resistant to potential injuries or achieve progress in various physical performance categories. Regardless, quantitative studies pointed to the overall usefulness of physical exercise in older adults. However, a systematic review of RCTs seems to be a more reliable foundation for concrete conclusions on exercise-based interventions’ effectiveness in terms of fall prevention.
References
Bjerk, M., Brovold, T., Skelton, D. A., Liu-Ambrose, T., & Bergland, A. (2019). Effects of a falls prevention exercise programme on health-related quality of life in older home care recipients: A randomised controlled trial. Age and Ageing, 48(2), 213-219. Web.
Brett, L., Stapley, P., Meedya, S., & Traynor, V. (2021). Effect of physical exercise on physical performance and fall incidents of individuals living with dementia in nursing homes: A randomized controlled trial. Physiotherapy Theory and Practice, 37(1), 38-51. Web.
Oliveira, J. S., Sherrington, C., Paul, S. S., Ramsay, E., Chamberlain, K., Kirkham, C., O’Rourke, S. D., Hassett, L., & Tiedemann, A. (2019). A combined physical activity and fall prevention intervention improved mobility-related goal attainment but not physical activity in older adults: A randomised trial. Journal of Physiotherapy, 65(1), 16-22. Web.
Patti, A., Zangla, D., Sahin, F. N., Cataldi, S., Lavanco, G., Palma, A., & Fischietti, F. (2021). Physical exercise and prevention of falls. Effects of a Pilates training method compared with a general physical activity program: A randomized controlled trial. Medicine, 100(13), e25289. Web.
Toots, A., Wiklund, R., Littbrand, H., Nordin, E., Nordström, P., Lundin-Olsson, L., Gustafson, Y., & Rosendahl, E. (2019). The effects of exercise on falls in older people with dementia living in nursing homes: A randomized controlled trial. Journal of the American Medical Directors Association, 20(7), 835-842. Web.