Identifying Clinical Question
In older adults (patient population), how does falls prevention exercises (intervention) compared with environmental modification (comparison) affect falls (outcome) after one months of treatment (time frame)?
Describing Clinical Problem
Falls in older adults is a clinical problem because the most common cause of traumatic injuries in older age groups is falls syndrome. In addition, it can cause sudden death in 70% of cases in patients over 75 years of age (Adam et al., 2020). A fall is an incident in which a person suddenly finds himself on the ground or on another low surface, except in cases resulting from a blow, loss of consciousness, sudden paralysis or an epileptic seizure. In the international classification of diseases, the fall occupies 19 points, which is quite a lot, 11 of them are falls from the height of their own growth (Finnegan et al., 2019). The fall belongs to the class of external causes of morbidity and mortality. There is a high risk of falling in people who are in an upright position for a little, no more than 4 hours a day, and also cannot sit down and stand up without assistance (Booth et al., 2020). Falling, as a rule, takes 1-2 seconds, losing balance is necessary to minimize injury (Kendhapedi & Devasenapathy, 2019). Preventing injuries, falls, and injuries in old age is an extremely important clinical outcome, as it will increase the quality and duration of life.
The physiological factors caused by age, which can lead to falls, include the following. These are orthostatic hypotension syndrome, vasovagal syncopal condition, cerebral circulation disorder, arterial hypertension with the development of hypertensive crises or a violation of cerebral or coronary blood flow. A decrease in muscle mass, changes in the configuration of the hip, a shift in the center of gravity, an increase in instability, a decrease in reflexes, an increase in reaction time, a balance disorder, cognitive impairment, a depressive symptom are additional characteristics and cause the development of gait changes (Pighills et al., 2019). In women, the risk of fractures is higher, due to the development of osteoporosis, which shows the need to prevent falls and optimize medical and social prevention and rehabilitation programs (Pighills et al., 2019). Injuries pose a particularly serious threat to the health and life of elderly people. The effect of all these factors can be reduced with the help of such clinical practice as falls prevention exercises, which is due to the opportunity of this intervention.
In old age, it is especially important to improve the work of the higher parts of the nervous system with the help of gymnastics, to fight age-related atrophy and the weakening of muscles that do not work well under normal conditions, to help the movement of blood and lymph, to improve breathing and metabolism (Booth et al., 2020). It is moderate gymnastics that helps an elderly person to remain active, prevent a number of diseases and significantly improve overall well-being. A restorative set of exercises for the elderly is a set of the simplest physical elements that raise the tone, but at the same time do not bring discomfort. Regular exercise performance leads to improved blood flow and oxygen metabolism (Finnegan et al., 2019). Moreover, a person’s musculature strengthens, muscle tissue atrophy slows down, the work of the vestibular apparatus normalizes, and overall coordination improves (Kendhapedi & Devasenapathy, 2019). Maintaining the mobility of the articular tissue is also one of the factors that have a beneficial effect on preventing falls as a result of performing special gymnastics.
Article That Supports Nursing Interventions
The article the best supports nursing interventions for my topic is Finnegan’s work considering the factors that enable elderly patients to continue performing preventive exercises against falls (Finnegan et al., 2019). Compared to the article by Adam et al. it pays more attention to diseases that lead to a fall. Article by Adam et al. considers multimorbidity, and how exercises affect multiple pathology in one patient, all the properties and characteristics of pathology and the patient themselves (Adam et al., 2020). The article considers the painful state of an elderly person’s body caused by a variety of pathological processes, not all of which are direct causes of the fall (Adam et al., 2020). All combined pathological conditions in one patient are not considered comprehensively, as a single suffering of the patient. Therefore, in the work of Adam et al. it is more difficult to distinguish whether the performance of physical exercises has a positive effect directly on the prevention of falls.
Compared to Booth’s article, Finnegan’s article looks at a broader sample. Finnegan considers a very wide range of problems leading to falls (Finnegan et al., 2019). Among them are many internal factors contributing to falls, which may be associated with impaired function of the cardiovascular system, musculoskeletal system, vision, motor, somatosensory, cognitive functions. The falls, which are often the culmination of an imbalance, Booth associates more with a violation of cognitive functions, and explores them (Booth et al., 2020). In particular, Booth et al. only two groups of factors are considered: falls associated with episodic cognitive dysfunction, and falls associated with permanent cognitive dysfunction (Booth et al., 2020). Therefore, Finnegan’s work is more complete than Booth’s article regarding the effect of exercise on factors of different groups leading to a fall.
The study of Kendhapedi and Devasenapathy combines both environmental assessment and the level of physical activity of older people (Kendhapedi & Devasenapathy, 2019). However, at the same time, scientists do not contrast these factors, considering them as components of one whole according to the fall prevention program (Kendhapedi & Devasenapathy, 2019). Falls in old age and senility are caused by a complex mutual interaction of biological and environmental factors, which are difficult to distinguish based on the work of Kendhapedi and Devasenapathy (Kendhapedi & Devasenapathy, 2019). The Finnegan et al. study allows to separate environmental assessment factors and the level of physical activity of older people from each other, evaluate and compare their impact (Finnegan et al., 2019). In addition, the cross-sectional study of Kendhapedi and Devasenapathy has a very narrow sample. They conduct observations exclusively on citizens of India, which is a specific location (Kendhapedi & Devasenapathy, 2019). The sample in Finnegan’s work is broader, and allows us to draw more universal conclusions.
A study by Pighills et al. focuses on environmental assessment and modification as ways to prevent falls in the elderly. It does not affect the evaluation of the effectiveness of preventive exercises, which is an important component of this study (Pighills et al., 2019). The risk factors of falls in this work are determined by the external interaction of a person and the environment. These include, for example, environmental features, such as insufficient or excessive lighting of the room; uneven, slippery floors and stairs (Pighills et al., 2019). Among the recommendations of scientists, there is no preventive gymnastics, but only the correct selection of shoes and clothing and auxiliary devices or means of transportation (Pighills et al., 2019). In a study by Finnegan et al. the internal factors of falls are considered, which can also be influenced by a person (Finnegan et al., 2019). Therefore, this article is the best one to answer the question chosen by PICOT research, since it examines both methods of interventions, allowing them to be compared.
References
Adam, L., Moutzouri, E., Baumgartner, C., Loewe, A. L., Feller, M., M’Rabet-Bensalah, K., Schwab, N., Hossmann, S., Schneider, C., Jegerlehner, S., Floriani, C., Limacher, A., Jungo, K. T., Huibers, K. J., Streit, S., Schwenkglenks, M., Spruit, M., Dorland, A. V., Donzé, J.,… Rodondi, N. (2020). Rationale and design of optimising therapy to prevent avoidable hospital admissions in Multimorbid older people (OPERAM): A cluster randomised controlled trial. BMJ, 9(6), 1–13.
Booth, V., Harwood, R., Hancox, J. E., Hood-Moore, V., Masud, T., & Logan, P. (2020). Motivation as a mechanism underpinning exercise-based falls prevention programmes for older adults with cognitive impairment: A realist review. BMJ, 9(7), 1–4.
Finnegan, S., Bruce, J., & Seers, K. (2019). What enables older people to continue with their falls prevention exercises? A qualitative systematic review. BMJ, 9(e026074), 1–9.
Kendhapedi, K. K., & Devasenapathy, N. (2019). Prevalence and factors associated with frailty among community-dwelling older people in rural Thanjavur district of South India: A cross-sectional study. BMJ, 9(e032904), 1–13.
Pighills, A., Drummond, A., Crossland, S., & Torgerson, D. J. (2019). What type of environmental assessment and modification prevents falls in community dwelling older people? BMJ, 364(l880), 1–4.