Literature Review Fall Prevention, Research Paper Example

Outline

Introduction

• Results of search activity
• Selection of the key papers according to the hierarchy of evidence

A critical discussion of relevant research literature

• Introduction and purpose
• Research questions
• Methodological approaches
• Results
• Conclusions

Conclusion

• Literature Review – Matic and integrated approach

Literature Review

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 – Multi-intervention; 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- comparison 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.

Results of search activity

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

http://google.com/scholar

http://www.pubmed.gov

http://ijahsp.nova.edu/

Summary of search results activity and selection of

Key papers according to hierarchy of evidence

As could have been observed key terms multicomponent 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

Critical discussion of relevant research literature

Study 1

Introduction and Purpose

The first study ‘A Multifactorial Intervention to Reduce the Risk of Falling among Elderly People Living in the Community ‘by Mary E. Tinetti, Dorothy I. Baker, Gail McAvay, Elizabeth B. Claus, Patricia Garrett, Margaret Gottschalk, Marie L. Koch, Kathryn Trainor, and Ralph I. Horwitz aimed at providing evidence that a multifactorial approach to fall prevention is appropriate based on the predisposing factors underlying this phenomenon (Tinetti et.al, 2004).

These researchers identified risk factors such as muscle weakness; medications and balance impairment to be the leading causes associated with falls in the elderly. Further, they provided the reader with a brief epidemiology of falls among this vulnerable age group relating that approximately 30% of people over 65 who live in the community fall frequently and it is the sixth leading cause of death among this age group. Besides, the acute cost of caring for the elderly due to falls, accounts for approximately $10 billion of the health care budget annually. Hence, the significance of falls among the elderly being a public health issue (Tinetti et.al, 2004).

Research questions

The research questions contained in this study were not explicit, but implied. They can be worded, what is the effectiveness of the multifactorial targeted risk-abatement strategy in reducing the risk of falls among elderly persons in the community? A second implicit research question can be identified as how effective is multifactorial strategy in altering the targeted risk factors themselves (Tinetti et.al, 2004).

Methodological approaches

• Research Design:-

Researchers did not distinctly state their design strategy in this report. However, it was observed to be a mixed method adapting elements of both qualitative and quantitative dimensions of scientific research. A controlled experiment was used where by subjects were selected and applications made overtime in evaluating the effectives of a treatment. Precisely, it can be described as an experiment case study design.

Experiments are used in designed where the research seeks to test or measure the effect of a process or product upon human subjects. This was clearly the case in this situation. The case study feature was highlighted in the descriptive nature of findings derived from the experiment conducted on groups of subjects (Yin, 2009).

Qualitative research seeks to gather data in order to develop in-depth knowledge of human behavior regarding a phenomenon. It goes beyond investigating when and where towards why and how as being explicit in this study (Denzin & Lincoln, 2005). Quantitative research employs empirical strategies involving statistical calculations in arriving at evidenced based findings. The objective is to develop mathematical models, hypotheses and theories. Statistical measurements were used in this study in calculating mean, median scored as well as determining standard deviation (Denzin & Lincoln, 2005).

• Sample :-

This was recruited from a population of 2522 enrollees of a health maintenance organization (HMO) in southern Connecticut. They were at least 70 years old. Sixteen of the 17 eligible physicians who cared for at least 100 of these enrollees agreed to participate. These 16 physicians were frequency-matched into four groups of 4 physicians each, on the basis of their high or low scores on two measures — namely, the number of people at least 70 years of age among their patients (>150 vs. ? 150) and the mean number of new prescriptions written per office visit (? 1 vs. <1)19. A control group was sample was used in this design. Two of the physicians in each group of four were randomly assigned randomly to the control group, and two to the intervention group. Enrolled subjects were assigned to the same study group as their physicians. 20 subjects became eligible for participation from the speculated population (Tinetti et.al, 2004).

• Inclusion/exclusion criteria:-

To be eligible subjects had to attain 70 years and over; reside outside of a nursing home; not enrolled in any similar study and obtain a score of at least 20 on the Folstein Mini-Mental State Examination (Tinetti et.al, 2004).

• Data Collection Procedures:-

This embodied development of assessment and intervention protocols targeting risk factors related to falls and intervention measures adapted to address these needs. Baseline assessments were conducted in participants’ homes. A nurse practitioner gathered demographic data, falls history, and data regarding depressive symptoms; chronic diseases, as well as independence level in daily activities. Subsequently, the Falls Efficacy Scale measurement was applied in ascertaining degrees of confidence while performing normal activities inclusive of walking/climbing fall incidences (Tinetti et.al, 2004).

Ambulation and mobility subscales of the Sickness Impact Profile were also used in the data collection process. Corrected near hearing and vision assessments was also a vital aspect of the data collection process. Names and dosages of all prescription and nonprescription medications were recorded from the containers holding them. Finally, a collection of hazards were defined through an examination of every room; pathways leading to and from them, stairs and furniture (Tinetti et.al, 2004).

One week after the physical therapist followed up to obtain further risk assessment data regarding muscle strength and balance. Subsequent multifactorial fall preventive measures were administered to the intervention group and the control just obtained regular visits to further asses how they were coping with their own fall prevention strategies (Tinetti et.al, 2004).

• Instruments: These were structured interviews and treatment

• Data Analysis:

Log-rank test; randomized tests and interaction of covariates test were among the statistical application utilized in interpreting data collected from this experiment.

Results

‘There was a significant difference between the intervention and control groups in the length of time to the first fall (P = 0.05) and in the proportion of subjects who fell (35 percent vs. 47 percent, P = 0.04); the crude incidence-rate ratio for falls in the intervention group as compared with the control group was 0.64 (95 percent confidence interval, 0.49 to 0.83). The risk reduction associated with the intervention was maintained in multivariate analyses in which age, sex, previous falls, and number of risk factors, as well as the week of follow-up for the incidence-rate ratio was adjusted’ (Tinetti et.al, 2004, p. 823).

Conclusions

According to researchers unlike many other studies the targeted intervention groups showed a reduction in falls in comparison to the control group (Tinetti et.al, 2004, p. 823).

Study 11

Introduction and purpose

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 where older adults reside.

Research questions

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)

Methodological approaches

• Research design:-

This entailed 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:-

These researchers developed 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).

• Instrumentation and Data Analysis :-

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.

Results and Conclusions

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).

Conclusion

Literature Review – matic and integrated approach

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 of researched material demonstrated this writer’s ability to adequately complete these duties mentioned in the previous paragraph. Two research studies were highlighted in the critical discussion of relevant research methodology, results and conclusions. Adapting a matic integrated approach it was revealed that these two studies contained appropriate evidence based material indicative of answering the PICO question how can older adults benefit from multifactorial intervention based strategies in fall prevention as against when multi-component support measures. From the findings in this literature review both pieces of literature concluded that a multifactorial model of fall prevention is most effective when conserving the supporting 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

Tinetti, M. Baker, D. McAvay, G. Claus, E. Garrett, P.Gottschalk, M. Koch, M. Kathryn

Trainor, L. , &. Horwitz, R. (2004). A Multifactorial Intervention to Reduce the Risk of Falling among Elderly People Living in the Community. N Engl J Med 331, 821-827

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

Links to studies used:- http://www.rehab.research.va.gov/jour/08/45/8/pdf/costello.pdf http://www.nejm.org/doi/full/10.1056/NEJM199409293311301#t=articleBackground