Applying the four elements of a statement according to PICOT format helps nursing researchers to formulate a question that would be easier to investigate using Evidence based Process (LoBiondo & Haber, 2017).

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Running head: EVIDENCE-BASED PRACTICES IN NURSING 1

 

EVIDENCE-BASED PRACTICES IN NURSING 6

 

 

 

 

 

 

 

 

 

 

Evidence-Based Practices in Nursing

Grand Canyon University

Class: NRS- 433V

 

 

 

 

Applying the four elements of a statement according to PICOT format helps nursing researchers to formulate a question that would be easier to investigate using Evidence based Process (LoBiondo & Haber, 2017). Regarding elderly persons, is implementing a program to prevent fall with normal care reduce the rate of falls in comparison to normal care? This problem statement follows the PICOT format with the exclusion of time as it is not applicable in this case.

P – In regard to elderly persons who falls

I – Program to prevent fall together with normal care

C – Normal care

O – Reduced rate of falls

Literature Review

1. Risk factors for falls among older adults: A review of the literature

Abstract

Falls are one of the major causes of mortality and morbidity in older adults. Every year, an estimated 30–40% of patients over the age of 65 will fall at least once. Falls lead to moderate to severe injuries, fear of falling, loss of independence and death in a third of those patients. The direct costs alone from fall related injuries are a staggering 0.1% of all healthcare expenditures in the United States and up to 1.5% of healthcare costs in European countries. This figure does not include the indirect costs of loss of income both to the patient and caregiver, the intangible losses of mobility, confidence, and functional independence. Numerous studies have attempted to define the risk factors for falls in older adults. The present review provides a summary and update of the relevant literature, summarizing demographic and modifiable risk factors. The major risk factors identified are impaired balance and gait, polypharmacy, and history of previous falls. Other risk factors include advancing age, female gender, visual impairments, cognitive decline especially attention and executive dysfunction, and environmental factors. Recommendations for the clinician to manage falls in older patients are also summarized.

2. The direct costs of fatal and non-fatal falls among older adults — United States

Abstract

This study sought to estimate the incidence, average cost, and total direct medical costs for fatal and non-fatal fall injuries in hospital, ED, and out-patient settings among U.S. adults aged 65 or older in 2012, by sex and age group and to report total direct medical costs for falls inflated to 2015 dollars.

Incidence data came from the 2012 National Vital Statistics System, 2012 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, 2012 Health Care Utilization Program National Emergency Department Sample, and 2007 Medical Expenditure Panel Survey. Costs for fatal falls were derived from the Centers for Disease Control and Prevention’s Web-based Injury Statistics Query and Reporting System; costs for non-fatal falls were based on claims from the 1998/1999 Medicare fee-for-service 5% Standard Analytical Files. Costs were inflated to 2015 estimates using the health care component of the Personal Consumption Expenditure index.

3. Older adults’ perceptions of technologies aimed at falls prevention, detection or monitoring

Abstract

This review provides an overview of older adults’ perceptions of falls technologies. We undertook systematic searches of MEDLINE, EMBASE, CINAHL and Psych INFO, COMPENDEX and the Cochrane database. Key search terms included ‘older adults’, ‘seniors’, ‘preference’, ‘attitudes’ and a wide range of technologies, they also included the key word ‘fall*’. We considered all studies that included older adults aged 50 and above. Studies had to include technologies related specifically to falls prevention, detection or monitoring. The Joanna Briggs Institute (JBI) tool and the Quality Assessment Tool for Quantitative Studies by the Effective Public Health Practice Project (EPHPP) were used.

4. Perspectives and Experiences Related to Physical Activity of Elders in Long-Term-Care Settings

Abstract

This qualitative study investigated individual and situational factors influencing physical activity (PA) practices of elders in residential-care/assisted-living (RC/ AL) communities. This article describes the results of focus-group interviews involving 47 residents across 6 RC/AL settings. Thematic analysis revealed 6 themes: staying active, past PA experiences, value of PA, barriers to PA, strategies to facilitate PA, and support needs to promote PA. Staying active meant walking indoors and out, attending chair-exercise programs, performing professionally prescribed home exercises, and using available exercise equipment. Past PA experiences shaped current preferences and practices. Participants agreed that exercise helped maintain physical functioning but recounted cognitive and situational barriers to PA. Lack of dedicated exercise space and short corridors hampered efforts to stay active. Participants wished for individualized home exercise programs and supervised exercise sessions. Future research should examine the extent to which the physical environment and PA programming in RC/AL communities affect elders’ PA

5. An Analysis of Patient Falls and Fall Prevention Programs Across Academic Medical Centers

Abstract

UHC conducted an analysis of more than 25 000 patient fall reports entered the UHC Patient Safety Net incident reporting tool. Gaps were found in the completion of fall risk assessments, the ability of tools to accurately assess risk, and prevention strategies inpatient units and emergency department. Common factors in falls resulting in major harm or death included age more than 80 years, altered mental status, ambulation (often without assistance), toileting, and diuretics and anticoagulants.

6. A qualitative study on the perceptions of preventing falls as a health priority among older people in Northern India

Abstract

Background in India, fall-related injury morbidity and mortality is an emerging public health problem in older people. Despite awareness of a growing burden, there is a scarcity of literature on effective and acceptable interventions. This study was undertaken to explore the perceptions of older people regarding the risk of falls and understanding of fall prevention programmes. We conducted six focus group discussions (FGDs), comprising single gender for three socio-demographic groups in a north Indian city, Chandigarh, in 2011. FGDs were conducted in local language (Punjabi), recorded, transcribed and translated in English. Two researchers independently conducted thematic analysis. Careful consideration of health priorities is required for development of falls prevention, particularly among the urban poor. Further, initiatives that foster community engagement, such as participatory action may increase acceptability of initiatives to prevent fall-related injury among older people in India

 

References

Ambrose, A. F., Paul, G., & Hausdorff, J. M. (2013). Risk factors for falls among older adults: a review of the literature. Maturitas, 75(1), 51-61.

Burns, E. R., Stevens, J. A., & Lee, R. (2016). The direct costs of fatal and non-fatal falls among older adults—United States. Journal of safety research, 58, 99-103.

Hawley-Hague, H., Boulton, E., Hall, A., Pfeiffer, K., & Todd, C. (2014). Older adults’ perceptions of technologies aimed at falls prevention, detection or monitoring: a systematic review. International journal of medical informatics, 83(6), 416-426.

Jagnoor, J., Keay, L., Jaswal, N., Kaur, M., & Ivers, R. (2013). A qualitative study on the perceptions of preventing falls as a health priority among older people in Northern India. Injury prevention, injuryprev-2012.

LoBiondo-Wood, G., & Haber, J. (2017). Nursing Research-E-Book: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences.

Phillips, L. J., & Flesner, M. (2013). Perspectives and experiences related to physical activity of elders in long-term-care settings. Journal of Aging and Physical Activity, 21(1), 33-50.

Williams, T., Szekendi, M., & Thomas, S. (2014). An analysis of patient falls and fall prevention programs across academic medical centers. Journal of nursing care quality, 29(1), 19-29.

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