Fall Precaution in the Elderly Patients

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FallPrecaution in the Elderly Patients

FallPrecaution in the Elderly Patients

Mostof the elderly falls occur around their homes or at nursing carehomes. Falls have been known to cause severe functionality outcomesincluding disability, fragility, critical and long-lasting healthcomplications as well as death. In most cases, these falls areusually associated with several risk factors such as unbalanced gait,general weakness, confusion, or while on certain treatments andmedications. In the US alone, among the mortality rates, at leasttwo-thirds are as a result of falls among the older population of ageabove 65 years (NCBI, n.d). Likewise, approximately 200,000 patientshave joints fractures or related serious injuries among the agedpopulation of above 65 years of age (NCBI, n.d).Preventive measuresof falls must revolve around the spectrum of the health states andthe ages of the population, and should explicitly address the varietyof the different causes without diminishing one’s quality of lifeand autonomy.

Somerisk factors which are intrinsic have been observed in controlledstudies which permit for the determination of those exposures and toinitiate possible preventive measures strategies. The olderpopulation with several health complications is especially atincreased risk. Existing discussion and studies concerning origin orcause of postural inability and falling remains to be narrow as thereexists limited information on the effectiveness of the interventionsto prevent falls. Recognizing those risks, whether environmental orotherwise at homes and in the nursing care facilities could, in agreat way, help to prevent the many falls resulting fromenvironmental causes. In the cases of medical risk factors, propermedical evaluations should be conducted to minimize the adverseimpacts on the related falls (Ungar et al., 2013). Additionally,other effective interventions programs can be applied, such asmodifying the potential environmental hazards, use of support toole.g. walkers and sticks, and use of hip protectors, among others.

SystematicReview of Randomized Trials/RCTs

TheWHO terms the clinical trials as that research study that samplesindividual respondents to one or more health-related interventions toexamine its effects on the overall health outcomes. On the otherhand, randomization is the method of applications of projects forinterventions or to allow further comparisons. All randomizedclinical trials (RCTs) are regulated by a protocol (Ellis, 2013).However, several studies have been subjected to standardsdeficiencies. Reporting rules are established to improve the contentof the research reports necessary to maximize the utility to therelevant stakeholders. The primary objective of the RCT systematicreview is to help in describing the regularity and the strategies ofthe randomized control trials while addressing the fall precautionsin the elderly population (NCBI, 2011). The purpose was to identifythe extent to which the RCTs have been applied in research methodsamong the elderly population in to determine the different types ofthe falls and safety precautions, as well as to examine the relevanceand the applicability of the randomized clinical trials among theelderly patients (NCBI, 2011).

Thereview of the study will entail exclusive and in-depth research informs of electronic or any other related media – print or otherwisespanning within the last five years. The study conducted in thevarious databases were from the MEDLINE, PubMed, NCBI, NationalInstitute of Health, psychological abstracts, social work andservices abstracts, health related journal and article features,supplementary sources, etc.(Saini, 2013). Those studies that wereincluded in the systematic review had to satisfy that they addressedthe health problems of the aged, incorporated a formal description ofresearch methodologies and outcomes, and were able to apply the RCTsto compare the health outcomes upon an intervention while using acontrol group (Ellis, 2013).

Severalstudies were found to meet the inclusion norms and conditions. Theywere able to address concerns including health costs, challenges, andrelated injuries after falls among the older people, the possiblerisk factors, and their causes, and the precaution measures (Child etal., 2012). The developed results in this systematic review of therandomized clinical trial of the fall precautions within the elderlypersons prove to show that there exists no standardized method andapproach for addressing the issues and that there is considerableinconsistency across the various studies. Considering the importanceof the RCTs in improving the health, safety and the wellness of theelderly persons, it is worth to formulate efficient and effectivestandards and policies that will specifically address the mattersthat are essential to performing RCT among the seniors. These effortswill help to clarify false impression, uncertainties, and any issuesraised thus making it more feasible to conduct random clinical withinthe elderly to better form approaches that will aid to combat fallsamong the elderly.

TheRCTs of fall precautions interventions are relatively considered tobe of high importance. As such, some agencies, including the NationalInstitutes of Health have geared up to aid and sponsor programs andentities of those conducting research, at the same time, muchconsideration should be given to ensure adequate funding to supportlarge numbers of RCTs programs(Child et al., 2012). As a result, theproposed invention clinical trials should provide sufficientinformation as to the effectiveness of the distinct treatmentelements through putting emphasis on either a single element or whenmultiple intervention programs are applied. These clinical trialsshould be performed within the community or an institutionalizedsetting.

Thecreation of a randomized clinical trial elderly population controlledmodel will be composed of new protocols for performing RCT with theolder people so that they can actively participate and contribute tothe research process. For the necessary controls to be attainedwithin the RCT designs, the participants must be actively involved inthe research process. The entire planning procedures of the RCT mustbe cautiously measured for importance and pertinence to thecommunity. Where necessary, the researchers should also providesufficient information regarding the overall costs and the benefitsof the program

SingleRandomized Trial/RCT

Fallshave been considered to pose a significant risk to the older people.As the numbers of the elderly population rises, fall incidences willcontinue to increase the demand and the burden on health caresystems. As such, it has been found that exercises will efficientlyreduce the numbers of fall accidents. From the PMC article, actionseniors, the Otago exercise program (OEP) was initiated as aprincipal intervention for fall prevention (Liu-Ambroseet al.,2015). An RCT was carried out to gauge the effectiveness andcompetence of the program for the prevention of falls among the olderpeople. Four clinical samples were selected based on age. Among thetrials done, only one delivered significant results.

Arandomized control trial was performed on 344 elderly persons whoregularly attended the falls prevention exercise to evaluate theeffectiveness and the cost efficiency for about one year (Liu-Ambroseet al., 2015). The participants were to be assigned to the OEP groupor the care group in the ratio of 1:1. The participants that wererandomized to the control group must continue to act in the same waythey did before the study program. The entire exercise will bemeasured in three parts i.e. at baseline, in 6 months and 12 monthsalthough there will be monthly reviews (Liu-Ambroseet al., 2015). With the increased health and financial problems as aresult of falling, the designed RCT could have significantly affectedthe health of the elderly and the health care systems in Canada.

SystematicReview Correlations/ Observational Studies

Forlong term results, experimental studies may not be appropriate thus,observational studies are more suitable to gather supplementaryevidence. In practice, many therapies and related remedies have beenanalyzed in health care facilities using observational studies wherea group of patients is followed through for a specific period eitherfrequently or on occasions. However, there are criticisms to thisapproach as possibilities of confounding can lead to a partialprediction of the impact of the treatments. Observational studies arenot responsible for the unknown confounders. However, new statisticalapproaches have been known to improve the assessments of thetreatment effects.

Adequatesupport should be warranted for the observational studies of fallingto expand our knowledge for the future improved intervention programdesigns through amassing the understanding of the original componentsof falling and the connections that exist within the risk factors.The main aim of this study is to develop the outcomes of theobservational studies to evaluate the effectiveness of interventionsfor falling accidents and also to determine whether clinicaleffectiveness alters risk factors of falling among the olderpopulation of above 65 years. With reference to Balzer andcolleagues, they conducted research to analyze the clinicaleffectiveness with relation to tests for evaluation of fall risk(Balzer, 2012).

Sixteenobservational studies and a cluster RCT were performed whilereferring to the clinical effectiveness of 30 tests and parametersfor the fall risk evaluation. Provided the test was aimed atidentifying persons at increased risk of falling the instructivebenefits were quite minimized. The internal legitimacy of the studywas conceded by bias due to the unclear autonomy of the index and thereference testing (Balzer, 2012). In contrast, the outcomes of thecluster RCT concluded that the implementation of the rating scale forthe risks of fall evaluation was not able to reduce fall accidents aswell as to maximize on the use of preventive measures.

SingleCorrelation/Observational Studies

Observationalstudies were conducted among the older people whom their medicationuse were recorded and documented. Despite encountering majorchallenges with the observational studies, meta-analysis will aid tomake some generalizations and conclusions which are necessary toallow effective conclusion comparisons with those of the randomclinical trials. The review on the patient’s medication usage hasan impact on the risk of fall among the older people. Psychotropicprescriptions that were associated with falling incidences werescrutinized. An example is based on the RNAO article, anobservational cohort study was carried out, and a total of 2,430nursing care facilities were reviewed (RNAO, 2011).

Theparticipants were compared as per the users of antidepressant and thenon-users. Trazodone, tricyclic medications, and selective serotonininhibitors were observed to multiply the chances of falls rate bydoubles the rate growth was attributed to the drug responserelationship. In addition, the rates of falling were noted toincrease as the dosage was increased for the tricyclic drugs and theserotonin inhibitors. When these prescriptions were intended to treatdementia rather than depression, the effect was a rise in the fallsrate. This led to the conclusion that when the older people takepsychotropic medications i.e. ≥ five medications contributes to agreater risk of falling (RNAO, 2011).

SystematicReview of Descriptive/Qualitative /Physiological Studies

Thisis a review of the study in which it only measures an experience orpersonal biological components (Ellis, 2013). Controlling andpreventing falls has been categorized as a global health priority. Tounderstand why the previous research failed, a system review shouldbe done to determine the effectiveness of the recommended program. Anexample is a case where Sue et al., (2012), conducted a literaturereview that was published between the years 1980 through 2012 for thequalitative study which analyzed the obstacles and the facilitatorsof successful implementation of the intervention of the fallprevention among the elderly and the health care practitioners. Atleast two assessors were involved with independent checks of thestudies for the collected data, additions, and evaluation of qualityto predefined standards. The findings were that the factors behindthe effective execution of prevention program were deemed intricatewith no solitary element being recognized as the primary facilitator.

SingleDescriptive/Qualitative/Physiologic Study

Sueet al, (2012), performed an evaluation of various studies where itwas shown to provide minimal evidence about the instruments throughwhich hindrances to a successful application of the fall deterrencehad been restrained. The blend of data offered three predominantmodels namely the concrete considerations, the psychosocial, and thefamiliarizing for the community. In the line of argument mix, itoutlines the obstacles and the facilitators for the implementation ofthe prevention program. These models tend to show that theimplementation of prevention programs is relatively more complicatedand multi-factorial.

Opinionsof Authority, Expert Committees

Theopinions of the authorities and the committee experts are defined asthose individuals that are qualified and skilled in a certain areaand are amassed with vast knowledge, understandings, and analysis(Spiva, n.d). To improve the intervention of fall preventions, thevalues, and behaviors at the personal, organizational and communitylevels need to be redressed. One recommendation suggested by theNational Research Institute of Medicine the use of E-codes in themedical records (RNAO, 2011). As such, this would aid to track thenation’s health goals, the overall performance of the analyticalstudies as well as the assessment of the effectiveness of theproposed intervention programs. Implementation of this project wouldbe of great beneficial to a wider range of injury studies and themanagement activities. It is high time that we conduct and implementquality education and services to the community. It would beessential for the public and private sector organizations to supportthe community-based programs and projects to prevent injuries andfalls.

Aspart of the programs, methods for coordinating and mobilizing newcommunity injury control tools and resources like creating tradeworkers, involving retired firefighters, etc., should be carefullyestablished and analyzed. The public education and training plansshould engage both the community and the elderly persons and shouldbe aimed at addressing relevant information on matters concerning therisk factors of falling, sources of assistance to reduce emanatingrisks and ways to manage these risks (Ungar et al., 2013). Theactivities applied should make use of the media both print andotherwise to reach a broad audience.

Similarly,numerous authors are advocating for more research on the issues offalls prevention. Further research on the falls prevention in thenursing and health care facilities is suggested, provided that it ismeant to develop interventions that will be readily reliable tominimize the cases of falls, and should also be related to the sickolder persons with compromised cognitive skills. Lastly, systems foreffective monitoring of falls and injuries must be broad, simple touse and properly coordinated with other structures within thehealthcare or nursing facilities. This implies that there must becontinuous feedback and action process on the outcomes just like withthe risk management and quality structures in organizations. Theseframeworks should also monitor specific risk factors including thefrequencies of injuries linked to falling and the related clinicalillnesses like the functionality ability.


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Child,S., Goodwin, V., Garside, R., Jones-Hughes, T., Boddy, K., &ampStein, K. (2012). Factors influencing the implementation offall-prevention programs: a systematic review and synthesis ofqualitative studies. ImplementationScience,7(1),1.

Ellis,P. (2013). Evidence-basedpractice in nursing.

Liu-Ambrose,T., Davis, J. C., Hsu, C. L., Gomez, C., Vertes, K., Marra, C., … &ampDonaldson, M. G. (2015). Action Seniors!-secondary falls preventionin community-dwelling senior fallers: study protocol for a randomizedcontrolled trial. Trials,16(1),1

NCBI.(2011). Clinical Research Methodology I: Introduction to RandomizedTrials.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2366892/

NCBI.(n.d). Falls in Older Persons: Risk Factors and Prevention.https://www.ncbi.nlm.nih.gov/books/NBK235613/

RNAO.(2011). Nursing Best Practice Guideline. Prevention of Falls and FallInjuries in the Older Adult.

Saini,M. (2013). A Systematic Review of Randomized Controlled Trials OfHealth Related Issues Within An Aboriginal Context.

Spiva,L. (n.d). WellStar Health System. Building Your Evidence Table.

Ungar,A., Rafanelli, M., Iacomelli, I., Brunetti, M. A., Ceccofiglio, A.,Tesi, F., &amp Marchionni, N. (2013). Fall prevention in theelderly. ClinCases Miner Bone Metab,10(2),91-5.

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