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An investigation of a clinical governance or clinical practice issue Essay Example

  • Category:
    Nursing
  • Document type:
    Assignment
  • Level:
    Undergraduate
  • Page:
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    1524

Importance of Falls Risk Assessment as a Falls Prevention Strategy in Older People

Introduction

Falls cause significant harm among the elderly. The rate of falls is high and so are the costs associated with treating injuries resulting from falls (Phelan et al, 2015). Therefore, falls have been identified as a national safety and quality issue. Prevention of falls is one of the key pillars of clinical governance in order to ensure there is delivery of safe and quality healthcare. Falls risk assessment has been identified as one strategy of preventing falls. Assessment of older individuals for their risk of falls is vital because after the risk assessment multi-factorial interventions are implemented basing on the identified risk factors (Milos et al, 2014). After performing falls risk assessment, the identified contributing factors to an individual’s risk to falls can then be addressed using a personalized plan that focuses on preventing falls (Goodwin et al, 2014). Therefore, this paper aims to critically appraise five journal articles that primarily focus on prevention of falls among the elderly people.

Background

Falls are the leading cause of injuries that result to hospitalization among the elderly people and they are among serious clinical problems that the elderly people face. Goodwin et al (2014) explains that falls cause significant mortality and morbidity and are major contributors to immobility and early placement in nursing homes.

Falls have numerous precipitating causes and predisposing factors and this makes diagnosing, treating and preventing falls a clinical challenge. In addition, falls among the elderly have multi-factorial and interacting predisposing and precipitating causes such as tripping over something on the floor because of factors such as poor vision and gait disorder (Commonwealth of Australia, 2009). These are some of the factors that make the elderly people susceptible to falls and hence high incidence of falls in this population. According to Commonwealth of Australia (2009) in Australia 39 percent of women aged above 65 years experience one or more falls in one year. The same study found out that 40% of women in New Zealand and 28% of men had a fall within a year. The overall incidence rate of falls among the elderly in Australia is approximately 35% (Commonwealth of Australia, 2009).

Therefore, in regard to the high rate of falls among the elderly and the allied adverse health and cost consequences, it is important to indentify effective interventions to prevent falls and fall-related injuries among the elderly.

Literature Critique

The appraisal tool used in appraising the five journal articles is Mixed Studies Review (MSR). This tool is commonly used in appraisal of the methodological quality of qualitative, quantitative and mixed methods studies. This tool was preferable because the five articles were varied in regard to the methodologies.

El-Khoury et al (2013) performed a systematic review and meta-analysis of randomized controlled trials. The literature search was conducted from Cochrane Library, PubMed, Embase, and CINAHL to locate pertinent studies. The inclusion criterion was English or French papers, RCTs, and had to be relevant to the study topic. Personal contacts with experts were sought and they analyzed the included studies. There was quality-control of all included studies. The presentation of the results is clear and precise. Generally the rigor of methodology in this systematic review and meta-analysis is extremely good and creditable.

Shaw (2007) is a systematic review of studies on preventing fall in elderly people with dementia. There was no bias during the location and selection of studies used in the article. The review also followed the planned study protocol and hence the validity and relevance of the study was not affected. In addition, adequate article were reviewed. However, there is no inclusion and exclusion criterion for the selection of the studies and the review does not indicate the method used in locating the reviewed studies. Generally, this systematic review meets most rigor elements and hence the methodology rigor is strong and good.

Goodwin et al (2014) conducted a systematic review and a meta-analysis on fall prevention strategies among the older population. This study included all published and unpublished materials. Enough studies were reviewed and quality-control of studies included. The presentation of the results is also clear and precise and was done using table presentation. Experts were sought to analyze the included studies. A planned study protocol was followed. There was a stringent inclusion criterion and all studies had to satisfy the criteria to be included. All included studies were appraised with the Cochrane risk of bias tool in order to avoid bias. The presentation of the results is clear and precise. Generally the rigor of methodology in this systematic review and meta-analysis is extremely good and creditable.

Phelan et al (2015) conducted a systematic review on the assessment and management of fall risk. Enough studies were reviewed and the study protocol adhered to. However, the study did not indicate the inclusion and exclusion criterion of the reviewed studies. Also there is no indication whether experts were contacted to perform the analysis. The presentation of the results is clear and precise. The rigor of the methodology is average because the study fulfilled relatively met rigor elements.

Milos et al (2014) conducted a cross-sectional study on falls risk among the elderly. The study participants were randomly allocated to the intervention and an acceptable method of randomization (computer-generated) was used. Confidentiality was observed and informed consent was sought from all study participants. Ethical approval was also sought. Student’s t-test and Fischer’s exact test were used in data analysis and these are renowned data analysis tools. The presentation of the results is clear and precise. Generally the rigor of methodology in this cross-sectional study is extremely good and creditable because the methodology fulfils most of the rigor elements.

Findings

According to Phelan et al (2015), fall risk assessment is a very important tool in preventing falls among the elderly. A fall risk assessment encompasses a falls history, reviewing medication, physical examination as well as functional and environmental assessments. Milos et al (2014) supports this and explains that fall risk assessment can identify factors such as contributing medications to falls and hence these medications can be reviewed. Shaw (2007) also adds that interventions such as reviewing medication for older people susceptible to falls and identifying all other risk factors to falls are very important in preventing falls. Risk factors to falls can be adequately identified by conducting an effective falls risk assessment (El-Khoury et al, 2013).

Goodwin et al (2014) found out that multiple component interventions used in preventing falls are effective in decreasing the rate of fall as well as the number of people that fall. The study further adds that in order to implement the multiple component interventions, it is important to first perform a comprehensive fall risk assessment in order to find out an individual’s risk to fall and then implement individually tailored interventions to prevent the falls. This is in line with Milos et al (2014) who emphasizes that fall risk assessment is effective in preventing falls because all risk factors are identified and appropriate interventions implemented. El-Khoury et al (2013) also supports this and explains fall risk assessment can be used to identify the suitable fall prevention programmes to prevent falls in older adults.

However, according to Goodwin et al (2014) multi-factorial risk assessment is the most effective strategy in preventing falls. Multi-factorial falls risk assessment followed by appropriate interventions is the most effective way of achieving higher success rate for falls prevention programs (Goodwin et al, 2014). This is because during risk assessment risk factors as well as any person who is at risk for falls is identified and the appropriate preventative interventions used to prevent falls. Since nurses are the primary healthcare providers involved in fall risk assessment, it is important to train nurses on how to perform the risk assessment using the required assessment tools.

Reference List

Commonwealth of Australia, 2009, Preventing Falls and Harm From Falls in Older People Best Practice Guidelines for Australian Community Care, Commonwealth of Australia.

El-Khoury F, Cassou B, Charles M & Dargent-Molina, 2013, The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials, MBJ, vol. 1, no, 347, pp: 1-10.

Goodwin V, Abbott R, Whear R, Bethel A, Jo T & Stein K, 2014, Multiple component interventions for preventing falls and fall-related injuries among older people: systematic review and meta-analysis, vol. 14, no. 15, pp: 1-8.

Milos V, Bondesson A, Magnusson M, Jakobsson U, Westerlund T & Midlov P, 2014, Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care, BMC Geriatr, vol. 14, no. 40.

Phelan E, Mahoney J, Voit J & Stevens J, 2015, Assessment and Management of Fall Risk in Primary Care Settings, Med Clin North Am, vol. 99, no.2, pp: 281–293.

Pluye P, Gagnon M, Grifiths F & Johnson L, 2009, A scoring system for appraising mixed methods research, and concomitantly appraising qualitative, quantitative and mixed methods primary studies in Mixed Studies Reviews, vol. 46, no. 4, pp: 529-546.

Shaw F, 2007, Prevention of falls in older people with dementia, J Neural Transm, vol. 1, no. 114, pp: 1259–1264.