Prevention of Falls in Elderly Care - Essay Example

PREVENTION OF FALLS IN ELDERLY CARE Literature Review Recurrent falls among the elderly are characterized by the degree of recurrence and therelative severity. For example recurrent falls are related to those consequent falls at least three times in a year. The available literature on the subject essentially focuses on co-morbidity as a factor that contributes both to the a priori and a posteriori elements in the process. Serious injuries and fractures occur in the elderly as a result of such falls though it is not necessary that such falls should result in fractures as of consequence. According to Masud and Morris the epidemiology of falls has been redefined to include such interventionist measure as constant monitoring of a patient's progress by healthcare professionals (Masud & Morris, 2001). The contributory factors according to the authors have been diverse and complicated. The risk assessment approach is based on the multicomponent risk determination and management strategy. According to Brown et al. (2005) there is a growing body of evidence to suggest that interventions which are effectively intended to prevent fall risk factors among elderly can be more result oriented. However the authors doubt the degree of prevalence of such evidence and its real impact on clinical practices and physical therapy. According to Brown et al, further there is a clear impact of the professional behavioral change on the related outcomes involving fall prevention programs among the elderly. According to a survey carried out by the authors among some physical therapists in Connecticut, USA, almost 91% of the respondents identified environment related risk factors, the gait and physical balance related deficits as the main fall risk factors. At the same time a remarkable feature of the survey was the fact that 82% of the respondents said that modern intervention techniques based on medication were responsible for effective prevention of fall among the elderly. In other words a systematic approach or strategy based on multi component change in behavior could produce better results. According to Haines et al. (2007) exercise programs intended to prevent falls could be clinically effective if well designed and managed. The authors carried out a randomized and controlled trial among elderly patients in sub acute hospital environment. The exercise based intervention was recommended to a selected group of participants. Their results showed a greater degree of improvement in the focus group while the control group participants had no any improvement. Yet again the authors admit that there were some significant differences in mobility and strength of participants alone with substantial presence of divergence in balance. According to recent research the risk factors of falls among elderly are not limited to old age only. For example female patients are more likely to have a fall than a mail patient (Barry et al. 2001). In addition to the above there are such factors as low weight, too much of self dependency, psychotropic medication, alcohol abuse, disturbed vision, disorders related to gait, diabetes, physical imbalance and environmental factors. However such extreme courses like hypotension and cognitive impairment cannot be determined with a realistic assessment. For example risk factors involved in falls among elderly can be basically related to physical disability arising from a variety of persistent weaknesses. Therefore habit forming behaviors might lead to falls that might become a pattern. The consequences of such falls have been identified as both mild and far reaching. For instance the current literature on the subject identifies the severity of falls along with their frequency to investigate the nature of outcomes. Weak bones in the elderly have been identified as one of the major causal factors for relative severity and frequency of falls. Falls that lead to fractures in the proximal femur, are often regarded as severe and mainly attributed to weak bones (Sherrington et al. 2007). Osteoporosis among elderly women is considered to be a major individual risk factor that results in frequent falls and fractures. Among much less known risk factors osteomalacia and Paget's disease are considered to be somewhat responsible as risk factors. The available literature on prevention strategies often advocates intervention. Clinical intervention apart on and off advice can be regarded as an effective technique though such advice might be misunderstood by the patient. Both the scope for and extent of prevention programs and strategies depend on a number of endogenous and exogenous variables such as environmental, psychological, physical, neurological, medical and visual impairment. Environmental factors have been identified by researchers to be the most negative by way of their extended impact on the individual. Thus prevention of falls among the elderly requires both primary and secondary intervention other than the clinical intervention. Environmental factors such as wet or slippery floors, electric shocks and floor mats can be effectively controlled and even removed through advice and direct intervention (Tideiksaar, 1997). However prevention of falls in the immediate environmental setting of the elderly patient can be highly unproductive if cognitive impairment persists. Similarly visual impairment and physical imbalance might put a constraint on the degree of freedom of the practitioner and therefore the scope for intervention by the practitioner, thus limiting the efficacy of intervention programs. Psychological, physical and neurological causal factors responsible for the falls among the elderly can be prevented through clinical intervention though according to recent research the degree of such prevention is ultimately determined by the extent of corporation given by the patient or the participant. For example alcohol abuse as a psychological factor might not be controlled if the participant in the clinical program happens to disregard advice (Arenson et al. 2009). Similarly physical imbalances lead to falls in uncontrolled circumstances such as low weight and extreme obesity. As for neurological factors clinical intervention must be both persistent and well articulated. Finally clinically intervention programs and advice based exercise related prevention programs have shown a greater degree of success in strictly controlled environments though as research suggest a recurring problem is the level of difficulty associated with identifying the extent of success primarily attributable to intervention only, be it clinical or non-clinical. Therefore this literature review would focus on the future possibilities of developing independent analytical tools to identify the efficacy of falls prevention programs while at the same time focusing attention on the complexity of causal factors irrespective of their origin (Kennie, 1993). Methodology This Chapter presents the research methodology utilised to analyse the research data and describes the various methods used in this study. This research paper basically consists of two data sets - primary and secondary. Primary data set consists of a survey and a questionnaire administered to 100 participants at geriatric clinics. While responses to the survey were recorded with much more accuracy and detail, responses to the questionnaire were sifted and collated to identify significant trends and process. Secondary data was collected through an extensive research effort conducted both online and in libraries. The researcher extensively used the books written on the topic and also studied research journals, reports, graphs, articles, newspaper articles and so on. References were taken from most of the research material available in the field. Primary research a. Interviewing Data collection is one of the central challenges in any research project. It is the process through which the opinion of people are collected and categorised. There are many methods of collecting data such as interviews; questionnaires; documents and observations provide invaluable information that is used for policy decisions, marketing strategies, and academic studies etc. Interviewing is a data collection method in which the researcher asks for information verbally from the respondents. Interviews are suitable when in-depth information is desired and this type of information is required in order to fulfil the purpose of this research. Therefore the interviewing research method will be followed in this paper. Preparation of questionnaire This is the most important part in the planning of a sample survey, because a poorly designed questionnaire may ruin an otherwise well conducted survey. At this stage it is always advantageous to think in advance what variables and tabulations would be required for later analysis. It is advisable that a dummy tabulation plan should have been prepared in advance, if possible. This would ensure the inclusion of the information, which would be needed for the questionnaire. While preparing the questionnaire the following points were kept in mind in order to overcome the related problems. (i) As few questions as possible were included. (ii) Individual questions were framed in a simple and straight language. (iii) Questions followed a logical sequence. (iv) Highly personal questions were avoided, and if necessary for some enquiry they should be kept at the end of the questionnaire. Administration of Questionnaire Once the questionnaire is prepared it may be administered by three different methods. (i) Direct personal interviews. (ii) Email inquiry. (iii) Telephonic conversation (this is important in interviewing practitioners) In this case study the method of direct personal interviews were used. This method was applicable because most of the respondents were educated and co-operative and they realised the significance and importance of such a sample survey. The problem of non-response due to carelessness on the part of respondents is expected to be very large, though in the current survey such negligence was minimal. Survey There are three types of interview: structured, semi-structured and unstructured interviews. This study utilises semi-structured type of interviews due to the fact that it helps the relatively structured interview guide, which includes ratings as well as relatively open questions. This type of interview is the most appropriate choice to gain the data necessary since it allows the researcher to lead informal conversations based on predetermined topics. Generally speaking, an interview is social interaction between two people, with one person gathering information from the other. Structured interviews enable the interviewer to ask each respondent the same questions in the same way. A tightly controlled structured schedule of questions and format is used, very much like a questionnaire. The questions contained in the questionnaire were planned in advance. The interviewer has some discretion how these might be elaborated/explained but the aim is to standardize data as far as possible and to eliminate biases due to different wordings. The questions in a structured interview may be phrased in such a way that a limited option response is elicited. The possible answers are defined in advance so that the respondent is limited to one of the pre-coded responses and thus data analysis becomes relatively easier. Interviews must be well prepared and must have clear objectives for each interview. Interviews can be conducted after the team has established the topical areas to be covered in the interviews and after the lead investigator has reviewed with the board the objectives of the interviews and strategies for obtaining useful information. Secondary Research Secondary data was collected through an extensive research effort conducted both online and in libraries. The researcher extensively used the books written on the topic and also studied research journals, reports, graphs, articles, newspaper articles and so on. References would be taken from most of the research material available in the field. This study depends mainly on the secondary material, because theoretical analysis is much well facilitated by it than primary material which is basically limited to responses in the questionnaire and the survey. The available literature will be analyzed with specific focus on the clinical programs and non clinical intervention. This researcher has tried to show the most important aspectual overview of the research in the Literature Review. Also there is considerable reflection on the state and relevance of current research. Future research possibilities in the field are discussed in depth to show how theoretical underpinnings evolve with time and space with specific reference to prevention of falls among the elderly both in clinical and non clinical settings. The qualitative aspect would focus on the efficacy of prevention programs as outline in the literature review while the quantitative aspect would focus on the clinical data already available and the data gathered through the survey and the questionnaire mentioned above. However the research methodology segment of this paper places emphasis on the qualitative aspect of it rather than the quantitative aspect. As such the available empirical evidence will be greatly utilized by the researcher to delineate the current line of arguments as expounded in the Literature Review of this paper. REFERENCES 1. Arenson, C, Whitehead, JB, Smith, KB & O'Brien, JG 2009, Reichel's Care of the Elderly: Clinical Aspects of Aging, Cambridge University Press, New York. 2. Barry, K, Blow, F & Oslin, D 2001, Alcohol Problems in Older Adults: Prevention and Management, Springer Publishing, New York. 3. Brown CJ, Gottschalk M, Van Ness PH, Fortinsky RH, Tinetti ME 2005, 'A multicomponent behavioral change strategy and its impact on fall prevention practices of physical therapists', Physical Therapy, vol. 85, pp. 394-403. 4. Haines, TP, Hill, KD, Bennell, KL & Osborne, RH 2007, 'Additional exercise for older sub acute hospital inpatients to prevent falls: benefits and barriers to implementation and evaluation', National Center for Biotechnology Information, vol. 21, no. 8, pp. 742-53. 5. Kennie, DC 1993, Preventive Care for Elderly People, Cambridge University Press, Cambridge. 6. Masud, T & Morris, KO 2001, 'Epidemiological Review of evidence behind risk factors causes and reasons for falls', Profane, vol. 4, pp. 3-7. 7. Sherrington, C, Menz, HB & Close, JCT 2007, Falls in Older People: Risk Factors and Strategies for Prevention, Cambridge University Press, New York. 8. Tideiksaar, R 1997, Falling in Old Age: Prevention and Management, 2nd edn, Springer Publishing Company, New York. Read More