Fall Prevention and Lighting - Essay Example

Running head: FALLS PREVENTION Falls Prevention (school) Falls Prevention Introduction Falls are considered a major challenge in health care. They can cause considerable injury and to some patients, it can even cause their death (Currie, 2007). Falls are also preventable injuries, especially where individuals take the necessary personal and professional precautions to prevent these falls. However, external and internal environmental issues may often impact on the occurrence and prevention of these falls (Currie, 2007). Unintentional falls are common risks mostly among elderly individuals who may experience non-fatal injuries from these falls. Fall-related injuries are common among these older adults, hip fractures being one of them. Mortality rates in relation to falls are also high in this age group, and death is even a major possibility among those 85 years and above (Currie, 2007). This is also the case in Australia where the common sufferers of falls belong to the above 65 age group (Department of Health and Ageing, 2012). Fall related injuries mostly include hip fractures and wrist fractures. Some patients have also been known to suffer head injuries from their falls. The older the patient, the risk of death is also higher, especially among the above 85 years old age group (Department of Health and Ageing, 2012). The cost and health impact of these falls are also significant, sometimes leading to other health problems and issues (Currie, 2007). For the elderly individuals, the recovery period from their falls is usually longer. Due to prolonged healing, they may also develop pressure ulcers which can further delay the healing process (Currie, 2007). Falls management cost the government millions of dollars, with costs amounting to 170 million dollars for fall-related injuries. Moreover, the risk of re-injury or future falls is also an ever persistent risk for patients (Currie, 2007). In effect, falls are a significant public health issue which needs to be addressed by health authorities. Throughout the years, various studies have been undertaken on the problem of falls and related injuries, including interventions to prevent and manage their occurrence. This study seeks to evaluate the clinical question: How significant is lighting in the prevention of falls among the elderly? This study shall first evaluate the literature on falls prevention, critically evaluating such literature and assessing their formal and structural validity and reliability. This review shall also discuss the search strategy applied in order to establish studies to be reviewed. Then, it will identify the critical assessment tool to be used to evaluate the data. A critical review of the validity of the study findings will also be discussed. Potential barriers and facilitators to the implementation and/or maintenance of the strategy shall then follow. This paper shall end with a conclusion which is based on the quality of the studies and relevance of the findings. Body There were six studies retrieved for this study, and most of them were quantitative studies. Five of the studies had a prospective experimental design. One study had a correlational design. All of the studies were quantitative studies, in other words they are an empirical assessment of a phenomena using numerical and statistical analysis and frameworks (Bruce, Pope, and Sanistreet, 2008). Five of the studies were prospective studies as they were carried out on respondents who would be recruited and who were to be subjected to various procedures and processes. Experimental studies are those which evaluate cause and effect relations among respondents which are studied under controlled settings (Bruce, et.al., 2008). Search strategy The literature search for this review included the following databases: Cochrane, PubMed, Medline Plus, EMBASE, and Google Scholar, using the following search words: falls prevention and falls prevention lighting. I further narrowed my search to English language articles published in credible and peer reviewed journals for the past five years. Relevant studies were evaluated based on information related to falls prevention measures, including lighting. Five studies which met the parameters of this review are now the subject of this review. Critical appraisal (McCoughlan, Cronin, and Ryan, 2007) In general, the five studies chosen for this review were able to effectively meet the quality criteria set out by McCoughlan, Cronin, and Ryan except for some notable elements where there were some issues with their validity. The age range of the respondents for the five studies ranges in the older adult population, mostly in the above 60 age range; however, the study by Zeitz and colleagues included a younger population in order to support a comparative study. The studies also covered both males and females, but the Zeitz study covered females only. Such details impact on the external validity of the studies where the results cannot extend outside the female population. This issue is however only apparent in the Zeitz study. The setting for the study was not specified in the Kim and the first Figueiro study. The other three studies covered rehabilitation facilities for the elderly, assisted living facilities, and in-house centers. These institutions have a diverse population of elderly adults where the study can be adequately carried out. As for the methods applied, all of the studies applied experimental conditions upon which the respondents could be studied, with manipulations made on the lighting conditions. All of the studies reviewed the impact of lighting, with the Kessler studies concentrating on lighting alone, without any structural manipulations. The outcome measures mostly applied measures for lighting clarity, sleep disturbance, and assistance attributed by handrails. In the study by Kim (2009), the report is concise, well-written and organized. The author is also a credible practitioner in the field of ergonomics, and the journal where the study is published is a credible and peer reviewed journal. The title is also clear and concise, containing the primary elements for the reader to easily determine the subject matter and variables involved. The author also clearly defined the problem, which was on establishing means by which falls during stairway descent among elderly adults can be prevented. The research also outlines and follows the logical steps of research and these steps naturally transition from one stage of the research to another. Most of the studies cited in the literature review are however not recent, dating more than 10 years from the research. All of these studies are however empirical in nature. The framework for the study has been described in the discussion of the author on visual acuity and falls. Such framework is appropriate for the study because it relates the visual field and acuity of the individual to the incidence and eventually, the prevention of falls. The target population was identified however, the author did not describe how the subjects were chosen and if there were any randomized processes applied. The age of the respondents is not diverse as it is concentrated in the older population only; moreover, the gender was not specified or distinguished in the population. This reduced the validity of the results because the results were not gender-specific or gender sensitive. Focusing on the older population also reduces the reliability of the results because the older population already has a higher risk for falls, regardless of lighting conditions. They are more likely to suffer from impaired vision which places them at risk for falling. The size of the population is also small and does not relate to a larger population. There is also no mention of the respondents’ informed consent being sought. The data gathering tool is however explained in detail. The instrument is also appropriate and developed based on measures of assessment for lighting and falls prevention. Validity testing of the studies was not tested beyond this research. No pilot study was undertaken. The data and statistical analysis is however clearly demonstrated and explained with these analysis and tools being the right fit for the research issue. This study provides a detailed report on the impact of lighting to visual acuity and eventually, the prevention of falls among the elderly. The results are however too technical and may not be palatable to a wider range or readers. The results are nevertheless logical and adequately supported by the table descriptions and subsequent analysis of such results. In the study by Figueiro, et.al., (2011), the authors set out to study the impact of lighting in improving balance in older adults with or without fall risks. The title alone provides a clear description of the goal and the variables involved in the study. Although the background and related literature for the study is very short, the important details relevant to the research are explained. These details relate to lighting and how it can improve visual information for older adults as a means of preventing falls. There is however insufficient background study on the topic. The study follows an orderly and logical process with effective transitions. The framework is based on the concept of visual range and lighting which relates to fall risks. The target population is appropriate for this study however, the means by which they were recruited were not explained by the authors. The age of the respondents, similar to the Kim study was also in the older range, above 65 years. No particular setting was indicated. No randomization processes were applied in sampling the population. The sample size is adequate, but since the recruitment process was not explained, the generalization of the sample population to a larger one cannot be ascertained. The authors also did not mention if the respondents’ informed consent was gained. Nevertheless, measures to protect their confidentiality were ensured by the researchers. The data gathering instrument was appropriate and well explained. The methodology was also adequately illustrated and is replicable. The results were explained and analyzed based on the Berg Balance Scale. The strengths of this study is on its innovativeness, it is not a common research topic and actually provides detailed and useful results for fall preventions. Weaknesses relate to the inadequate compliance with methodological elements of research. These weaknesses impact on the validity of these results. Kessler, et.al., (2010) discussed preliminary evidence on the use of lighting in falls prevention. The purpose of the research was clearly defined and the research process flowed easily. The theoretical framework was also based on lighting within the visual field. The target population was also clearly identified and the recruitment process detailed. The age range of the population is much wider as compared to the other studies as this study covers the 54-93 years age range. The designation of the participants as respondents was carried out randomly, allowing for generalizability in study results. The confidentiality of the research process was not mentioned by the authors. The results were not presented in a table or a graph, but were presented through percentages which were integrated in the text. The results were not extensively explained, but the relationship of lighting and fall risks was significantly explained by the authors. Moreover, as compared to the other studies, this Kessler research focused more on the manipulation of lighting; in contrast to the other studies, which considered stair structure as fall risk factors, this Kessler study did not consider these. No pilot study was taken and the findings were not linked with the literature review. The strengths of this study are on its random designation of respondents to each control group. Its weaknesses relate to its overall structure which seems to be too simplistic to secure more academic results. In the study by Zeitz, et.al., (2011) the authors set out to study the stepping qualities and center of mass control in stair descent and the impact of age, fall risk, and visual elements to these qualities. The purpose of the study has been clearly defined. The report also follows a logical research process with smooth and logical transitions from one section to another. Only females were however recruited for this study, with a comparative group from the younger population included. This is different from the other studies in this review which covers a higher population. Moreover, only interviews were undertaken on the respondents, which limits the reliability of the results because the results are not based on prospective clinical applications. The review is logical and has been critically analyzed. The theoretical framework also helped provide a strong and effective explanation for the study. The target population was clearly defined and the designation of the respondents to the study groups was randomized. The informed consent of the participants was gained. The results were presented logically based on outcome measures. These results were presented in tables; statistical tools were appropriately applied by the researchers. Correlations with the literature review were made. The strengths of this study lies in its detailed explanation of results. Its weaknesses are however apparent in terms of its technical details which general readers can find difficult to understand. The relationship between lighting and falls is also discussed in the study by Figueiro and colleagues (2011). The purpose of the study was clearly identified and the research process was also very much clear and logical. The literature review provided a critical analysis of studies which sufficiently provided a background for the study. The conceptual framework also laid out a foundation for the clinical issue raised. The hypothesis was identified and clearly stated. The target population was also indicated with sampling processes also explained. The respondents were also recruited from assisted living facilities. The terms were well explained and the confidentiality of the respondents was ensured, along with their informed consent. The results of the study were explained in detail first through tables and through the correlations with stride lengths and other variables measured through the application of the ANOVA statistical tool. The results were related and consistent with the literature review studies. The strength of this study is based on its detailed explanation of the methods applied to perform the study. Such explanation allowed for the replication of these methods and the study as a whole. Weaknesses are seen based on its relatively small sample size; this study could have benefitted from a larger sample size, further ensuring its generalizability to a larger population. Potential Barriers/facilitators in the implementation/maintenance of the strategy Based on the studies cited above, barriers to the implementation of maintenance strategy for fall prevention lies in the inadequate assessment of lighting within the visual range, as well as the relationship between visual acuity and fall prevention measures. In implementing prevention measures which relate to lighting, failure to understand when, where, and what type of lighting is needed can cause the risk of falls to increase. For those whose visual acuity is already compromised, specifically, the elderly, issues with day time light and night time light, with sit-to-stand efficacy, as well as assisted living can lead to falls. Facilitating the prevention of falls is based on the understanding of the visual field, visual acuity, and lighting. Implementing lighting as a means of preventing falls does not necessarily mean keeping every part of the house or room well lit. It also means installing the right kind of lights to the right place or putting in the appropriate brightness of light into the right place. Facilitators to the implementation of this strategy include the understanding of how lighting can be used strategically around the room or house. A better understanding of the mechanics of this intervention can help facilitate the implementation of improved lighting in the prevention of falls. Conclusion In general, the studies have a high degree of quality, however, some issues in methodology are apparent. These issues mostly refer to randomized processes in choosing sample respondents. Some of these studies also do not mention their compliance with informed consent requisites. The age range was concentrated to the older population, which already carry a fall risk due to their impaired visual acuity and their impaired musculoskeletal condition. The findings are however very much significant because they clearly suggest the relevance of lighting in preventing and managing falls. The implementation of these findings are very much warranted, especially in terms of the correct type, correct brightness, and correct locations of these lights in the home or assisted living facilities for the elderly. Barriers in the implementation of this strategy include the inadequate assessment of the visual range, including visual acuity of the elderly. A better understanding of the impact of lighting can help ensure its effective use and application in the prevention and management of falls among the elderly. References Coughlan, M., Cronin, P. & Ryan, F. (2007). Step-by-step guide to critiquing research. Part 1: quantitative research. British Journal of Nursing, 16(2), 658-663. Currie, L. (2007). Fall and injury prevention. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2653/ Department of Health and Ageing (2012). Help with health. Retrieved from http://www.agedcareaustralia.gov.au/internet/agedcare/publishing.nsf/content/Falls+prevention-5 Figueiro, M., Gras, L., Rea, M., & Plitnick, B. (2012). Lighting for improving balance in older adults with and without risk for falls. Age and Ageing, 41(3), 392-395. Figueiro, M., Plitnick, B., Rea, M., & Gras, L. (2011). Lighting and perceptual cues: Effects on gait measures of older adults at high and low risk for falls. BMC Geriatrics, 11(49), 1471-2318. Kessler, D., Knoefel, F. & Rafik, G. (2010). The use of lighting to prevent falls: Some preliminary evidence. Occupational Therapy Now, 12(6), 11-13. Kim, B. (2009). Prevention of falls during stairway descent in older adults. Applied Ergonomics, 40(3), 348-353 Zietz, D., Johannsen, L. & Hollands, M. (2011). Stepping characteristics of centre of mass control during stair descent: Effects of age, fall risk, and visual factors. Gait & Posture, 34(2), 279-284. Author/year Design Sample setting Major findings Strengths/Limitations Figueiro, M., Gras, L., Rea, M., & Plitnick, B. (2012) Prospective experimental Non-randomized Visual system has a huge role in managing control of balance among elderly; nightlights provide visual cues and low ambient illumination; lighting can reduce falls without disturbing sleep. The strengths of this study is on its innovativeness, it is not a common research topic and actually provides detailed and useful results for fall preventions. Weaknesses relate to the inadequate compliance with its methodological elements. These weaknesses impact on the validity of the research results. Figueiro, M., Plitnick, B., Rea, M., & Gras, L. (2011) Prospective experimental Non-randomized Participants performed best under the general ceiling-mounted light system and worst under the night light alone. The pathway plus night lights increased gait velocity and reduced step length variability compared to the night lights alone among those at greater risk of falling. The strength of this study is based on its detailed explanation of the methods applied to perform the study. Such explanation allowed for the replication of these methods and the study as a whole. Weaknesses are seen based on its relatively small sample size; this study could have benefitted from a larger sample size, further ensuring its generalizability to a larger population. Kessler, D., Knoefel, F. & Rafik, G. (2010) Correlational Non-randomized Clients with walking aids may have greater security in walking when they can turn on lights The strengths of this study are on its random designation of respondents to each control group. Its weaknesses relate to its overall structure which seems to be too simplistic to secure more academic results. Kim, B. (2009) Prospective experimental Non-randomized Lighting may contribute in increasing confidence during stair descent while compromising declined stride length in older adults and the possible element of “rush” in descending stairs. This study provides a detailed report on the impact of lighting to visual acuity and eventually, the prevention of falls among the elderly. The results are however too technical and may not be palatable to a wider range or readers. Zietz, D., Johannsen, L. & Hollands, M. (2011) Prospective experimental Non-randomized Dimmed ambient light resulted in decreased step length in HROA compared to bright lighting. High stair edge contrast led to reduced vertical COM acceleration variability in HROA and increased distance between COM and anterior base of support in LROA. YA increased horizontal foot clearance when stair edge contrast was high. Strengths of this study lies in its detailed explanation of results. Weaknesses are however apparent in terms of its technical details which can be difficult to understand by general readers. Read More