PHASE 3 Implementation APA SEVEN RUBRIC AND INTRUCTIOS ATTACHED

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Falls in The Long-Term Care Settings

Nayaris Reyes

Florida National University

June 12, 2021

Brief Literature Review

The elderly in the long-term care facilities are typically predisposed to falling and might fall for various reasons. Some predisposing factors might be related to unsteady balance and gait, poor vision, weak muscles, dementia, and medications. In addition, various medical conditions, including stroke, low blood pressure, brain disorders, and poorly managed epilepsy, might increase older people's risk for falls (Golmakani et al., 2014). Therefore, several studies have been conducted to evaluate the efficacy of multi-factorial interventions on the occurrence of falls in long-term care settings, including psycho-geriatric nursing home patients. Based on the clinical study, it was concluded that various multi-factorial interventions used in preventing falls such as a general medical assessment emphasizing falls, specific fall risk evaluation devices, assessing medication intake, fall history, and mobility, using protective and assistive aids play a significant role in reducing the incidence of falls among the elderly (Ungar et al., 2013). Accordingly, it was evident that fall prevention, usually geared towards psycho-geriatric patients in a long-term care facility, is possible and efficient in minimizing falls among older people.

Other researchers carried out a study in developing a fall prevention program for the aged patients in long-term care entities, especially those at risk of falling, by increasing caregiving expertise or skills and motivating staff members. From the analysis, exercise programs encompassing warm-up, muscle reinforcement, especially in the lower extremities, and proprioceptive neuromuscular expedition are used in increasing motivation and caregiving skills (Donath et al., 2016). Another research conducted to evaluate the statistics of falls among the elderly found out that falls are the leading cause of injury-interrelated visits to emergency facilities in the U.S. They are also the primary etiology of accidental deaths in persons aged 60 and above. From the analysis, falls might be markers of diminishing function and poor health and are significantly attributable to morbidity.

To assess the risk factors related with falls among the older people in the long-term care facilities, it was realized that more than 25% of facility-dwelling older individuals and 60% of nursing home residents fall yearly (Pfortmueller et al., 2014). Various risk factors linked to their falls are medication use, increasing age, sensory deficits, and cognitive impairment. Studies depict that older persons who have fallen must undergo a thorough clinical evaluation (within the facilities) to analyze the preventive strategies further. This will aid in determining and treating the underlying cause of their falls, return them to baseline function, and minimize the likelihood of recurrent falls (Karlsson et al., 2013). Such measures have a significant effect on the mortality and morbidity of falls.

Methodology and Design

General Overview

The research paper tries to analyze the issue of falls among the elderly in the long-term care setting. This section will encompass justification of the research methods, data collection procedures, and research design. Research methods are the strategies, techniques, and procedures utilized in data collection and evidence to analyze the collected information. The ideal research methods for this research topic will be quantitative and qualitative. The two research techniques will follow under a mixed research method and precisely assist in finding a solution to the existing problems. Mixed methods use qualitative and quantitative methods in the same study and mainly used in clinical settings. Quantitative research techniques in the nursing profession are fundamental since they utilize accurate approaches to collect and analyze measurable data (Kim et al., 2015). This is a precise technique because it is a number-based technique that gives accurate results critical factors in the medical field outcomes. Besides, qualitative techniques deal with the lived experiences of different patients and nursing professionals. The research on chronic infections such as falls gives the healthcare professionals a sound understanding of the lived experiences of the elderly patients.

Research Design

Consequently, the research design will act as the guiding framework for the fundamental research. The study will use mixed methods (quantitative and qualitative) since it will address the research issue more inclusively than qualitative or quantitative methods alone. Quantitative research is attributable to a positivist stance and assumes that reality might be measured and observed objectively. It will be the best technique due to its procedures of minimizing falls among older people. Thus, it will be the dominant paradigm in health issue research. Moreover, qualitative research majorly comes from an interpretive framework and assumes multiple realities are framed by individual perceptions, meaning, and context. This will be suitable for the issue under research. Therefore, there is a need to ensure high-quality qualitative research to generate sturdy theory which applies to the contexts outside the area under research.

Data Collection Procedures

The quantitative research will employ clinical trials or observational studies to generate relevant data for patients experiencing falls. Thus, there will be surveys where questionnaires will be issued to the patients and collected after filling them. The questionnaires will comprise close-ended questions entailing putting responses into groups and multiple lists where the patients will choose from. The structured questions are suitable for this clinical issue because they are cheap, swift, and practical tools for attaining a comparatively large amount of pertinent data from samples. The qualitative research methods will incorporate semi-structured interviews, participant observation, and focus group discussion (Singh, & Okeke, 2016). For the semi-structured interviews, the researcher will allow the patients to share their daily experiences within the scope of the clinical issue and determine the ideal prevention measures. The researcher will also visit the care settings and homes of the older adults and assess the comfortability and safety of their living environment. Calling them in groups to hold discussions will also be appropriate since they will state their risk factors for falls and suggest the best measures to prevent its occurrence.

Data Sampling

Sampling entails techniques in which researchers infer information regarding a given population based on findings from a subsection of the whole populace (Karlsson et al., 2013). The ideal sampling method to investigate falls among older persons in long-term care institutions includes a randomized controlled trial (RCT). These are the gold standards to establish the efficacy of various interventions. In clinical and long-term care facilities, RCTs are the best techniques in studying the safety and effectiveness of new interventions for preventing falls among older patients. This is because they are used in answering patient-interrelated issues. In trials with randomized and controlled design, the impacts of the clinical interventions will be compared with those of control treatment, and the participants will be randomly assigned to the selected groups. Randomized controlled trials of fall prevention strategies targeting the elderly population in the long-term care settings with various elements including reach, timeliness, and adherence to the program must be reported consistently.

Necessary Tools

There are vital tools used in the research and fall risk assessment, such as Falls Risk for Older People (Long-term-care setting) and RESPOND intervention (a telephone-related falls prevention program for older persons. The RESPOND intervention must encompass various evidence-based modules linked to falls risk factors, including better bones, better strength and balance, better sleep, and better eyesight. Every RESPOND must have an associated pamphlet that should have positively framed clinical messages concerning the recommended preventions, including how exercise might help one feel revitalized and relaxed. The RESPOND physician must make subsequent telephone coaching calls through the use of motivational interviewing strategies. Notably, good timing, intended dosage, and conveyance style must be pre-determined in the randomized control trial protocol. Using Falls Risk for Older People will be possible to evaluate patients for fall risk and motivate them to adopt recommended evidence-based prevention approaches. Such approaches might assist patients in reducing their likelihood of falling and experiencing injuries, death, and functional decline.

Algorithms or Flow Maps Created.

To determine preventive strategies for reducing falls among the elderly in a long-term care facility, a decision tree analysis might be used in developing a prediction algorithm for the frequency of occurrence of falls. The long-care patients will be assessed using a Resident Assessment Instrument-Home Care (RAI-HC) model. The validity of the fall algorithm might be tested and verified among long-term care patients in the designated settings. Such algorithms must incorporate assistive tools, age, unsteady gait, pain, cognition, and incontinence to various categories from low to high risk. The algorithms would only be used in long-term care settings using the RAI-HC system. There is a need to determine how the percentage of falls would behave following an upsurge in the risk class. Logistic regression analysis must be utilized to derive odds ratios to assess the algorithm's validity in various samples. Fall algorithms might provide a typical assessment model to facilitate the allocation of assistive resources, improve the efficacy of the healthcare system and minimize costs (Panneman et al., 2021). This is because falls are a prevalent cause of death and injuries among the elderly in long-term care facilities and are extremely expensive in healthcare institutions.

References

Donath, L., van Dieën, J., & Faude, O. (2016). Exercise-based fall prevention in the elderly: what about agility?. Sports medicine, 46(2), 143-149.

Golmakani, E., Usefi, M. R., Tabatabaeichehr, M., Moayyed, L., & Mortazavi, H. (2014). Fall in elderly: A literature review. Journal of North Khorasan University of Medical Sciences, 5(5), 1159-1163.

Karlsson, M. K., Magnusson, H., von Schewelov, T., & Rosengren, B. E. (2013). Prevention of falls in the elderly—a review. Osteoporosis international, 24(3), 747-762.

Kim, E. J., Arai, H., Chan, P., Chen, L. K., Hill, K. D., Kong, B., ... & Won, C. W. (2015). Strategies on fall prevention for older people living in the community: a report from a round-table meeting in IAGG 2013. Journal of Clinical Gerontology and Geriatrics, 6(2), 39-44.

Panneman, M. J., Sterke, S. C., Eilering, M. J., Blatter, B. M., Polinder, S., & Van Beeck, E. F. (2021). Costs and benefits of multifactorial fall prevention in nursing homes in the Netherlands. Experimental gerontology, 143, 111173.

Pfortmueller, C. A., Lindner, G., & Exadaktylos, A. K. (2014). Reducing fall risk in the elderly: risk factors and fall prevention, a systematic review. Minerva Med, 105(4), 275-81.

Singh, I., & Okeke, J. (2016). Reducing inpatient falls in a 100% single room elderly care environment: Evaluation of the impact of a systematic nurse training program on falls risk assessment (FRA). BMJ Quality Improvement Reports, 5(1).

Ungar, A., Rafanelli, M., Iacomelli, I., Brunetti, M. A., Ceccofiglio, A., Tesi, F., & Marchionni, N. (2013). Fall prevention in the elderly. Clinical Cases in mineral and bone metabolism, 10(2), 91.