Turning and Repositioning To Reduce Pressure Injuries

Running head: EXERCISE PROGRAMS TO PREVENT FALLS 1

EXERCISE PROGRAMS TO PREVENT FALLS 5

Exercise Programs to Prevent

Fall Related Injuries in Older Adults

Student

Student

Gwynedd Mercy University

Abstract

The implementation of exercise programs was evaluated to identify best-practice in fall-related injury prevention. This paper incorporates information from four different studies to identify the evidence that suggests best-practice protocol. Evidence of these studies suggests that implementing exercise programs helps to prevent fall-related injuries in long-term care facilities for older adults. Incorporating exercise programs increases patient safety, prevents further injury, and promotes communication between patients and staff. By implementing these programs, patients’ overall health improves and they’re more satisfied by their ability to perform activities of daily living on a more independent level.

Exercise Programs to Prevent Fall Related Injuries in Older Adults

As individuals age through life, the risk for falls increase immensely. This is due to the lack of strength as well as a lack of balance in the human body. It is important for nurses to take l precautions to help stop patient falls because in many instances, falls are preventable (Ambutas, Lamb, & Quigley, 2017). Fall prevention includes important interventions that stop subsequent injuries from happening to patients. Everyday, nurses take precautions to prevent falls but additional actions could be taken in order to make these interventions more effective. Every patient is at risk of falling, especially older adults because they lose muscle mass and balance as they age (Taylor, Lillis, & Lynn, 2015, p. 142). After performing fall-risk assessments on each patient, nurses implement suggested best practice protocols for low-risk, moderate-risk, and high-risk patients. Best practice includes educating patients and families on fall risk, using bed or chair alarms, lowering the beds, encouraging regular toileting and other precautions (Taylor, et al., p. 145). Exercise programs act as another important measure that nurses could implement, in order to help patients improve their balance, strength and mobility while performing activities of daily living, and reduce risk for falls (Ambutas, Lamb & Quigley).

The following clinical question will be used to identify best practice related to exercise programs in order to prevent falls in older adults:

P: Older adults living in long-term care facilities

I: Exercise programs

C: (none)

O: Prevent fall-related injuries

T: (None)

In long-term care facilities for older adults, how do exercise programs help prevent fall-related injuries?

Review of Literature

Dal Bello-Haas, Thorpe, Lix, Scudds, and Hadjistavropoulos (2012) completed a quantitative research study that focused on the implementation of a walking program in long-term care facilities, in order to prevent falls. Risk for falling increases with advancing age. The research question that these authors asked was a to assess the effectiveness of an individualized, progressive, walking program compared to usual care in individuals residing in long-term care facilities. The study participants were over the age of 60, resided in a long-term care facility, and participated in several different walking programs. The results of this study suggested increased activity and participation in exercise contribute to prevention of falls in the long-term. The researchers stated nurses and health care providers working in long-term care environments should implement exercise programs for residents to prevent falls.

Kato, Izumi, Hiramatsu, and Shogenji (2006) also investigated the use of exercise to prevent falls in the older adult population, who are at increased risk for falls. The participants in this quantitative study completed stretching, muscle strengthening, and toe exercises three times per week. Results of this study showed older adults who participated in the exercise program experienced less falls. The researchers suggested exercise programs were effective in reducing falls in residents of long-term care facilities and should be considered for use with this patient population.

In addition to focusing on strength and balance, a quantitative study by Gschwind, Kressig, Lacroix, Muehlbauer, Pfenninger, and Granacher (2013) also investigated the effects of exercise on improvement of psychosocial well-being. Preventing falls in the older adult may require interventions to address more than one focus area. The researchers designed a rehabilitation program for older adults living at home in which patients worked to improve everyday balance, strength, and psychosocial well-being. The objective for this program is to prevent the risk of falls in the older adult population. Older adults in the study were taught balance and strength training exercises. Participants were contacted by phone to encourage use of the exercises. The results of this experiment showed improvement in strength, balance, and an increase in daily living activities. The researchers state that patient education is important for older adults living in community settings to incorporate exercise into daily activities.

Sherrington, Tiedemann, Fairhall, Close, and Lord (2011) also investigated the use of exercise to prevent the risk of falls. In addition to focusing on older adults, the researchers included participants from other age groups in this quantitative study. Study participants completed balance exercises and participated in progressive walking activities. The results suggested exercise can help lower the risk of falls in the older adult. In addition, the researchers stated fall prevention exercise training should not be confined to just the aging adult, but also offered and implemented in the general population. In doing so, everyone can increase their balance ability, which ultimately decreases the risk of falls. The type of training should vary with each individual. If the patient is healthy, the balance exercise along with strength training and brisk walking is appropriate. On the other hand, if the patient is at high risk for falls, balance exercises should be the area of focus.

Summary

Results from the reviewed studies suggest that the implementation of exercise programs is effective in preventing fall-related injuries in older adults and can be effective for use in long-term care environments. Exercise allows for the strengthening of muscles in the lower extremities, which in turn helps to prevent loss of balance and mobility. Ultimately, falls are reduced when patients gain strength and ambulate regularly. According to these authors, patient safety is increased with the implementation of exercise programs that include walking, muscle strengthening and balance routines. The findings presented by these authors suggest that implementing exercise programs for older adults in long-term care facilities would be beneficial for safety and satisfaction of patients.

Barriers and Suggested Strategies

There are potential barriers to the implementation of the recommendations in the reviewed studies. Patients with decreased mobility or complete immobility would not be able to complete these exercise programs. It would also be difficult to implement the exercise protocol for patients with physical, cognitive, or psychosocial impairments. Nurses should consider variations in exercise regimens appropriatge for patients with decrased mobility or other impariments. Nurse could provide passive exercise activities for patients who are completely immobile.

Implementation of the suggested interventions may be difficulty for patients experiencing pain. Adequate and appropriate use of pharmacological and nonpharmacological interventions for pain management should be implemented before use of the suggested exercise interventions. Nurses should assess patients’ pain and collaborate with other health care providers to provide pain relief.

It could be very costly to implement the recommended exercise programs, as many of them would have to be individualized to the patient which would require trained personnel. This could be a potential barrier to implementation of the suggested strategies. Nurses may have to work with managers and administrators to find solutions for financial resources.

Lastly, patient interest is a potential barrier to the recommendations because patients have to be willing to exercise. Nurses should involve patients in exercise decisions and provide patient education to support the patient’s treatment decisions. Nurses should also be flexible and creative in determining exercise regimens for patients, allowing the patient input into desired activities and activities based on patient interests.

Conclusion

Patient safety has always been a main concern in nursing practice but further precautions to fall-related injuries can be taken. Exercise is proven to have many positive outcomes on the mind and body. Therefore, incorporating exercise programs in long-term care facilities, nurses can increase patient safety measures and promote improved overall quality of life.

References

Ambutas, S., Lamb, K.V., & Quigley, P. (2017). Fall reduction and injury prevention toolkit: Implementation on two medical-surgical units. MEDSURG Nursing, 26(3), 175-179.

Bello-Haas, V PM., Thorpe, L., Lix, L., Scudds, R., and Hadjistavropoulos, T. (2012). The

effects of a long-term care walking program on balance, falls and well-being. BMC

Geriatrics, 12(76), N.PAG. doi: 10.1186/1471-2318-12-76

Kato, M., Izumi, K., Hiramatsu, T., & Shogenji, M. (2006). Development of an exercise

program for fall prevention for elderly persons in a long-term care facility. Japan Journal

of Nursing Science, 3(2), 107–117. doi:10.1111/j.1742-7924.2006.00057.x

Gschwind, Y. J., Kressig, R. W., Lacroix, A., Muehlbauer, T., Pfenninger, B., & Granacher, U.

(2013). A best practice fall prevention exercise program to improve balance, strength / power, and psychosocial health in older adults: Study protocol for a randomized controlled trial. BMC Geriatrics, 1 (105), N.PAG. doi: 10.1186/1471-2318-13-105

Sherrington, C., Tiedemann, A., Fairhall, N., Close, J., & Lord, S. (2011), Exercise to prevent

falls in older adults: An updated meta-analysis and best practice recommendations. New

South Wales Public Health Bulletin, 22(3-4), N.PAG. doi: 10.1071/NB10056

Taylor, C., Lillis, C., & Lynn, P. (2015). Fundamentals of nursing: The art and science of

nursing care. (8th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams &

Wilkins.