NSG7020 - Week 9 project

2

Week 2 Project

Elizabeth Hernandez

South University

Dr. Crystal Dodson

NSG7020

March 27, 2025

Falls are a significant concern for older adults, leading to injuries, hospitalizations, and deterioration in quality of life. Over one-third of community paramedic calls are related to falls, according to the Community Assistance Program (CAP) health professionals subgroup. These occurrences often include recurrent fallers who get only emergency assistance. This problem must be addressed using evidence-based methods to improve community safety and reduce needless EMS calls. Given the available resources, an intervention-based strategy centered on fitness programs is a viable solution. This paper will develop a PICOT question to guide an evidence-based study on whether exercise programs can prevent falls in older adults within this community.

Background Question and PICOT Type

The scenario focuses on fall prevention in older adults. CAP members discussed how exercise may minimize falls. The type of PICOT question that best fits this scenario is an intervention question that examines whether an exercise program reduces the incidence of falls. Evidence-based intervention questions compare a treatment, therapy, or preventative strategy against its alternatives or standard care Gosak et al. (2024). One intervention involves a structured workout regimen, while the other does not. Sherrington et al. (2019)

An alternative method for framing the question could have been to pose a prognosis or prediction question, which assesses the probability of falls occurring in various demographics. However, the scenario prioritizes solution implementation above risk prediction. An etiology question may investigate the causes of falls in this community. Fall risk factors are crucial, but action is more important. A diagnostic question and a meaning question were ruled out because the subject is neither a fall risk diagnosis nor a resident's perception of falls. Given these factors, an intervention question is best.

PICOT Question Development

Well-structured PICOT questions enable targeted literature searches and evidence-based results. The formulated PICOT question is:

In community-dwelling older adults aged 65 and older (P), does participation in a structured exercise program (I), compared to no structured exercise program (C), reduce the incidence of falls (O) over six months (T)?

To meet scenario objectives and improve literature search, each PICOT element was carefully selected:

· Target population: "community-dwelling older adults aged 65 and older." According to the scenario's demographics, the majority of inhabitants are in their 60s, 70s, and 80s. Fall prevention measures vary for nursing home residents and "community-dwelling" older adults. Also explored were "seniors" and "elderly," but these were too wide for a search.

· Intervention: "Participation in a structured exercise program." The physical therapists' advice that exercise could reduce falls supports this choice. The word "structured" emphasizes planned, evidence-based fitness programs over informal or self-guided exercise. Other titles, such as "balance training" and "physical therapy," were explored but rejected because they indicate more sophisticated therapies than community-based exercise. Liu-Ambrose et al. (2019)

· The comparison group is "no structured exercise program." This ensures that the research compares the effects of structured interventions to those without. The parallel is accurate, as many older adults avoid formal exercise despite its numerous advantages. Since this neighborhood may not have fall prevention measures, "standard care" was rejected.

· The goal is "reduced incidence of falls." This directly targets frequent paramedic calls due to falls and examines whether the intervention is effective in reducing falls. Another goal, "improved balance" or "increased mobility," was explored but omitted since it does not directly evaluate fall reduction, CAP members' main concern.

· The timeframe is "six months." This term is long enough to see substantial fall rate changes and follow and evaluate a community intervention. A shorter time (such as three months) may not collect enough data, while a longer period (such as a year) could make installation and monitoring more difficult.

Rationale for Word Choices in the PICOT Question

The chosen words are specific enough to focus on high-quality, relevant research yet wide enough to incorporate a variety of evidence-based fitness programs. The use of a "structured exercise program" instead of "balance training" or "physical therapy" allows for a wider inclusivity of programs, such as Tai Chi, strength training, and group fitness courses. Gerontological researchers prefer "community-dwelling older adults" over "elderly" because it distinguishes this category from nursing facility residents. For direct connection to frequent EMS calls, "reduced incidence of falls" was utilized instead of "improved physical function." The six-month timeline assures practicality and allows for quantifiable progress.

Conclusion

A well-defined PICOT question enables the CAP health professionals subgroup to conduct a focused literature search to determine whether a structured exercise program reduces falls in this elderly population. The question keeps the emphasis on practical, evidence-based fall prevention. After reviewing relevant literature, CAP members may create a cost-effective community-specific solution. Fall prevention may enhance the safety, independence, and quality of life for older adults while reducing the workload of emergency services.

Reference

Gosak, L., Štiglic, G., Pruinelli, L., & Vrbnjak, D. (2024). PICOT questions and search strategies formulation: A novel approach using artificial intelligence automation. Journal of Nursing Scholarship. https://doi.org/10.1111/jnu.13036

Liu-Ambrose, Teresa, et al. “Effect of a Home-Based Exercise Program on Subsequent Falls among Community-Dwelling High-Risk Older Adults after a Fall.” JAMA, vol. 321, no. 21, 4 June 2019, pp. 2092–2100, https://doi.org/10.1001/jama.2019.5795.

Sherrington, Catherine, et al. “Exercise for Preventing Falls in Older People Living in the Community.” Cochrane Database of Systematic Reviews, vol. 1, no. 1, 31 Jan. 2019, www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012424.pub2/full, https://doi.org/10.1002/14651858.cd012424.pub2.