Background
The rate of falls among the elderly population in Australia is bound to increase by more than 10% if efficient risk prevention programs are not implemented. The number of falls in various environments affecting the older adults above the age of 65 is significantly increasing thereby hampering their physical as well as emotional wellbeing. Most worryingly is the fact that fall related injuries are one of the leading causes of death among this population (Sherrington et al, 2016, p. 2). Exercise based interventions have been touted as the most effective paradigm to resolve this issue. In such programs, evidences suggest that focus should not only be placed on balance but also on strength in order to reduce fall related injuries.
As a public health issue, the risk of falls is costly and increases the level of dependence among the elderly, or in some cases, it can also be fatal. Studies have also indicated that falls can result in life threatening injuries, reduce the level of confidence and demoralize individuals from continuing with physical exercises that enhances their postural control. Thus, there is dire need to institute initiatives that are specifically tailored to meet the needs of this population and most importantly, reduce the risk of falls. Virtual reality programs are significantly important to the elderly primarily because they enhance postural control, motivation, functional movement patterns and cognitive development factors which basically foster balance among the elderly and also improve their muscle strength. To rectify such deficiencies, a program that focuses on balance, endurance, flexibility and additional strengthening particularly within the knee area is therefore necessitated. As a prevention program for the risk of falls, VRs are therefore crucial in reducing the number of falls among the elderly population.
What is the effectiveness of exercise-based interventions in reducing falls in older adults living in residential care facilities?
The first study investigates the efficacy of exercise programs in reducing the risk of falls among the aged. The study illustrates that a complex exercise with virtual reality (CEVR) consisting of a series of exercises such as endurance, flexibility, balance and strengthening is superior and effective compared to balance exercise with virtual reality (BEVR) (Lim et al, 2017, p. 64).
The second study indicates that mobility related disability such as lower limb and pelvic fractures arising from falls can be managed through self-management interventions that primarily focus on exercises. Also, exercises and fall prevention self-management intervention reduces the incidences of falls and associated disability to the elderly population (Sherrington et al, 2016, p. 9).
The third study focused on measuring the efficiency of Virtual Reality Balance Games (VRBG) in lessening the threat and distress of falls. From the 56 participants in this study, the findings indicated that the practice of VRBG significantly reduces the risk of falls among women (Singh et al, 2012, p. 239).
The fourth study emphasizes that aside from regular group exercises, there is need to incorporate additional training sessions that comprises of jumping, stretching, strength and aerobic exercises in order to increase stability, and decrease fall risks.
Also, the findings of this study indicate that such programs can improve the value of life and reduce despair among older people in nursing care homes.
Clinicians understand that for the elderly population, falling is a serious health issue with muscle weaknesses and balance deficits identified as the main risk factors. As such, clinicians should look to implement prevention programs comprised of training sessions that encompass various exercises that strengthens an individual’s body, enhances their functional performance and, bolster their flexibility and endurance. Furthermore, this initiative has the capability of exposing participants to a virtual world where they get to experience realistic situations and limited amount of space. (Lim et al, 2017, p. 65). Current clinical practice should therefore be guided by optimal content of rehabilitation programs that are exercise intensive.
In many cases especially for the elderly residing at home, relatives are the primary caregivers to this population. With their diverse health needs coupled with the risk falls, relatives are faced with high levels of caregiver stress (Singh et al, 2012, 239). Hence, learning the benefits and effectiveness of virtual reality exercises is pivotal in relieving such stress. Aside from increased dependence, relatives are likely to incur high costs in the rehabilitation process of their relatives (Lim et al, 2017, p. 65). Exercise-based interventions therefore present a less costly alternative and also an efficient to improve the relative’s stability thereby reducing their level of dependency.
Patients are adversely affected with the risk of falls. Notably, patients incur high costs and are at high risk of facing fall related injuries some of which may be fatal. Evidence indicates that falls’ injuries are leading causes of death among the elderly. Life threatening injuries such as hip fractures usually last for long periods since most survivors do not fully recover and may not regain their former levels of mobility or activity. Also, for patients funding their own medication, they are likely to incur high costs in surgery of these injuries (Sherrington et al, 2016, p. 4). Therefore, exercise prevention programs could ultimately prove to be beneficial for fracture survivors.
In long term residential homes, nurses are tasked with providing care to the elderly population.. Older adults living in nursing care homes have increased frailty compared to their home dwelling counterparts thereby presenting caregiver stress. Studies indicate that the fall rates in residential care facilities are three times compared to the fall rates occurring within the community. Caregivers in these facilities are therefore presented with an additional challenge to protects the wellbeing of this patient population (Cakar et al, 2010, 59).To counter such challenges exhibited in their area of practice, there is need to incorporate evidence-based practice to improve the quality of life of the elderly as well as reduce the risk of falls with their associated dire consequences.
In such cases therefore, the findings from Cakar et al (2010) indicates that caregivers such as nurses need to institute appropriate exercise regimens in order to reduce the fall risks and associated fall related injuries. In this light, regular exercises can be combined with additional jumping, stretching and aerobic exercises which will increase balance, enhance the quality of life and reduce the risk of falls as well as depression status of their patients. Ideally, jumping maximizes osteogenic responses of the lower extremities which ultimately reduces bone related fractures and osteoporosis. Hence, such programs can prove to be beneficial to the nurses since they enhance postural stability and reduces problems associated with balance (Cakar et al, 2010, p. 60). Hence, such positive effects can go a long way in ensuring that the risk of falls are reduced in these facilities and that the patient’s quality of life is also enhanced.
Four Primary Research References
Cakar, E., Dincer, U., Kiralp, M. Z., Cakar, D. B., Durmus, O., Kilac, H., & Alper, S. 2010. Jumping Combined Exercise Programs Reduce Fall Risk and Improve Balance and Life Quality of Elderly People who Live in a Long-Term Care Facility. European Journal of Physical and Rehabilitation Medicine, 46(1), pp. 59-67.
Lim, J., Cho, J., Kim, J., Kim, Y., & Yoon, B. 2017. Design of Virtual Reality Training Program for Prevention of Falling in the Elderly: A Pilot Study on Complex Versus Balance Exercises. European Journal of Integrative Medicine, 15, pp. 64-67.
Sherrington, C., Fairhall, N., Kirkham, C., Clemson, L., Howard, K., Vogler, C., & Lord, S. 2016. Exercise and Fall Prevention Self-Management to Reduce Mobility Related Disability and Falls after Fall-Related Lower Limb Fracture for Older People: Protocol for the RESTORE Randomized Control Trial. BMC Geriatrics, 16(34), pp.1-10.
Singh, D. K., Rajaratnam, B. S., Palaniswamy, V., Pearson, H., Raman, V. P., & Song, P. S. 2012. Participating in a Virtual Reality Balance Exercise Program can Reduce Risk and Fear of Falls. Maturitas, 73, pp. 239-243.
These studies fail to indicate the optimal content of rehabilitation, that is, the duration and the level of intensity of these exercises. Also, the number of participants is relatively small to warrant the generalization or rather the application of such interventions to the entire elderly population.
Disparities exist in the population groups that should be subjected to the intervention programs. Whereas some studies emphasize that the appropriate group to be involved in these programs should comprise of individuals above the age of 65, other studies illustrate that they are most effective for post menopausal women. Additionally, findings on the success of exercise based mediations on reduction of fall related injuries is also lacking.
The number of participants need to be increased and the duration of training sessions also need to be elongated. These changes can reinforce the credibility of the evidence and ultimately make it applicable among a wider patient population.
In regards to the fourth study, there is need to increase the number of participants and also increase the number of follow up durations in order to enhance the credibility of the findings. In such cases, there is need to monitor the daily fall rates with more participants in order to strengthen the evidence.
Future studies need to indicate the level of intensity of virtual reality exercises as well as the duration such exercises on a daily basis. There is also need to demonstrate the effectiveness of these exercises on a long term basis. Finally, studies need to illustrate the effects of these exercises on reducing fall related injuries. Available evidence only indicates that such exercises reduces the risk of falls but not the associated injuries such hip fractures.
Nurses are tasked with providing first line care in various practice settings. In this critical task, nurses are required to exhibit critical thinking skills and be able to make timely decisions that are essential in protecting the lives of the patients. Furthermore, developing strong patient-centered care that is grounded on evidence-based knowledge is essential in the clinical practice (Curtis et al, 2016, p. 862). Ideally, nurses should be equipped with the knowledge and expertise to disseminate findings of evidences by researchers in the nursing field and apply such knowledge in their practice and particularly in the clinical decision making (Kristensen, Nymann & Konradsen, 2016). To achieve such goals nurses need to achieve certain key objectives including; demonstrating awareness of the available literature applicable to their practice domains, be able to acknowledge the research and also critique the same literature using alternative evidences, apply the findings of these studies in their practice areas, and contribute to the available research by conducting their own independent research.
Also, while providing care to their patients, nurses need to exercise self-compassion and encourage self-care among patients. This notion is grounded on the fact that nurses are required to provide holistic and quality care to their patients. As such, they need to empathize with their patients a factor which should ideally guide their action plans (Curtis et al, 2016, p. 870). By doing so, nurses can ensure that they provide quality care that is specifically tailored towards improving the patient’s quality of life or alternatively improving their physical and emotional wellbeing.
To foster a conducive working environment, nurses need to peacefully coexist with their colleagues and collaborate or alternatively work as a team for the benefit of the patients. This objective requires that nurses be aware and appreciate the different cultural backgrounds that are existent within the clinical practice environment. As such, they need to respect the diverse cultures of their colleagues and patients as well Furthermore, nurses need to be resilient characterized by their ability to get along with others and observe the workplace culture that influences positive and quality patient outcomes (Hezaveh, Rafii & Seyedfateni, 2016, p. 217). Resilience also implies that nurses need to recognize that they are in a continuous learning process and as such, they have to look up to their supervisors and always be willing to learn new things and accept the input being given by their colleagues (Nesbitt & Barton, 2014, p. 4). Similarly, such traits also builds up to collegial trust. Ideally, for nurses to thrive in clinical settings, there is need for developing formidable relationships that are based on trust. In doing so, nurses are required to operate as a team and always be willing to acknowledge the need for help when necessitated. This quality will provide the grounds for which trust can be built among nurses. On this note also, nurses need to identify the key contacts both in the workplace and outside the workplace (Peterson et al, 2014, p. 61). This group of individuals can provide critique or an alternative way of thinking that can beneficial to the nurses’ clinical work.
Reference List
Curtis, K., Fry, M., Shaban, R. Z., & Considine, J. 2016. Translating Research Findings to Clinical Nursing Practice, Journal of Clinical Nursing, 26(5), pp.862-872.
Hezaveh, M. S., Rafii, F., & Seyedfateni, N. 2014. Novice Nurses’ Experiences of Unpreparedness at the Beginning of the Work. Global Journal of Health Science, 6(1), pp. 215-22.
Kristensen, N., Nymann, C., & Konradsen, H. 2016. Implementing Research Results in Clinical Practice: The Experience of Healthcare Professionals. BMC Health Services Research, 16(48).
Nesbitt, J., & Barton, C. 2014. Nursing Journal Clubs: A Strategy for Improving Knowledge Translation and Evidenced Informed Clinical Practice. Journal of Radiology Nursing, 33(1), pp. 3-8.
Peterson, H., Barnason, S., Donelly, B., Hill, K., & Whiteman, K. 2014. Choosing the Best Evidence to Guide Clinical Practice: Application of AACN Levels of Evidence. The Journal for High Acuity, Progressive, and Critical Care Nursing, 34(2), pp. 58-68.
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