Give a systematic review on to reduce the incidence of falls among elderly living in residential aged care setting by exercise therapy program”.
Change Record
Comparing to the younger generation following changes can be seen older generation in term of physiologically (Thor et al., 2011)
System |
Older vs. younger |
Importance |
Nervous system |
There is higher occurrence of cognitive injury, their ability to assess pain becomes weaker |
May have become worst because of pain medications. This can be analyzed by using behavioral scale |
Cardiovascular system |
Frequency if heart diseases increases |
Number of consequences may arises because of treatment supplied to hypertension |
Pulmonary system |
Sleep apnea increases in incidents |
Treatment of oxygen after operation; more than required interval between doses |
Hepatic system |
Metabolism of drugs decreases |
Reduction in doses |
Skin of older people becomes more wrinkled with visible lines, it elasticity also decline with the pace of increment in the age. Due to the reduction in hair pigments cells hairs becomes thin and grey. When old aged people reach in their 80’s the normal rate of height fall is 2 inches. Changes occur in hearing ability of older people, they start listening less clear voice from the year of 55. A very common change occurred in every old person is their eye sight, its tends to reduce when they get older (2015)
Older adults face serious fall because of unstable balance are considered to be one of the serious clinical problems. These falls have become very conmen in elderly aged people further these falls leads elderly aged people toward mortality and morbidity. Even these falls are the reasons of placing them in immobile and premature homes of nursing. Kellogg (Gibson, 1987) defined elderly fall as absence of consciousness, not intentionally moving toward ground. Many researchers have utilized this or similar definition in defining the elderly aged falls in their study.
These falls are devastating in nature because these provide injuries to individuals and also bother their support network. Martin and his group (2013) mentions in his study that these falls can be reduced up to high extent with proper treatment of physiotherapy. The problem have become so widened that at 65 years old people falls at least once or more often in a single year. These falls brings reduction in confidence, increment in injuries and also lowers the rate of day today activities carried by their own self for self purpose. If these falls are not reduced for present population due to proper measure taken than the number of falls will get increase due to the global rate of population moving toward older age. Likewise in Australia 65 aged people were expected to increase from 13 % that is approximately three million people till the end of 2010 and 24 % which is nearly nine million people are expected to reach old age by 2050 (Begg et al., 2008). This clearly means that more old aged people in near future means more rate of their falls; when there will be more injuries which may lead them to mortality.
In the usual life of human, they are supposed to perform certain activities in order to meet their requirements of daily desires. These falls usually occur when these is abnormal mismatch between the individual physiology and support from environmental material. There are number of body structure needed for the position of upright. In order to have proper upright than balanced combination of body structure and functions are required. Older people needs many things together at adequate if they want to reduce the number of falls. They have to be understand the environmental challenges where they are moving aren’t that place is slippery or uneven to walk properly. They are needed to understand the insight of their body parts. They must have mental as well as physical awareness to understand and take action against the possible fall. They are also expected to have strength required to move on against the direction of fall. The combination of all these things together can prevent falls among older people.
This study requires to include the manual with automated search because the nature of the study. The basic ground for any research or study is required and relevant information needed right from the beginning of the study till the end of study. Information for study has been taken from books because it gives general to specific information. Journals are also included in the study because it plays an important role of source in providing specific and current information. Useful and relevant information have been taken from internet in addition because many articles are published online, statistics of old age people included in study are taken with help of internet. So in order to provide the complete but relevant information in study both searches have been taken into consideration.
Exton smith in 1977 found out that woman fall rate was more as compare to the man fall rate. Further (Campbell et al., 1981) results exposed from 533 subjects that were above 65 had falling experience of 33% as compare to its last year experience of fall. In current years of study it has been observed from the old age study that there has been increase in the fall rate of old aged people. Lord concludes in his study that 39 % woman out of 241 had two or one fall in a single year (Lord et al., 1993)
There were about 50% of falls used to occur inside of homes or nearby home. Within the house falls used to occur in bedroom, from stairs, through stools and even in living rooms (Luukinen et al., 1995). The findings about location of fall reveals that location of has strong connection with the majority of actions took place either outside or inside. Study conducted on the time of fall shows that most of the falls used to occur on day and afternoon time where as only 20% of fall used to occur at night timings (Campbell et al., 1990)
Consequences concerning to fall are quite severe because old people are not so strong to deal or recover from the injuries easily as compare to the younger people. People having age above 65 years are hospitalized because they casually fall and this accounts almost 4 % admission rate of hospitals (Baker & Harvey, 1985). In some of the serious cases theses falls leads people towards lifelong immobility due to hip fractions, this fraction also leads to death in often more sever situation (Marottoli et al., 1992)
A study on 17 hospitals considering 29,972 as participants reveals that proper intake of vitamin D brings major reduction in number of falls occurring in old age. Proper number of facilities in the environment of hospitals, exercising provisions meant at providing improvement in physique and bones of older people. But this provision did not provided accurate result of improvement as extent to the amount of proper exercise carried varied from hospital to hospital. On the other hand number of interventions carried together provided sufficient improvement in the number falls rate of old aged people. Therefore though it was evidenced that interventions together will improve the fall rate if proper facilities are provided in hospitals however but however it was inconclusive as it still did not covered the whole risk of falling (Cameron et al., 2012).
When we follow many interventions at a time it becomes very difficult to verify or determine the results. Even the impact cannot be measured properly. Therapy exercise program followed as a single intervention can be easily measured for better and accurate results. These results can also leads to proper remedies which can heal the causes of fall in old aged people.
It has been observed that people who remain active in their schedule experience lesser fall as compare to the people who are not active in their schedule (Haseech et al., 2008). Nonetheless, there are no such evidences available which can prove that activeness can be the major remedy, when it comes to reduce number of older aged people falls. So encouraging older people to remain active in their schedule will not heal the problem of severe falls. On other hand it can be highly possible that people having no exposure of physical activities may lead them to fall because they find it risky to get involved as they become physically weak due to none of any physical activity.
Several number of analysis have concluded in their studies that exercises includes the challenges of balance are more likely to prevent falls with comparison of type of exercises which do not hold balancing challenge (Sherington et al., 2008). Training of balancing provides 19 times much effective results in preventing the number of falls as compare to the exercise without this training. Extreme level of training includes the structuring of balance in which allowing older aged people to stand for longer hours. For doing so participants are directed to follow these steps:
Huge success in improvement can be observed when training of balance is combined with other few exercises but with no inclusion of walking. This combination have provided 42% of improvement in the fall rate of old aged people which states that 42% number of falls were reduced. Programs having exercises and walk together also reduced the number of falls but programs having walking and balancing together did not provided that effective results.
The rationale behind exclusion of walking from other exercising approaches for prevention of fall among old age people is because:
Even though walking did not provided any purposeful benefits in preventing the falls for older people but on the other side it has other benefits for same age group (Nelson et al., 2007). Walking would have been included as one of the way of preventing falls among elder people but due its requirement of huge time taken in providing balance it is excluded. Programs of exercising aims at providing the prevention if in any case is including walk than participants are well assessed before implementing as it involves risk of balancing and participants may face falls.
Impact of exercise is observed very less among old aged people who tried to reduce the number of falls with help of exercise when reached the level of higher level risk in falls. Therefore the impact of exercise works more effectively when is less number of falls per year that is 2 falls per year.
Meta analysis study conducted to determine the significant difference of care took among personal residence and nursing homes to reach the conclusion that which one was more effective in providing better prevention in the number of falls. The study revealed that the exercises followed at the personal residence did not provide any measurable impact on the prevention of falls. On the other hand it was seen that older aged people who were taken care and were provided with exercises from time to time their rate of fall per year was reduced (Cathrene et al., 2008).
The previous studies on the schedule of the exercises followed per week and required time to make more effective result reveals that
In the testing of Meta analysis study, huge impact of exercise was observed which was included almost higher than 50 hours of exercising. This resulted into 20% of improvement in preventing the number of falls per year. The testing of exercising considering different hours turn our out to be different around 22% (Sherington et al., 2008).
The total time taken in testing was a combination of following the exercising partially at home and with group, so this means that once a week outside of home with group otherwise rest of the days performing exercise at home (Barnett et al., 2003). Exercising used to be carried out in smaller portions either performing the exercise twice a week for one hour sometimes for three days in week, even occasionally these 60 minutes of exercise used to be replaced with 40 minutes.
This was also observed that when exercise sessions were not in continues format the benefit occurring out of it used to be lost (Nelson et al., 2007). So programs aimed at reducing the number of falls had to remain continue in process in order to be beneficial. All participants following the programs of exercise have to be encouraged to remain in touch with exercise.
Some of the Meta analysis study proves that there is limited scope of preventing falls within residential area on the other some Meta analysis turns out be highly positive in results. The study which proves exercise is beneficial within homes suggest exercise can prevent falls, programs that are including continues schedule of exercise with training of balance are highly effective in reducing the number of falls.
Older age people who have completed their 85 years of life in some cases even more than that or they are having limitations in performing certain movements they may face more risk of falling. Exercising aimed at reducing the number of falls must not prescribed to people for whom it may become reason to fall, therefore before prescribing the number of exercises to people their physical ability to carry out that exercise needed to be analyzed at primary priority. There is evidence which suggest that number of exercises seems to be good and relevant to aged people is successful at minimizing number of falls (Sherington et al., 2008).
There had been number of falls observed in New Zealand which became the cause of many older people mortality. In order to reduce the research group specifically took this issues into consideration and focused on its solution. Therefore they launched program of exercises at home to prevent usual falls among old people. The program was named as Otago, this aimed at providing strength to the older muscles and training them to learn balance at their home place through a well trained instructor
In prevention of falls among old people Otago program considered the strength of leg muscle and balance highly important. Stability can only be achieved through this. People belonging from the age group of 90s can also reduce the number of falls with suitable home based exercises.
Exercises must be designed or scheduled in way that it must be able to carry on the benefits it is holding within. This can be achieved when exercises are slow in movements in initial times. Old aged people need motivation in this process, instructor have to remain in touch with these people sometimes through personal visits or sometimes asking the improvements through telephonic conversation. Family also play vital role by supporting and motivating the old people to remain continue in exercises.
The programs also required measures to be monitored for desired success. There must be proper record of falls each month occurring by maintain the calendar. Reasons of falling and place where fall is occurred must be verified. A close check dairy should be maintained which bears the record of conformity with exercise instructor. In between tests must be taken to verify the improvement this not only will motivate older age people to be continued with exercises but also makes sure the level of improvements.
This program has complete package as it includes activities focusing on the strength of leg muscles, balancing and some cases if suggesting walk than prescribing proper measures to be taken. These programs puts light on the assessment of achievement in that they verify stamina of ankle cuff, safety in performing each exercise. In this programs increment is number of exercise is made on slow speed. Frequency of these programs also verifies the comfort zone by keeping rest days in between for older people.
Safety of older people must be scrutinized at priority. The older people should not be allowed to hold any materialistic thing which may have feature of movement. Older people may be are in need of having something to hold while performing exercise than they should be suggested to hold something sold material or things such as bench or table but usage of these material is again restricted if it is not prescribed by the instructor. Older people are suggested to cal their doctors if they feel chest hurting and dumpiness of breath (Li et al., 2016) .
In olden studies subjects or selected participants were asked to provide the number of falls they had in past period but this did not provided the accurate result as they used to forget the accurate number of falls (Cummings et al., 1988). But in recent studies old aged people were asked to fill the questionnaires twice in between months or weeks to verify the exact number of fall.
It is very important to have participants or respondents who represents the entire population so in this study man or woman having reached the age of 60 (James et al., 2009), starting from sixty of age because generally from this age people start complaining about bone issues or other health related issues. Therefore participant belonging from age 60 or above are considered to be as old. So people not belonging to this age group are excluded from the study. These studies have also concentrated on primary data derived from the sample selected from the targeted population. Interviews of physiotherapist also has been taken in order to understand what measure exercises are needed and what nutrients are required to be taken in order to avoid such falls.
The chosen language in reviewing the articles or books fir this study was English. Almost every country study published in English language is taken into consideration. Records of trauma are not relating to falls in this study.
Two assessors separately checked the quality of studies included. Controlled studies and RCTs were assess by using Cochrane Collaboration risk bias tool (Deeks et al., 2011), uncontrolled studies were assessed through two check lists; however full details can be seen below in table:
Randomized controlled trails all either scored as Yes (+)/ No (-)/ Unclear |
|
Sequence generation |
Was allocation of the sequence properly generated? |
Allocation secretion |
Was the allocation properly kept as a secret? |
Blinding |
Was knowledge of the allocation properly kept secret from the result assessors? |
Incomplete outcome data |
Was each outcome adequately addressed/ |
Selective result reporting |
Are the reports of this study free of advices of selective outcome reporting? |
Other biases |
Was the study away from the claims that can put this at high risk of bias? |
Controlled before after studies all scored as Yes (+)/ No (-)/ Unclear |
|
Selection bias |
Are individual included in the study were presenting targeted population? |
Blinding |
Was knowledge of the intervention were concealed from the outcome assessors? |
Detection bias |
Was outcome measure and were reported in standardized way |
Incomplete data |
Was data adequately addressing each of the outcomes? |
Selective outcome data |
Report were free of outcome suggestions or not |
Other sources of biases |
Was the study free from risk of biases? |
Two assessors reviewed separately the titles and abstract having proper citations recognized through search engines, applied and criteria of selection was probably relevant study papers and also extorted the data among the selected studies by applying the standardized form which was well piloted before use. Disagreements occurring were sorted out with assistance of third reviewer. We extracted the information on basis of type of study design, aims of study, selections of participants, their settings, intervention (having details about provider, time and intensity) and results.
Longitudinal studies were analyzed throughout the literature and few were Meta analysis. From longitudinal study results show that analyzing and evaluating the impact of interventions of exercises at home had evidenced impact on older people. Meta analysis of longitudinal studies also proved the same. Studies were classified into group of different types of interventions used in studies for healing the fall of older people.
Chapter |
Topic |
% |
Words |
Months |
1 |
Introduction |
5 |
3500 |
3 |
2 |
Literature review |
30 |
21000 |
6 |
3 |
Methodology |
20 |
14000 |
4 |
4 |
Data analysis |
25 |
17500 |
5 |
5 |
Conclusion and implication |
20 |
14000 |
6 |
Total |
100 |
70,000 |
24 |
|
(Phillip & Pough, 1987) |
3. Conclusion
Fall in old age people have become very common these days. Number of falls is ever increasing may be because of no proper implementation of studies conducted in this era. Studies show that injuries occurring from falls among old people lead to them to face mortality. Sometimes it brings lifelong immobility which again is half death for any normal human being. It has been widely investigated that number of older people will increase globally in coming years. As compare to man there is relatively more rate of fall in older women. When they fall they do not have that strength to put all adequate requirements from their weak body and utilize this strength in keeping them safe from fall.
There are no problems which do not serve solutions, every problem bring hints of solution with them. In this case to prevent these falls in residence, proper and well trained instructor that can be hired who can give time to time required instructions about exercise. Along with these instructions the weak body of old people must be scrutinize well than tailored exercise suitable to their physiques must be provided to them.
These old aged people not only need support from instructor for remaining fit to fights falls but they also need motivation from family and friends. It also been observed that old people not only falls outside the home but also inside of home so home environment also have to scrutinize and well settled in order protract these delicate bodies from falling. Not only homes but when they are admitted in hospital for any reason than their also regular exercised had to be continued in order to sustain its benefits. These exercises are needed to be properly assessed and well co ordinate with stamina of body. As it should not be the case that while exercising they become more expose to risk of other injuries because exercise are meant at benefiting the health not at providing the hazardous to life
The research gaps in this area can be meant at investigating the interventions such as dance, bowls or golf games, study carried on these interventions may bring beneficial impact on old age people. Numbers of different exercises are available but there is no comparative study discovered yet which can prove the difference along with its importance.
The further study can also put light on concentration paid on mid life exercise whether these can prevent old age falls. Despite of observing the impact of trials on people on 4 to 5 times it can increase to 7 to 9 trials. The comparative benefits I still not analyzed by keeping single intervention versus multi interventions.
References
Anon., 2015. Web-MD; Healthy Aging-Normal Aging.
Baker, S.P. & Harvey, A.H., 1985. Fall injuries in the elderly. Clinics in geriatric medicine, 1(3), pp.501-12.
Barnett, A. et al., 2003. Communityâ€Âbased group exercise improves balance and reduces falls in atâ€Ârisk older people: a randomised controlled trial. Age and ageing, 32(4), pp.407-14.
Begg, S.J. et al., 2008. Burden of disease and injury in Australia in the new millennium: measuring health loss from diseases, injuries and risk factors. Medical journal of Australia, 188(1), p.36.
Bunn, F..D.A..S.C..N.V..H.D..G.C..M.W.a.V.C., 2014. Preventing falls among older people with mental health problems. a systematic review. BMC nursing, 13(1), p.1.
Cameron, I.D. et al., 2012. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev, p.12.
Campbell, A.J. et al., 1990. Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study. Age and ageing, 19(2), pp.136-41.
Campbell, A.J., Reinkin, J., Allen, B.C. & Martinez, G.S., 1981. Falls in old age: a study of frequency and related clinical factors. Age and ageing, 10(4), pp.264-70.
Cathrene, S., Lord, R.S. & Close, J.C., 2008. Best practices recommendations for physical activity to prevent falls in older adults. sudney: Prince of Wales Madical Research Institute.
Cummings, S.R., Nevitt, M.C. & Kidd, S., 1988. Forgetting falls. Journal of the American Geriatrics Society, 36(7), pp.613-16.
Deeks, J.J., Higgins, J.P.T., Altman, D.G. & Green, S., 2011. Cochrane handbook for systematic reviews of interventions version 5.1. 0 (updated March 2011). The Cochrane Collaboration..
Gibson, M.J..A.R.O..I.B..R.T.a.W.J., 1987. The Prevention of Falls in Later Life-A Report of the Kellogg-International-Work-Group on the Prevention of Falls by the Elderly. Danish Medical Bulletin, 34, pp.1-24.
Haseech, K.C., Byles, J.E. & Brown, W.J., 2008. Prospective association between physical activity and falls in community-dwelling older women. Journal of epidemiology and community health, 62(5), pp.421-26.
James, K. et al., 2009. Falls and fall prevention in the elderly: insights from Jamaica.
Li, F. et al., 2016. Exercise and Fall Prevention: Narrowing the Researchâ€Âtoâ€ÂPractice Gap and Enhancing Integration of Clinical and Community Practice. Journal of the American Geriatrics Society, 64(2), pp.425-31.
Lord, S.R., Sherington, C. & Menz, H.B., 2001. FALLS in older people. 1st ed. Sydney : Cambridge university Press.
Lord, S.R., Ward, J.A., Williams, P. & Anstay, K.j., 1993. An epidemiological study of falls in older communityâ€Âdwelling women: the Randwick falls and fractures study. Australian journal of public health, 17(3), pp.240-45.
Luukinen, H., Koski, K., Laippla, P. & Kivela, S.L., 1995. Predictors for recurrent falls among the home-dwelling elderly. Scandinavian journal of primary health care, 13(4), pp.294-299.
Marottoli, R.A., Berkman, L.F. & Cooney, L.M., 1992. Decline in physical function following hip fracture. Journal of the American Geriatrics Society, 40(9), pp.861-66.
Martin, J.T. et al., 2013. The Effectiveness of Physical Therapist–Administered Group-Based Exercise on Fall Prevention: A Systematic Review of Randomized Controlled Trials. Journal of geriatric physical therapy, 36(4), pp.182-93.
Nelson, M.E. et al., 2007. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation, 116(9), p.1094.
Phillip, E.M. & Pough, D.S., 1987. How to get a PhD.Milton Keynes. U.K: Open university Press.
Sherington, C. et al., 2008. Effective exercise for the prevention of falls: a systematic review and metaâ€Âanalysis. Journal of the American Geriatrics Society, 56(12), pp.2234-43.
Thor, H., Martin, J. & Viscomi, C., 2011. Acute Postoperative Pain Management in the Older Patient.
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