Introduction
The population of older adults is expected to grow continually. Recent statistics estimate that the number of adults aged 65 and above will increase by 24% from 771 million by 2050 (WHO, 2022). The need to effectively address the risks associated with longevity, such as fear of falls and decline in functional performance in older adults, is increasingly demanding. The intensity of these risks is caused by physical inactivity, which further causes general adverse health outcomes for older adults (El-Khoury et al., 2013).
Practicing approaches that foster healthy aging will promote functional mobility, improve independence, and increase quality of life. Many studies have demonstrated the effectiveness of physical exercise programs for older adults. Oh et al. (2012) posit that these programs have resulted in significant outcomes such as improved balance, reduced falls, and increased muscle strength. With this vital discovery, controlled studies examining the efficacy of community-based programs are vast, and there is a need to explore and evaluate the body of literature addressing this subject.
This project will examine the effect of home-based exercise programs among the retired elderly population. A PICOT question is then formulated after investigation, and thorough literature synthesis is done on the variables present in the research questions. The PICOT approach will help summarize the emerging concerns this research question is attempting to explore (Ford et al., 2019).
The vast body of literature reviewing the effect of physical activity focuses on acute care rehabilitation, management of specific health conditions, and fall prevention. By doing a scoping review, the research question should address intervention measures that increase physical activity among elderly individuals, appropriately structured exercise programs that increase physical activity and reduce sedentary behaviors among retired older adults, and current evidence supporting the effectiveness of home-based exercise programs.
PICOT Question
Creating purposeful and detailed research questions is one of the steps that needs to search for different sources of knowledge. PICOT question is a search strategy used in research topics. It serves as a mechanism for identifying effective and unbiased search terms that provide the best evidence in answering a case (Ford et al., 2019).
A PICOT question majorly helps in forming a question that focuses on an important issue within a population and filtering selected results directly related to the topic of study. (P) refers to the population or the sample of subjects related to the study. (I) refers to the Intervention measure used to treat the subject of the survey (Abbade et al., 2016), (C) refers to comparing a reference or a controlled group with the group of the study, (O) refers to the outcome or effectiveness of the study, and (T) refers to the duration of data collection.
This study must consider several factors before the PICOT question is formulated. The considerations are how specific the literature search terms should be in quality and level of breath; the study designs that fit the project research question, whether the population should include more similar cases (Abbade et al., 2016), whether the intervention has to be specific or should a combination of tailored interventions be included, if the effectiveness of the intervention by a validated tool on a form verbally from the populate ion of study, and the amount of difference and how many individuals from the population would be required to both clinically and statistically conclude the effectiveness of the intervention. The developed PICOT question of the study is as follows;
Population
Older adults residing in a retirement community. The older adults in this study are defined as individuals aged 65 and above. This study targets adults over sixty-five; the target audience must report high falls and physical functional declining rates. The aging population in this study is not limited to physical inactivity but also an aging population that presents ethical and medical challenges in a retirement community. The aging population in this study should correspondingly have increased dependence on society’s resources for general physical activity.
Intervention
The study focuses on determining the effect of home-based exercise programs among retirement community adults. A developed community setting that provides access to physical activity that will enhance the likelihood of fitness is of interest to this study. The primary interest is to find the effects of structured home-based exercise strengthening programs, including heel walking, sideway waking, tandem stands, walking and turning around, backward walking, tandem walking, and knee bends (Sherrington et al., 2008). The study also aimed to seek the effects of strength retraining and home-based balance that utilizes knee flexors, hid abductors, ankle plantar flexors, and knee extensors.
Comparison
The qualitative analysis in this segment highlights the control mechanism and connected comparisons of the program to existing frameworks. All interventions associated with the isolated challenges facing the minority group in the experiment form the larger composition of this section. For instance, a standardized supervised non-exercising population is used as an active control group to assist participants in understanding their strengths and weaknesses. The examination must minimize non-specific effects, such as attending the clinic to improve the productivity of the retired population.
Outcome
The program intends to reduce the risk of falls among elderly persons residing in retirement communities. The principal outcome is to assess the number of falls reported in 6 months. This project defines falls as unintentional coming to rest due to unconsciousness or sustaining a mild blow (Chang et al., 2004).
Secondary outcomes may include general mobility and balance. The search sought current findings that support the efficacy of community-based programs in reducing falls and improving physical functions compared to control participants. Several evidenced-based reductions in falls were found from a scoping review that evaluated the effectiveness of community home-based exercise programs.
Time
Time frame is essential in developing PICOT questions because it assists researchers in being specific in strategic planning. Timing helps the program evaluators and developers understand the relationships between the interventions and existing problems facing older adults. The home-based program is divided into segments lasting for six months for effective results.
The first phase will involve participation in a two-month program, exposing them to physical exercise and peer interactions. The next stage will involve professional exchanges between the target population and caregivers. In other words, the outcome of this intervention will be assessed after six months.
Model for the Research
Completing a systematic review of randomized control trials will be the model used in this research. The systemic review will follow the preferred systematic review guidelines and reporting items. RCTs to be included must be conducted in the elderly population living in a general community. Still, only trials with participants in the retired community with a greater risk of falls will be of significant interest. Studies will be independently selected for review, and discussions will later resolve differences.
Following the criteria for research using a systematic review by Cumpston et al. (2019), trials of older adults in which home-based exercise was the primary principal intervention and the number of reported falls rated reduced are eligible for inclusion. The inclusion criteria include studies published in English that evaluated the effect of home-based exercise programs on falls in the population aged 65 years and above according to the WHO definition of elderly (WHO, 20220). Studies with non-exercise or trials in which control groups received exercise are eligible for exclusion.
A systematic review of randomized control trials is best suited for this study. The rationale for using a systematic review is that only through it can a reproducible, objective, and comprehensive search strategy for relevant data be adopted for inclusion in this discussion (Cumpston et al., 2019). A systematic review is conducted on three premises: reduce the vast amount of data in the literature body into comprehensible units, simplify relevant studies to make informed decisions, and infer effectively from the studies collected.
Further, only through systematic review can research results be identified and synthesized to summarize relevant studies promoting evidence-based research (Cumpston et al., 2019). Additionally, systematic reviews can address narrow research questions like “Does home-based exercise reduce falls,” which can be discussed using meta-analysis evidence and techniques from a random control trial utilizing the same measure.
Search Strategy
Conducting a comprehensive search in the extant literature body is the first step of a systematic review. OVID-MEDLINE and PubMed are the databases searched from the inception of this study. Many strategies are incorporated to identify relevant journal articles vital to this study. The search is conducted to access journal articles of at least fifteen years since publication. This database search needed the Social Sciences Citation Index to filter recent and influential studies. The essential keywords used in this electronic search included older adults/falls, retirement community, home-based exercise program, geriatric falls exercise programs, treatment goals, and adherence standards.
Moreover, the following filters were used: aged 65 years and above, randomized control trials from 2013 to 2023, and English language publications. Retrieving data from electronic sources satisfying this research’s need can be very challenging. Therefore, to decide on the data that will make the query, this search will use a precise choice of words using Boolean operators. OR, AND is sued with terms such as falls, exercise, and elderly to bring more desirable results.
The second phase of this systematic review search is designed to assess citations found in four significant core journals with information relevant to this study. These journals are The Effect of Fall Prevention Exercise Programs on fall induced injuries in Community-dwelling Older Adults by El-Khoury et al., 2013; Intensive Exercise Reduces the Fear of Additional Falls in Older Adults by Oh et al., 2012; Effectiveness of Tai Chi as a Community-based falls prevention intervention by Taylor et al., 2012 and, Effective exercise for the prevention of falls by Sherrington et al., 2008.
Titles, background information, abstracts, and discussion of these core journals are screened and assessed independently. Searched terms for relevant systematic reviews were then checked for additional references. The search tracker is obtained as indicated in Table 2.
Evaluation and Synthesis
The synthesis table has given two contributions. First, it has separated different review methodologies and integrated approaches depending on the search’s quality and purpose. Second, it has mapped theoretical approaches or themes and identified the knowledge gaps in the literature, as shown in Table 3.
The evaluation and synthesis table shows that the research studies done on this topic are interdisciplinary and disparate. The synthesized search findings show that the evidence on this topic is a meta-level, and there are some uncovered areas where more research is needed to build conceptual modes and create a theoretical framework (Table 3 Appendix). Importantly, it shows that relevant works of literature essential for this research subject have been yielded.
The Evaluation and Synthesis Table 1 covers the vast literature on this topic. This literature volume will be imperative in examining the evidence on the specific question the subject is trying to address. The evidence from this body of literature informs the best practice for this topic; it provides the principal methodology for assessing the replicative research findings and the possible inconsistencies (Gusenbauer et al., 2020). The synthesis evaluation output in Table 4 indicates the expected interventions for the program. Additionally, the topic of study is more complex.
Therefore, the evidence from this literature informs on how to counter the possibilities of potentially producing conflicting findings (Xiao et al., 2019). Suppose the conclusions of this project replicate or become inconsistent. In that case, “What is the effect of home-based exercise programs among the old adults in a retirement community?” remains unanswered. Further, the evidence provides a platform for collecting, synthesizing, and analyzing all the literature studies to give an overall impression of the nature, extent, and quality of information related to this research question, highlighting gaps in what is known and what is not known.
The body of evidence is critical in designing practice improvement for this topic and is drafted in Table 5. New theories and emerging literature on this subject can now be integrated from the body of evidence to understand and locate the core constructs embodied in this topic. As stated by Xiao, Yu, & Watson (2019) on the significance of a large body of evidence in a scoping review, the body of evidence will now bring the potential of evaluating, extending, and developing ideas to link evidence to theories and theories to evidence.
While designing the project, the body of evidence makes it easy to draw broad and robust inferences by producing data and a summary that is not biased by what the cumulative evidence tells on this research topic (Gusenbauer et al., 2020). Additionally, the body of evidence will impose a focus and a discipline that will make presenting information digestible and tangible. It is possible to break down the massive task into sections that will enable the project’s progress to be concretely monitored based on the body of evidence.
Changes can be pervasive in modern research. If the reverse of the research topic holds, the outcome that will be used to measure the change is non-adherence to the intervention program. Non-adherence based on incompletion or completion of the exercise program but with no advantageous effect on reducing falls will form the basis of change. Suppose the exercise programs are to yield conflicting results. In that case, a literature review will be done on the effects of home-based exercise programs on factors such as increased musculoskeletal injury and falls.
The concern that physical activities among older people create different health-associated problems will be expressed by doing a literature review of randomized control studies with evidence supporting the notion. Key outcomes to consider when the intervention program has failed include fall rate, risk assessment, functional mobility assessment, and gait and balance performance (Taylor et al., 2012). The data on the above outcomes can be obtained through electronic health records, which are used to do a scoping review of the studies available on the conflicting effectiveness of the intervention program.
Change Model
The change model I will use to motivate stakeholders is Lewin’s change model. The Lewins change model can support research through transitions in identifying areas of resistance and strength before implementing change. Lewin’s change model is a three-phase model (freezing, movement, and unfreezing) that effectively describes modification processes, structures, and processes of a project (Hussain et al., 2018). If there is a change in the research topic, the current project will be unfrozen, and an analysis of the need for change and improvement can be made. After making the changes, stakeholders are then guided throughout the change transition.
The new status quo will be solidified or refrozen once revisions have been tweaked and deployed according to the stakeholders’ feedback. Three phases in this model do not guarantee fat transition (Wojciechowski et al., 2016). Spreading out the changing face may take a long time to provide training and seek stakeholders’ approval. This model will be applicable after seeking strong support from stakeholders and with the need to make broad changes to the project.
The rationale behind using Lewin’s change model is that it contains theories, methodologies, and concepts that have an in-depth approach to effecting change in this project. Lewin’s model gives an easy guide to making changes, navigating the transformation process, and designing implementation to solidify the difference in research (Hussain et al., 2018). Additionally, this change model is ideal because it stresses a gradual but purposeful change, keeping wrapped in the benefit of change until full implementation.
The unfreeze step is that the more change is acknowledged, the more urgency and the more likely to pull a motivation to accept change (Wojciechowski et al., 2016). Lewin’s change model positions a vision for change. It is ideal for making frequent updates to all staff and stakeholders involved in the change process. Moreover, the activity planning on the change model provides a road map for specific activities and events, such as temporal orientation and integrated change tasks, that promote a successful transformation.
Conclusion
Home-based exercise programs improve physical fitness and reduce falls. Based on evidence from Random control trials, studies have demonstrated that a well-structured exercise program can effectively improve muscle strength and functional mobility, countering the risk of falls. The systematic review indicates that exercise programs are more effective than no standard care or no intervention.
The scope reviews highlight the diversity of measures used in measuring falls and their implications to include multiple studies in a meta-analysis to produce specific intervention implementation guidelines. However, assessing the evidence from a systematic review reveals essential gaps and areas of future research that can be addressed to improve the implementation of individualized home-based exercise programs to reduce older people’s falls within the retired community.
With the help of a formulated PICOT question, it is easy to develop a search strategy that allows easy navigation into the database containing a vast body of literature on this topic. By completing a systematic review, it is possible to synthesize evidence that will inform a research practice that is unbiased and non-conflicting with other published findings. Synthesizing the evidence from the vast body of literature is also imperative in designing a project that integrates new theories, concepts, and emerging evidence in the research topic. The research is not immune to change. Lewin’s change model is best suited to motivate stakeholders and orient the research topic into a new area of interest.
References
Barnett, A. (2003). Community-based group exercise improves balance and reduces falls in at-risk older people: A randomized controlled trial. Age and Ageing, 32(4), 407–414. Web.
Chang, J. T., Morton, S. C., Rubenstein, L. Z., Mojica, W. A., Maglione, M., Suttorp, M. J., Roth, E. A., & Shekelle, P. G. (2004). Interventions for preventing falls in older adults: Systematic review and meta-analysis of randomized clinical trials. BMJ, 328(7441), 680. Web.
Cumpston, M., Li, T., Page, M. J., Chandler, J., Welch, V. A., Higgins, J. P., & Thomas, J. (2019). Updated guidance for trusted systematic reviews: A new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database of Systematic Reviews. Web.
El-Khoury, F., Cassou, B., Charles, M.-A., & Dargent-Molina, P. (2015). The effect of fall prevention exercise programs on fall induced injuries in community-dwelling older adults: British Journal of Sports Medicine, 49(20), 1348–1348. Web.
Ford, L., & Melnyk, B. M. (2019). The underappreciated and misunderstood PICOT question: A critical step in the EBP process. Worldviews on Evidence-Based Nursing, 16(6), 422–423. Web.
Gusenbauer, M., & Haddaway, N. R. (2020). Which academic search systems are suitable for systematic reviews or meta‐analyses? Evaluating retrieval qualities of Google Scholar, PubMed, and 26 other resources. Research Synthesis Methods, 11(2), 181–217. Web.
Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123–127. Web.
Oh, D. H., Park, J. E., Lee, E. S., Oh, S. W., Cho, S. I., Jang, S. N., & Baik, H. W. (2012). Intensive exercise reduces the fear of additional falls in elderly people: Findings from the Korea falls prevention study. The Korean Journal of Internal Medicine, 27(4), 417. Web.
Sherrington, C., Whitney, J. C., Lord, S. R., Herbert, R. D., Cumming, R. G., & Close, J. C. T. (2008). Effective exercise for the prevention of falls: A systematic review and meta-analysis. Journal of the American Geriatrics Society, 56(12), 2234–2243. Web.
Taylor, D., Hale, L., Schluter, P., Waters, D. L., Binns, E. E., McCracken, H., McPherson, K., & Wolf, S. L. (2012). Effectiveness of tai chi as a community-based falls prevention intervention: A randomized controlled trial. Journal of the American Geriatrics Society, 60(5), 841–848. Web.
WHO, (2022). Aging and health. World Health Organization. Web.
Wojciechowski, E., Pearsall, T., Murphy, P., & French, E. (2016). A case review: Integrating Lewin’s theory with Lean’s system approach for change. OJIN: The Online Journal of Issues in Nursing, 21(2). Web.
Xiao, Y., & Watson, M. (2017). Guidance on conducting a systematic literature review. Journal of Planning Education and Research, 39(1), 93–112. Web.
Appendix
Table 1: Outcome Grid.
Table 2: Search Tracker.
Table 3: Synthesis Evaluation Table.
Table 4: Intervention Table.
Table 5: Design, Sample, and Outcome Table.