Introduction
Fall prevention in geriatric patients remains one of the most pressing issues in nursing. Older people, especially those with dementia and other cognitive impairments, are at higher risk of falling and sustaining injuries. Physical exercise is frequently proposed as an effective fall risk reduction intervention in older adults (Toots et al., 2019). However, the potential benefits of exercise as a fall prevention method should be explored more thoroughly to make an informed conclusion on its efficacy. In theory, exercise programs should reduce fall risk by delaying the physical decline of the patients. This paper critically evaluates two qualitative studies on fall prevention in geriatric patients in order to answer a related PICOT question.
PICOT Question
In geriatric patients, what is the effect of physical exercise-based interventions on fall risk prevention compared to the standard care process?
Background of Studies
The first qualitative study by Burgon et al. (2019) focused on exploring the experiences of healthcare professionals working in fall prevention and memory assessment services in the East Midlands, United Kingdom. The study was part of a large-scope project aimed at testing and developing fall-prevention interventions for patients with dementia. As such, the study had an empirical significance for nursing since it provided valuable information based on the first-hand experiences of healthcare workers. The researchers strived to identify barriers and facilitators to fall prevention. Thus, the research question was: “Which themes are most common in fall prevention in elderly adults with dementia?”
The second study explored the effects of physical exercise on various dimensions of older patients’ lives. Gonçalves et al. (2020) contributed to nursing by establishing criteria for the Core Outcome Set, a guideline for evaluating exercise-based interventions in geriatric patients. In that regard, the researchers’ key objective was to reveal the most valuable benefits of exercise from the perspective of all stakeholders — patients, carers, and healthcare professionals. Essentially, the paper’s research question was: “Which health outcomes are most important in exercise-based interventions?”
Support of the Nursing Studies Problem
Burgon et al. (2019) dedicated a specific section of their study to evaluating the effectiveness of exercise-based interventions in fall prevention. In particular, healthcare professionals were asked about the outcomes of exercises in terms of fall prevention and about potential concerns arising during the intervention deployment. This research goal is directly related to the PICOT question since Burgon et al. (2019) attempted to elicit healthcare professionals’ feedback on the efficacy of exercise as a fall prevention method. The study by Gonçalves et al. (2020) has a less direct relation to the PICOT question. The researchers explored the overall effect of physical activity in elderly patients with dementia rather than its fall prevention aspect. However, the paper still provides insight into the potential efficacy of exercise as a fall prevention strategy since physical activity may positively affect such predictors of fall prevention as patients’ strength, agility, and stamina.
The exercise-based interventions in both studies were primarily focused on strength and balance training in older adults with dementia. These methods and comparison groups are similar to those stated in the PICOT question — physical exercise-based fall prevention interventions and geriatric patients. Healthcare professionals, patients, and carers expressed their opinions on whether exercises helped prevent falls or improved the patients’ physical well-being. Therefore, results provide a solid baseline for comparison against the standard care process.
Method of Studies
Both articles utilized a research method based on in-depth semi-structured interviews. This method is a staple in qualitative studies since it allows the researchers to obtain structured responses for subsequent thematic analysis. However, the authors used slightly different interview execution techniques in their papers. Burgon et al. (2019) used only a face-to-face technique; meanwhile, Gonçalves et al. (2020) offered the respondents a choice between face-to-face, phone, and video formats. Such flexibility can be explained by the difference in sampling since Burgon et al. (2019) interviewed healthcare professionals exclusively, while Gonçalves et al. (2020) also talked to patients with dementia and their carers.
Overall, the in-depth semi-structured interview followed by a thematic analysis is a solid choice for eliciting real-world perspectives and experiences. The respondents give long and detailed answers to clearly stated questions, which makes their input particularly valuable. However, the studies based on a semi-structured interview methodology frequently lack generalizability. Arranging long conversations with people from a large research sample is too time-consuming. As a result, interview-based qualitative studies are primarily helpful for revealing subthemes and directing to potential answers rather than giving generally applicable solutions.
Results of Studies
Burgon et al. (2019) found healthcare professionals’ general approval of exercise-based interventions deployment as a fall prevention method in elderly patients with dementia. However, the respondents also believed that patient engagement depends on their pre-dementia interest in physical exercise. Furthermore, any decision to deploy exercise-based interventions should be based on patients’ safety and ability to perform the exercises. The latter result aligns with the findings by Maula et al. (2019) and Stødle et al. (2019). Geriatric patients need supervision and emotional support to perform exercises safely and achieve positive results.
Gonçalves et al. (2020) found that physical exercise positively contributed to the patient’s mental and physical well-being, the most important health outcomes for older adults. At the same time, the researchers advised supervision to prevent falls during physical activity or calm the patients if they become frustrated or agitated (Gonçalves et al., 2020). These findings are related to Sterke et al. (2021), and Hwang et al. (2019), who suggested avoiding the “one size fits all” approach to exercise-based interventions and motivating older adults by focusing on their progress.
Overall, both studies have practical implications for nursing practice as they point to the potential efficacy of physical exercise in fall prevention. Furthermore, Burgon et al. (2019) and Gonçalves et al. (2020) pointed to the areas of concern for practitioners who would try to deploy exercise-based interventions. In particular, geriatric patients need supervision and encouragement to stay motivated and achieve results. Extra attention should be paid to ensuring the patients’ safety during exercise.
Ethical Considerations
Both studies had similar ethical considerations associated with the research design. Firstly, the authors had to obtain an agreement to share the respondents’ answers with the public. Secondly, they had to minimize any distress or harm during the interview process. The first consideration was taken into account in a similar manner, as Burgon et al. (2019) and Gonçalves et al. (2020) obtained informed consent from all participants. The second ethical issue had different solutions due to the researchers’ preferred interview techniques. Burgon et al. (2019) made healthcare professionals more comfortable by assigning their colleague, a fellow occupational therapist, to an interviewer duty. Gonçalves et al. (2020) offered different options for giving an interview; if the respondents felt uncomfortable with a face-to-face conversation, they were allowed to choose a video or a phone format.
Conclusion
In summary, one can claim that both qualitative studies pointed to the potential efficacy of exercise-based interventions in fall prevention in geriatric patients. However, the researchers revealed certain areas of concern that should be considered to ensure efficacy. Geriatric patients need supervision and moral support throughout the intervention delivery process. Otherwise, they may either fall and sustain injuries while exercising or become too frustrated and agitated to exercise effectively. Nevertheless, correctly delivered exercise-based interventions seem to be a promising path toward fall risk reduction.
References
Burgon, C., Darby, J., Pollock, K., van der Wardt, V., Peach, T., Beck, L., Logan, P., & Harwood, R. H. (2019). Perspectives of healthcare professionals in England on falls interventions for people with dementia: A qualitative interview study. BMJ Open, 9(2), e025702. Web.
Gonçalves, A. C., Marques, A., Samuel, D., & Demain, S. (2020). Outcomes of physical activity for people living with dementia: Qualitative study to inform a Core Outcome Set. Physiotherapy, 108, 129-139. Web.
Hwang, J., Wang, L., Siever, J., Medico, T. D., & Jones, C. A. (2019). Loneliness and social isolation among older adults in a community exercise program: A qualitative study. Aging & Mental Health, 23(6), 736-742. Web.
Maula, A., LaFond, N., Orton, E., Iliffe, S., Audsley, S., Vedhara, K., & Kendrick, D. (2019). Use it or lose it: A qualitative study of the maintenance of physical activity in older adults. BMC Geriatrics, 19(1), 1-12. Web.
Sterke, S., Nascimento da Cunha, A. P., Oomen, H., Voogt, L., & Goumans, M. (2021). Physiotherapy in nursing homes. A qualitative study of physiotherapists’ views and experiences. BMC Geriatrics, 21(1), 1-9. Web.
Stødle, I. V., Debesay, J., Pajalic, Z., Lid, I. M., & Bergland, A. (2019). The experience of motivation and adherence to group-based exercise of Norwegians aged 80 and more: A qualitative study. Archives of Public Health, 77(1), 1-12. Web.
Toots, A., Wiklund, R., Littbrand, H., Nordin, E., Nordström, P., Lundin-Olsson, L., Gustafson, Y., & Rosendahl, E. (2019). The effects of exercise on falls in older people with dementia living in nursing homes: A randomized controlled trial. Journal of the American Medical Directors Association, 20(7), 835-842. Web.