Introduction
The problem of fall-related injuries is common among the elderly. People who live at home or in a long-term care setting and are not able to care for themselves often encounter the issue of moving independently. Thus, they may fall while trying to perform some daily tasks. The lack of awareness about this issue is usually coupled with one’s reduced physical strength and agility, which results in them being unable to coordinate their movements.
The occurrence rate for this problem can be measured. For example, to assess the scope of such a problem as falls in the elderly, one can define the type of fall and estimate the number of falls per person for people who did not undergo any type of intervention (Spath, 2013). Then, the same rate of falls can be determined for individuals who went through an intervention process. This data can help establish the success or failure of intervention and prove that it does or does not work.
The issue of falling is very serious for older individuals, as it can lead to a number of traumatizing and lasting outcomes. For instance, one’s fall may cause long-term pain, fractures, psychological distress, and even prolonged hospitalization. For some persons, the lack of personal freedom and the inability to perform basic tasks may negatively affect their mental stability. Although people in long-term care are helped by professionals, it is important for them to retain a level of autonomy.
Therefore, this problem has to be addressed in order to lower the rate of falls and prevent some related injuries. It is necessary to find a working intervention process and implement it in practice. The problem of falling among the elderly in long-term care is critical and requires intervention as it may lead to serious and long-lasting physical and mental harm.
Literature Review
The topic of falls for elderly patients is discussed in a variety of scholarly works. Many authors not only describe the scope of the problem but also evaluate different types of interventions and test their effectiveness. In the analysis of the issue, authors note the significance of the effect that falls have on the elderly. For instance, Siegrist et al. (2016) state that frequent and infrequent falling can result in higher rates of mortality among older patients.
Such problems as institutionalization and complete loss of self-sufficiency are also often linked to falling. The authors note that falls can be caused by many factors that are directly and indirectly linked to the patient’s health and environment. It is undeniable that some age-related changes and correlated diseases affect the way people move. Nevertheless, other factors may play their role as well. The authors outline exercising as the best way to reduce falls.
Ungar et al. (2013) establish that changes in sight, hearing, and locomotor functions of the body are the main reasons for falling. However, these initial factors are also followed by various conditions of neurologic, musculoskeletal, cardiovascular, and other systems. Thus, the reasons for falling are complicated and should be addressed by multiple interventions. The authors conclude that appropriate medication, regular exercise, and modification of the surrounding environment can help older individuals to reduce the risk of falling.
The article by Karlsson, Magnusson, von Schewelov and Rosengren (2013) also reviews some approaches to fall prevention. The authors outline the same outcomes to the issue and highlight the increasing cost of treatment that usually occurs after the patient falls. This article, however, divides all possible risks into two types – modifiable and non-modifiable where the former can be improved with an intervention while the latter cannot be changed significantly.
For example, the environment of the person can be made safer to avoid falling. On the other hand, such conditions as cardiovascular disease should be treated separately from fall prevention. The authors distinguish seven different types of intervention, including exercise, vitamin D supplements, drug treatment, surgery, home modifications, and specific footwear. The seventh category is multifaceted intervention, which combines multiple approaches to create a more personalized plan. The authors conclude that an exercise program that targets various groups of muscles is the most effective type of fall prevention. Environmental alteration can also make one’s surroundings safer.
The effect of falls and the importance of exercise in their prevention are also discussed in the article by Granacher, Gollhofer, Hortobágyi, Kressig, and Muehlbauer (2013), where they link the trunk muscle strength to one’s ability to keep balance and avoid falling. The authors suggest that the stability of core muscles significantly impacts the daily activities of people and may prevent or reduce falling. The proposed exercises promote mobility and improve balance. The conclusion states that trunk stabilization and balance significantly improve one’s overall health and reduce the rate of falls.
The same conclusions can be found in the study by El-Khoury, Cassou, Charles, and Dargent-Molina (2013), who attempt to determine the success rate of exercising for fall prevention. The article provides some measurable data about the number and severity of falls and their outcomes and their change after the implementation of the prevention technique. El-Khoury et al. (2013) state that exercise is extremely successful in lowering the rates of falling as they are reduced by almost half in all presented trials. Thus, it is possible to assume that specific exercise programs that are designed for older individuals can prevent falls and mitigate the physical outcomes of falling as well.
Quality Improvement Process
The majority of the articles discussed above highlight exercising as the best improvement process that can help older patients to lower the rate of falls. The benefits of exercise are found to be the most visible and useful for individuals with various musculoskeletal and cardiovascular problems. Moreover, many scholars describe the overall improvement of patients’ health, which can be reached by organized and regulated physical activity.
It is also interesting to note that exercising is cost-beneficial to both patients and medical establishments. According to Carande-Kulis, Stevens, Florence, Beattie, and Arias (2015), various programs that promote some type of physical activity give healthcare organizations the ability to avoid using expensive equipment and medication, while patients usually are able to save their money as well. Thus, the implementation of an exercise program in long-term care has many advantages.
Long-term settings allow patients and their care providers to create a system for exercising, which can be easily monitored and measured. One of the tools suggested by scholars for its ability to include the opinions of the elderly is the Fall Efficacy Scale, which can assess patients’ fear of falling (Siegrist et al., 2016). This tool can help medical professionals to evaluate various concerns of their patients and see whether exercising makes them more confident in their abilities.
Furthermore, Lee, Lee, and Khang (2013) point out that the Timed-Up-and-Go Test can help caregivers to evaluate the postural stability, balance, and gait of the individual and measure the effects of physical training. The final result of this improvement can be measured by counting the number of falls before and after the program’s implementation.
Evidence-Based Practice (EBP) Plan
The majority of the examined studies highlight the importance of physical activity for older patients. Their evidence-based practice (EBP) includes the need to implement an exercising plan into the daily routine of the elderly in order to strengthen their muscles and help them to regain balance. One can look at a number of practices for this plan. However, it is important to mention that each program, while being somewhat universal, often has to be adjusted to accommodate the needs and health problems of each person. As Lee et al. (2013) note, there are many risk factors for the elderly that can cause frequent falls, and each patient should be evaluated before intervention implementation. The following plan is an example of possible exercises which can be used to improve patient’s posture, balance, and trunk muscle strength.
This EBP plan should include a number of exercises for balance training. Gschwind et al. (2013) point out that patients’ health benefits from a program with a changing dynamic, where tasks get more challenging with time. For instance, the plan can start with such activities as standing on one leg (single-limb stance, single leg raise, or single-limb stance with arm) or with feet close together.
These exercises should also gradually limit the use of hands and supporting equipment as older patients do not possess the necessary strength to rely on their arms alone during movement. The difficulty depends on the abilities of patients, but it should be raised with time to challenge the patient continuously. One can start with a partner or use a chair as an assisting tool for performing leg raises. Chair exercises can also include back, and side leg raises for back strength. Then, the chair is to be removed, while the patient lifts his or her foot slowly and balances on the other foot.
Core strength exercises are more difficult to perform as they test the strength of muscles as well as balance. Robinovitch et al. (2013) point out that muscle strength should be enhanced to prevent falling during transferring. Penney (2016) describes a number of possible activities such as trunk stabilization with medicine balls, squats, planks, lateral and floor bridges, and throws. The author also proposes to use various equipment that ranges from simple elastic bands to abs machines.
Nevertheless, all training is aimed to challenge one’s core strength, improve resistance, and stabilize trunk muscles. These exercises should also start simple and become more and more complex with time. For instance, patients can begin with semi-sit ups, light hand weights, and pelvic rotations and continue by adding exercises with a bouncing ball, bridging, crawling, and crunching. Such training as the plank and lateral bridge is rather hard and should be implemented only for experienced patients.
The frequency and intensity of exercises depend on the patients’ initial strength. However, the main factor of the plan’s success is its regularity. Training should be frequent enough for patients to challenge their abilities but not exhausting as it may negatively affect their health. Benjamin, Edwards, Ploeg, and Legault (2014) support daily exercises in long-term care and discuss their benefits for the elderly. One can suggest starting with simple daily balance exercises and core training twice a week.
Then, patients who are confident in their abilities can try to either add another day of core training or prolong the duration of their sessions (Penney, 2016). Therefore, two sessions a week can be 45 to 60 minutes long, while three sessions a week can be 20 to 30 minutes long. Balance exercises should not be rushed and can take approximately 20 minutes per session. The combination of these training types should not overbear patients’ health and take up a small portion of their daily routine.
The place of implementation for this intervention should be furnished to ensure patients’ safety and comfort. Such exercising tools as bouncing balls and weights should be clean, sturdy, and safely stored away between sessions. Chairs used for balance training have to be without wheels or movable parts. Furthermore, as these exercise sessions are usually supervised and community-based, patients have to have a room with enough space not to intervene with each other’s training. If a person is home-based, he or she should perform hard exercises either under the supervision of staff or in equipped facilities. All in all, the costs of training depend on the used facility and equipment (National Council on Aging, 2017). While various abs machines and other complicated equipment can be costly, such tools as hand weights and elastic bands are usually not very expensive.
Long-term care facilities can implement this plan in a number of ways. First of all, the establishment can contact existing programs, community centers, or gyms and discuss the possibility of collaboration. Here, the equipment and the place would not be on the medical establishment’s property, and patients would have to travel. This option is beneficial as the space for training is already equipped with the necessary tools.
However, patients would have to be transported, which can result in additional costs and higher risks of injury (Robinovitch et al., 2013). Second, if numerous patients cannot travel far and have to be in one building for the majority of their time, it is possible to dedicate a specific room inside the facility to training. This approach would require such expenses as purchasing exercising tools, educating or hiring experienced staff, and making the place safe for the elderly. All in all, the second plan may offer more stability to both the facility and its patients.
Falls are a common concern in the environment of the elderly home care. In fact, the specified issue is linked closely to a larger problem of moving independently, which has been observed among elderly patients and proven to have affected a vast number of people of senior age. Despite the threats that the specified issue leads to a significant negative outcome for the target population, people of the identified age group are unaware of the problem, which makes the concern even greater.
Introducing a measurement tool such as the rate of falls compared between the people that have been exposed to proposed interventions and those that have declined the available treatment opportunities can be viewed as an important device for convincing the target demographics to change their attitude and start acquiring the relevant information so that the specified patient outcomes could be improved.
Furthermore, the focus in addressing falls among the elderly must be shifted toward the active promotion of physical exercises as the means of reducing the threat of a fall. The application of an exercise-based technique is bound to contribute to the development of physical skills such as flexibility, better motor skills, etc., therefore, causing the possibility of a fall to be reduced significantly. Thus, the foundation for enhancing both short- and long-term care for the elderly will be built. Falls are an issue of major concern at present; currently, it is the lack of control over the problem that makes it so dangerous. By creating the environment in which the target population will have an opportunity to control the proximity of the risk, one will be able to address the problem of a fall efficiently.
References
Benjamin, K., Edwards, N., Ploeg, J., & Legault, F. (2014). Barriers to physical activity and restorative care for residents in long-term care: a review of the literature. Journal of Aging and Physical Activity, 22(1), 154-165.
Carande-Kulis, V., Stevens, J. A., Florence, C. S., Beattie, B. L., & Arias, I. (2015). A cost–benefit analysis of three older adult fall prevention interventions. Journal of Safety Research, 52, 65-70.
El-Khoury, F., Cassou, B., Charles, M. A., & Dargent-Molina, P. (2013). The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: Systematic review and meta-analysis of randomised controlled trials. BMJ, 347(f6234), 1-13.
Granacher, U., Gollhofer, A., Hortobágyi, T., Kressig, R. W., & Muehlbauer, T. (2013). The importance of trunk muscle strength for balance, functional performance, and fall prevention in seniors: A systematic review. Sports Medicine, 43(7), 627-641.
Gschwind, Y. J., Kressig, R. W., Lacroix, A., Muehlbauer, T., Pfenninger, B., & Granacher, U. (2013). A best practice fall prevention exercise program to improve balance, strength/power, and psychosocial health in older adults: Study protocol for a randomized controlled trial. BMC Geriatrics, 13(1), 105.
Karlsson, M. K., Magnusson, H., von Schewelov, T., & Rosengren, B. E. (2013). Prevention of falls in the elderly — A review. Osteoporosis International, 24(3), 747-762.
Lee, A., Lee, K. W., & Khang, P. (2013). Preventing falls in the geriatric population. The Permanente Journal, 17(4), 37-39.
National Council on Aging. (2017). Evidence-based falls prevention programs. Web.
Penney, S. (2016). Exercise tips for fall prevention. Web.
Robinovitch, S. N., Feldman, F., Yang, Y., Schonnop, R., Leung, P. M., Sarraf, T.,… Loughin, M. (2013). Video capture of the circumstances of falls in elderly people residing in long-term care: an observational study. The Lancet, 381(9860), 47-54.
Siegrist, M., Freiberger, E., Geilhof, B., Salb, J., Hentschke, C., Landendoerfer, P.,… Blank, W. A. (2016). Fall prevention in a primary care setting: The effects of a targeted complex exercise intervention in a cluster randomized trial. Deutsches Ă„rzteblatt International, 113(21), 365-372.
Spath, P. (2013). Introduction to healthcare quality management (2nd ed.). Chicago, IL: Health Administration Press.
Ungar, A., Rafanelli, M., Iacomelli, I., Brunetti, M. A., Ceccofiglio, A., Tesi, F., & Marchionni, N. (2013). Fall prevention in the elderly. Clinical Cases in Mineral and Bone Metabolism, 10(2), 91-95.