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Older adults often face a lot of health-related issues that affect their well-being and require special treatment. However, rather often their condition is affected by unexpected falls. In fact, this experience is currently treated as a major public concern, which proves that it requires proper investigation. In their work, Helgadóttir, Laflamme, Monárrez-Espino, and Möller (2014) emphasized that even in high-income countries where the elderly can obtain high-quality care up to 60% of the whole older adult population fall every year. Such numbers prove that the issue is extremely critical and cannot be ignored. The rates of morbidity and mortality increase due to this problem dramatically. Thus, negative influences of falls can be seen on both individuals and society.
Professionals indicate that the elderly may fall and hurt themselves because of different reasons (Ramsey, Hin, Prado, & Fernandez, 2015). While ones believe medication intake to be among the most critical of them, others emphasize the influence of personal characteristics and lifestyle. Due to aging and aligned diseases, people tend to have several drugs prescribed, and scientists tend to argue whether this combination can affect other personal risk factors, such as health status or age, and worsen the situation. Physical activity and alcohol consumption, for example, can increase the probability of being injured, and some previous studies proved that medication can be fall-risk-increasing (Helgadóttir et al., 2014).
Professionals believe that the number of falls among the elderly can be minimalized with the help of preventive patient education, assessment of their condition by screening, training in risk assessment, etc. (Chang & Do, 2014). What is more, they indicate that paying attention to the medication, the situation is likely to be improved as well. However, previous studies were not enough to make a clear statement regarding the outcomes. Thus, this research will explore them, addressing a PICO statement: in elderly aged 65 and above with multiple diagnoses who are at a greater risk for fall (P) how does taking more medications for multiple diagnoses (I) compared to taking less medications with lifestyle change (C) benefit/reduced risk for fall (O).
Review of Literature
In their research, Alpert and Gatlin (2015) focused on the use of different medications by an elderly person. They indicated that such treatment is often caused by the necessity to deal with several chronic conditions and interaction with more than one provider. The authors concentrated on the issues caused by polypharmacy. They claimed that it increases the risk of falls and adverse effects. It also worsens medication compliance. As a result, it can lead even to individual’s death.
Chang and Do (2014) focused on the same issue but emphasized gender-related peculiarities as they are rarely discussed. They used cross-sectional study and addressed almost 15,000 individuals. The influences of socio-demographics, lifestyle, and medication were also considered. The impact of the last ones on the fall risks was not the highest. Protective effects were addressed and proposed in the framework of prevention strategies. The connection between the discussed factors was revealed.
Helgadóttir et al. (2014) wondered if polypharmacy has an influence on fall injuries. They wanted to find out whether outcomes differ due to demographics, health habits, and status. With the help of research based on case-control study and self-administered surveys, the professionals discovered that individual characteristics and lifestyle change might increase the number of falls among people who are 65 years and older even more than the consumption of more than five medications. The sample included about 450 cases and more than 21,000 controls so that it can be easily generalized to the wider population.
Ramsey et al. (2015) discussed why the elderly fall to have an opportunity to define the most effective strategies for prevention. With the help of mixed methods that allow to obtain different types of information, the researchers found out that medications cause such injuries in almost 30% of all cases of fall incident while about 50% of this population takes at least five medications. Still, more than 55% were caused by mechanical factors.
Tamura, Bell, Inaba, and Misaki (2012) stated that polypharmacy is very harmful to the elderly. Thus, they wanted to prove the necessity of medication reaction. A quality improvement intervention study based on the online database search was maintained. It was interesting that “polypharmacy was associated with increased ADEs, increased DDIs, and increased hospitalizations” but “was not consistently linked to falls, fractures, and mortality” (Tamura et al., 2012, p. 217).
However, Watanabe (2016) discussed the issue related to the PICO question – the connection between falls and multiple medications – and revealed that the association exists. The author stated that medication users experienced worries based on the possibility to fall and get hurt more than those who do not take so many medications. However, the majority of the sample had at least one incident in the past year.
This research will argue the influence of polypharmacy on the risk of falls. Even though this topic is not widely discussed yet, a lot of professionals identified the connection between these two elements, which can be seen in the previous section. However, some scientists claim that multiple medications lead to falls while others believe that using fewer drugs and implementing lifestyle changes the elderly turn out to be at the highest risk. The absence of a clear statement regarding this issue proves the necessity of research. For example, Tamura et al. (2012) stated that there is an evident connecting between polypharmacy and falls. In fact, they were rather surprised when realized that this link was not thoroughly investigated previously. Ramsey et al. (2015), on the other hand, pointed out that the number of falls among the elderly who do not take more than five medications and changed their usual behavior is almost 20% higher than among those who resort to polypharmacy.
The future paper is going to fill existing gaps in the geriatric treatment and care. The elderly aged 65 and above will be targeted because they are indicated as a population that is the most vulnerable in the framework of injuries obtained due to falls. In fact, the sample of this age is used in the majority of the studies that discuss the same topic, which can be seen in the article prepared by Chang and Do (2014), for example. In this way, the combination of the information obtained with the help of the literature review and this research will answer the PICO question mentioned above.
In addition to that, individuals of the discussed age often suffer from multiple health issues that require effective medication. Alpert and Gatlin (2015) support this claim with authoritative evidence and state that multiple chronic conditions are not rare among the elderly. Basically, that is why polypharmacy started to be discussed as one of the reasons for the increased number of falls among older adults. Professionals emphasize the significance of the problem and add that these patients often address multiple care providers, which prevents them from obtaining a decent image of client’s condition. As a result, some patients are treated with a couple of similar drugs while others get a wide range of various medications. Of course, some operational improvement is needed to minimalize such issues. Still, the first step should be the identification of the most appropriate medications and their approximate number. Only in this way, professionals will have an opportunity to state what intervention should be used to reduce the risk of fall: lifestyle change or polypharmacy.
Alder adults tend to lack independence due to their overall condition that is why they feel even worse when experiencing falls and injuries related to them. According to Ramsey et al. (2015), these people also start feeling more vulnerable. They suffer from depression and frustration, which prevents them from achieving positive health outcomes as soon as possible. In addition to that, they often face self-blame that worsens their relations with the family and friends. Such emotional state can lead to suicidal attempt and death, which makes the discussed issue even more critical.
The proposed research study will be rather advantageous for the clinical practice because it will show whether it is really better to treat multiple diagnoses with several medications than use a lot of them in order to reduce the number of falls. As a result, it will provide the scientists with the opportunity to develop an appropriate guideline for healthcare professionals to use in practice and enhance patients’ well-being, reducing the risk of injuries as well as mortality. That is why the arguments for the study can be considered significant enough to prove the necessity of research and suggestion of a future change in practice.
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The evidence obtained due to the literature review was not conclusive considering the necessity to implement a change in clinical practice. Those professionals who discussed the connection between polypharmacy and lifestyle changes with falls among the elderly were divided in opinion. In fact, they did not address the selected PICO question in particular. That is why it will be rather advantageous to conduct an additional study that will prove the benefits of polypharmacy. Thus, this research will basically answer three questions:
- What are the benefits of polypharmacy for the reduction of falls among the elderly with multiple diagnoses?
- What are the benefits of taking fewer medications with lifestyle change for the reduction of falls among the elderly with multiple diagnoses?
- What approach provides more advantages and should be implemented in clinical practice?
It will be a cross-sectional study, which is rather advantageous for research because it will be possible to maintain it within a relatively short period of time. The researcher will address a couple of healthcare facilities and ask them for a possibility to father the recent cases of falls among the elderly. Convenience sampling will be used to define the participants. Focusing on client charts, the researcher will identify whether the participants have multiple diseases and how they are treated. Obtained information will be assessed statistically so that it will be possible to state what approach works better. In addition to that, such related factors as the personal characteristic, environment, particular injuries, and diseases will be discussed. However, they are beyond the specific topic of interest. The thing is that they are likely to affect the outcome; that is why they cannot be ignored.
Provision of healthcare on the basis of the obtained results will be beneficial for the elderly and will make it easier for personnel to treat patients. Professionals will be aware of how to treat clients with multiple diagnoses to benefit them. Patients will obtain better care and enhance their mental and physical state. They will not fall so often and will avoid serious injuries, which will reduce morbidity and mortality rates as well.
Thus, it can be concluded that the stakeholders are likely to benefit from this research because with its help professionals to become able to prescribe appropriate treatment for the elderly with multiple diagnoses. The peculiarity of this treatment will be its positive influence on the reduction of risk for fall. In this way, the targeted population (older adults aged 65 and above) will fall less, which will definitely have positive effects on its well-being, as the number of injuries and adverse outcomes will be minimalized. The researcher will indicate whether it is better to resort to polypharmacy or lifestyle changes when providing care to such populations. The readers of this study will obtain enough evidence from the practice of the benefits from these two approaches for the reduction of the number of falls. They will have a thorough description and support of a change in the clinical practice. Thus, the existing ambiguity will be resolved.
Alpert, P., & Gatlin, T. (2015). Polypharmacy in older adults. Home Healthcare Now, 33(10), 524-531.
Chang, V., & Do, M. (2014). Risk factors for falls among seniors: implications of gender. American Journal of Epidemiology, 181(7), 521-531.
Helgadóttir, B., Laflamme, L., Monárrez-Espino, J., & Möller, J. (2014). Medication and fall injury in the elderly population; do individual demographics, health status and lifestyle matter? BMC Geriatrics, 14(92), 524-539.
Ramsey, R., Hin, A., Prado, C., & Fernandez, M. (2015). Understanding and preventing falls: Perspectives of first responders and older adults. Physical and Occupational Therapy in Geriatrics, 33(1), 17-33.
Tamura, B., Bell, C., Inaba, M., & Misaki, K. (2012). Outcomes of polypharmacy in nursing home residents. Clinics in Geriatric Medicine, 28(2), 217-236.
Watanabe, J. (2016). Medication use, falls, and fall-related worry in older adults in the United States. The Consultant Pharmacist: The Journal of the American Society of Consultant Pharmacists, 31(7), 385-393.