Vlaeyen et al., A Systematic Review and Meta-Analysis of Randomized Controlled Trials
According to the report, falls among the elderly in nursing homes are gradually becoming a source of concern in both emerging and developed countries. Falls among the elderly can have serious medical, physical, social, psychological, and economic consequences. The rate of falls in nursing homes is estimated to be 1.6 per bed per year, with over half of adult patients falling at least once each year. It is said that many falls lead to severe injuries, with, for instance, a hip fracture estimate of the incident rate of 4 percent annually. Besides the physical consequences, falls has the psychological effects of the fear of falling and also reduced the quality of life especially for the elderly.
Summary of the Findings of the Literature Review
The objective of the study was to determine the features and the effectiveness of the prevention type of programs on elderly individuals who fall in nursing homes. The article employed the meta-analysis and the systematic review of the content. The setting of the study is a described group of the nursing homes facilities that offer 24-hr-daily surveillance, limited clinical care and personal care for individuals who are typically infirm and also the elderly. The participants of the study are the nursing home residents who comprise of the old and ill population. The findings show that 13 reviews were able to meet the criteria for inclusion. The six-fall type of prevention programs were single, comprising a single intervention component offered to the residents, one was composed of multiple, whereby two or more intervention components were not customized to the fall risk of every resident. The meta-analysis technique showed that there were less recurrent falls, especially in the intervention group. However, there was no significant impact of the intervention on falls or fallers. The article points out that multifactorial type of interventions suggestively reduced the falls, whereas multiple or single interventions failed to prevent. Education and training indicated an essential kind of harmful impact seen in intervention entities following the number of falls.
The article review reveals
that the meta-analysis technique failed to show the significant impact of fall prevention type of interventions on the fallers or falls but, for the first time, indicated that the prevention of fall intentions suggestively reduced the figure of the recurrent fallers by 21 percent.
Critical Appraisal
Characteristics and Effectiveness of Fall Prevention Programs in Nursing Homes used a systematic literature search in many databases that include; EMBASE, MEDLINE, Cochrane Central Register of Controlled trials, CINAHL, PEDro, and SportDiscus, and restricted the search to get articles from the database inception up to September 2013. Relaying on the chosen database Medical Subject Headings, free text was incorporated with the Boolean operators 'OR/AND' in building a search technique. Terms utilized were 'faller', 'fall', 'elderly' and many others. The article meets the criteria for a systematic review since it aims at addressing various research findings. It identifies, critically doing the evaluation, and also doing the integration of the research findings of all the high-quality individual studies, relevant ideas that address one or more study questions (Baumeister & Leary, 1997; Bem, 1995; Cooper, 2003). The article in the review has established the depth in which the current research and how it has progressed in addressing a health solution aspect. Secondly, the material is able in identifying the associations, gaps, contradictions, and the inconsistencies in the literature, and the exploration of the reasons for these discrepancies, therefore proposing a new conceptualization that accounts for differences identified. Accordingly, the article is systematic, objective replicable, transparent and objective. The article in the review has incorporated a routine search of database technique in locating various studies that address a specific research question, and also the systematic synthesis and presentation of the features and findings of the results of the concerned search. The article has identified itself as in the abstract, introduction, and in the methodology section. The author has outlined the kind of databases they searched, and the type of the articles included and excluded.
From the article review
there is no conclusive evidence present concerning the effectiveness of the fall prevention programs in the nursing residentials, partly because of using various study approaches. For instance, 5 out of 7 published reviews utilized a narrative plan, one of which only reviewed the multifactional type of intervention. The recent two reviews used meta-analytical and recorded no effect of any intervention, except a single intervention showing improvement in fallers and fall through the supplementation of Vitamin D to residents. It is evident that these reviews failed to distinguish between the recurrent fallers and fallers.
Clinical Practice Connection
The concerned study is unique, since it utilized a meta-analytical technique of the effectiveness of the whole prevention intervention, through focusing on a precise setting. Regarding clinical implications, the findings from this review recommend that nursing homes should try in implementing customized, multidisciplinary, multifactorial type of interventions so that to reduce falls in their settings. Although such kind requires more effort and time, it is essential if the nurses want to prevent falling, mainly since, single interventions can be harmful or lack an effect.
Conclusion
Multifactorial fall prevention kind of programs is capable of reducing the number of falls and the recurrent fallers in a residential setting especially the nursing homes for elderly. However, single interventions like education may be harmful.
References
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Vlaeyen, E., Coussement, J., Leysens, G., Van der Elst, E., Delbaere, K., & Cambier, D. (2015). Characteristics and Effectiveness of Fall Prevention Programs in Nursing Homes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of the American Geriatrics Society, 63(2), 211-221. doi:10.1111/jgs.13254
