we are to choose a nursing issue that is related to one of the key safety and
quality in health care areas. The chosen issue is FALLS PREVENTION; Preventing falls
and harm from falls in older people. we need to use (5)five primary and/or secondary peer
reviewed articles/studies related to the chosen issue above and summarise, analyse and
critique the literature related to this issue. The following criteria must be successfully
addressed; Section 1(statement of the issue addressed, this includes introduction,
background to the issues and importance of the issue). Section 2(Critique the literature,
this includes rigorous critical appraisal of the study designs and methods, which studies
were more rigorous and why, description of the critical appraisal tool used and why it was
the chosen tool. we are to go with the CASP tools.
Finally Section 3(Findings) this includes presenting individual study findings as well as
being able to synthesize (compare and contrasting) the study findings.
Falls result in physical injury to patients. At times, the injuries could be severe
necessitating hospitalization or even causing death. The elderly have a higher predisposition to
falls than their younger counterparts. As people age, their mobility diminishes and when
accompanied by events such as deteriorating eyesight, people get an elevated risks to falls and
physical injuries (Zhang, Shuai, & Li, 2015). So as to prevent falls, it is necessary to first assess
the level of risk that people have to the occurrence. Measures that would prevent falls would be
addressing and resolving factors that predispose people to falls. In most cases, interventions
work best when they address baseline risk factors.
The prevention of injury has been a challenge in the care of elderly patients. It is
common for old people to experience unintentional falls though most of them are nonfatal
(Rosen, Mack, & Noonan, 2013, Pg. 61). Hospitalized elderly patients face a high risk for falls.
The state of being ill coupled with the effects of treatment and the unfamiliarity of the
environment are the major reasons for the high predisposition of hospitalized patients to falls
(Dykes, Carroll, Hurley, Lipsitz, Benoit, Chang, & Middleton, 2010, Pg. 1912). Patients who fall
are more likely to experience subsequent falls than those who do not (Leavy, Byberg,
Michaëlsson, Melhus, & Åberg, 2015). Patients develop the fear of falling and end up limiting
their movement and losing their mobility (Dykes et al., 2010, Pg. 1912). Falls have their
associated financial losses in addition to health complications. For instance, there would be a
need for extra treatment, and patients may have to stay longer in hospitals hence raising the cost
of their care. Previously, people did not address falls as clinical problems worth much space in
discussions. Increased awareness that there are significant severe consequences of falls has
motivated the emergence of falls prevention programs. Such programs offer suggestions to
practices that would minimize the occurrence of falls in high-risk groups (Child, Goodwin,
Garside, Jones-Hughes, Boddy, & Stein, 2012).
Importance of Exploring Falls Prevention among Old People
There is significant data indicating that falls are common occurrences among the elderly
(Child et al., 2012). On a yearly basis, a third of people aged sixty-five years and above
experience at least an instance of a fall (Child et al., 2012). Again, though some programs have
initiated various preventive measures, they do not depict the expected results due to various
hindrances (Child et al., 2012). It would be important to research on the matter and give
satisfactory response regarding the established and novel methods of preventing falls. The issue
is also necessary in the clinical setup considering its broad range of impacts. People may get
long-term pain, lose the functionality of their organs, require admission in a care home, and incur
financial losses (El-Khoury, Cassou, Charles, & Dargent-Molina, 2013). Exploring preventive
measures of falls would be important as it would also facilitate the minimization of the
associated undesirable effects of falls.
There has been extensive research on falls prevention especially among elderly patients.
Some of the studies employed clustered randomized trials where participants were from different
settings (Dyke et al., Pg. 1912). Such studies were appropriately described and they had such
aims as determining how effectively measures such as health information technology reduced
falls in hospital settings. There were also secondary sources that incorporated literature review as
their primary sources of data. Such studies had objectives such as that of informing clinicians on
practical evidence-based solutions to fall prevention among the aged (Al-Aama, 2011, Pg. 771).
The method of research applied fitted the study purpose as it involved reviewing studies to
establish practices that reduced the occurrence of falls among the elderly hence being excellent
choices for clinicians. The method also allowed the researcher to explore multiple aspects of falls
simultaneously. The scientists referred to literature when addressing the pathophysiology of falls,
its risk factors, screening and assessment, prevention, as well as its treatment (Al-Aama, 2011).
The findings were particularly vital for clinicians.
There were also studies that employed systematic review in their design (Bloch, Thibaud,
Dugué, Brèque, Rigaud, & Kemoun, 2010). Studies that employed the technique had objectives
such as determining the effectiveness of fall prevention strategies in preventing the occurrence of
injuries that result from the falls (El-Khoury et al., 2013). Systematic review studies extracted
articles from authoritative databases such as CINAHL, Cochrane library and EMBASE. The
studies exploited the most appropriate methods of data synthesis to critique their sources (El-
Khoury et al., 2013).
There were secondary sources that focused on the causes of falls. Some of the studies
employed a systematic review and referred to previous research studies to generate their
conclusions. Such studies were motivated by a high occurrence of falls and its related injuries
among other factors. Research indicated that drugs used by patients posed a significant threat to
development of falls in patients (De Jong, Van der Elst, & Hartholt, 2013, Pg. 147). The
researcher purposed to examine the epidemiology, risk factors, and treatment strategies (De
Jong, Van der Elst, & Hartholt, 2013).
CASP tools served as appropriate approaches to critiquing literature concerning various
subjects on fall prevention that researchers had investigated. The tools addressed studies such as
randomized trials, systematic reviews, and qualitative studies (CASP, 2013). Different checklists
matched the design of research that researchers had applied.
Studies offered varied interventions to falls and their associated injuries. Researchers
found that people subjected to falls had to embrace the new technology as it led to reduced risks
for falls. They found the healthcare demands for falls patients to be above 30% higher than in
other patients (De Jong, Van der Elst, & Hartholt, 2013, Pg. 148). The research gave informed
discussions of treatment approaches and found them to be active in reducing the impact of
injuries resulting from falls. There were also other studies discussing treatment approaches to the
problem. The strategies included the use of medications that focused on the etiology of the falls.
Cardiac arrhythmias and orthostatic hypotension were examples of conditions whose treatment
reduced the risk of falls (Ungar, Rafanelli, Iacomelli, Brunetti, Ceccofiglio, Tesi, & Marchionni,
2013, Pg. 93). Studies that explored the effectiveness of preventive measures found the tools to
cause significant reduction in the cases of falls compared to their absence in management. The
results implied that physicians should apply the preventive tool kits so as to lower the risk of
falls for their patients (Dykes et al., 2010, Pg. 1912). In the determination of practices that
lowered the risk of falls among patients, researchers identified exercises as a crucial factor
(Burton, Cavalheri, Adams, Oakley Browne, Bovery-Spencer, Fenton, & Hill, 2015). In the
studies concerning barriers to the implementation of preventive strategies, researchers found the
process of applying preventive measures to be multifactorial and demanding critical
considerations (Child et al., 2012).
Al-Aama, T. (2011). Falls in the elderly: Spectrum and prevention. Canadian Family Physician,
Bloch, F., Thibaud, M., Dugué, B., Brèque, C., Rigaud, A., & Kemoun, G. (2010). Episodes of
falling among elderly people: a systematic review and meta-analysis of social and
demographic pre-disposing characteristics. Clinics, 65(9), 895–903.
Burton, E., Cavalheri, V., Adams, R., Oakley Browne, C., Bovery-Spencer, P., Fenton, A. M., …
Hill, K. D. (2015). Effectiveness of exercise programs to reduce falls in older people with
dementia living in the community: a systematic review and meta-analysis. Clinical
Interventions in Aging, 10, 421–434.
CASP. (2013). Critical Appraisal Skills Program.
Child, S., Goodwin, V., Garside, R., Jones-Hughes, T., Boddy, K., & Stein, K. (2012). Factors
influencing the implementation of fall-prevention programmes: a systematic review and
synthesis of qualitative studies. Implementation Science : IS, 7, 91.
De Jong, M. R., Van der Elst, M., & Hartholt, K. A. (2013). Drug-related falls in older patients:
implicated drugs, consequences, and possible prevention strategies. Therapeutic
Advances in Drug Safety, 4(4), 147–154.
Dykes, P. C., Carroll, D. L., Hurley, A., Lipsitz, S., Benoit, A., Chang, F., … Middleton, B.
(2010). Fall Prevention in Acute Care Hospitals: A Randomized Trial. JAMA : The
Journal of the American Medical Association, 304(17), 1912–1918.
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 : British
Medical Journal, 347, f6234.
Leavy, B., Byberg, L., Michaëlsson, K., Melhus, H., & Åberg, A. C. (2015). The fall
descriptions and health characteristics of older adults with hip fracture: a mixed methods
study. BMC Geriatrics, 15, 40.
Rosen, T., Mack, K. A., & Noonan, R. K. (2013). Slipping and tripping: fall injuries in adults
associated with rugs and carpets. Journal of Injury and Violence Research, 5(1), 61–69.
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.
Zhang, X.-Y., Shuai, J., & Li, L.-P. (2015). Vision and Relevant Risk Factor Interventions for
Preventing Falls among Older People: A Network Meta-analysis. Scientific Reports, 5,