Efficacy of Physical Exercises in Fall Prevention: A Case Report

This paper explores the efficacy of physical exercises in fall prevention by conducting a literature review and synthesizing the evidence obtained. It discusses a case related to fall in a clinical setting and proposes solutions for fall prevention.

Running head: Case Report: What Does the Research Say?
Case Report: What Does the Research Say?
Name of the Student
Name of the university
Author’s note

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Case Report: What Does the Research Say?
Introduction
Fall has always been one of the leading causes of the injuries occurring among the older
Americans. Most of the falls caused due to the complex factors like medications, environmental
conditions like slippery floors, lack of proper lighting, problems with balance and gait due to old
age (Edwards et al., 2016). However, some of the literary sources have suggested that exercise
regimen can actually strengthen muscles and helps in improving balance and gait.
This paper will discuss about a case related to fall in a clinical and will explore the
efficacy of physical exercises in fall prevention by the conduction of a rigorous literature review
and through synthesis of the evidences obtained by the literature search.
PICOT Question Template
Section 1: In this section provide one word to describe each section of your proposed PICOT question
P Population Vulnerable older adults
I Intervention Physical exercises
C Comparison No special interventions
O Outcome Reduced rate of falls
T Timeline Within 6 months
Section 2
PICOT Does physical exercise reduces the rate of falls in the vulnerable older adults within a
timeframe of six months, in clinical settings?
Section 3
Problem Statement Slips and falls are the leading cause of injury and morbidity in adults aged 65 and in
spite of interventions like environmental modifications and effective lighting has not
been much effective in preventing falls. Few literary sources have emphasized on the

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Case Report: What Does the Research Say?
effectiveness exercises like Yoga an Tai chi. However, not much sources are
available to validate the statement
Section 4:
Purpose Statement The purpose of this research is to find out the effectiveness of physical exercises on
reducing the rate of falls among the older patients in a hospital settings.

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Case Report: What Does the Research Say?
Literature review
Literatures have suggested the importance of balance exercises strengthening the muscles
and increasing the falls. Sherrington et al., (2018) have provided strong evidence that designed
program interventions teaching exercises to the older patients have shown the same effectiveness
like multifactorial interventions. Solloway et al., (2016) have stated that Tai-chi involves low
impact movement that integrates minds, breath in the physical wellbeing. It does so by
improving the flow of blood through the body. It strengthen and stretches the body, improves
balance, proprioiception and increases consciousness of how a body moves through space and
can also be participated in group or alone. Youkhana et al., (2016) on the other hand have
emphasised on the effectiveness of Yoga in improving the balance and the mobility in patients
of age 60 years or above by increasing strength, litheness and balance by relaxation and
meditation. Previous trials have demonstrated the benefits of yoga in the reduction of
hypertension, reduction in the chronic back pain and disability, improved quality of sleep.
Elderly adults with cognitive problems are more prone to falls, may be due to the type of
medications that they are having. According to (Morris e al., (2017) patients with be disease are
more prone to falls and a 6 week comprehensive home exercise program has been found to
reduce falls, disability and improve health related quality of life. Training in Resistance strength ,
movement strategy training and education regarding fall prevention strategies , has not provided
any statistically significant result in reducing falls. It can be due to the fact that the dosage that
has been used in this study is not sufficient enough.
Cameron et al., (2018) have suggested that dynamic exercises like the balance and
resistant training in a training program can be effective to increase strength and the balance in

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Case Report: What Does the Research Say?
older adults. Berry et al., (2017) on the other hand have stated that not strong evidence for the
reduction in the hip fracture can be reduced. Most of the studies have emphasized on the
effectiveness of multifactorial interventions in reducing the rate of falls. The paper has also
emphasized on the administration of more than one interventions like using Vitamin D
supplements along with exercise and changes in the environment like the optimization of the
lighting.
Description of the case
The literature search in being done to explore evidence based literature based on a case
that has been provided below:-
Mrs Brooker is a 67 year old woman, who have had a cholecystectomy surgery and has been
transferred to the general ward after the surgery, had suffered from a fall as she was trying to
walk at through the corridor. The patient was mobile and was attempting to walk under the
instruction of the doctor. She reported that she goes for walk every day, but does not feels steady
while walking. She has reported that her knee sometimes hurt while walking. Mrs. Brooker has
reported that it is her third fall.
The medical problem list has been provided below:-
 Seizure
 Hypertension
 Hypothyroidism
Medications
 Zyprexa

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Case Report: What Does the Research Say?
 Levothyroxine
 Colace
 Tylenol
The doctor has proposed that the patient should always be accompanied by a nurse or a health
care workers due to the probability of the fall. Secondly, due to the increasing amount of falls in
the geriatric department, the occupational therapist of the hospital have proposed the introduction
of an exercise program to spread awareness and to strengthen balance and gain in older women,
such that they can be practiced at home or at the clinical setting.
Detailed explanation of the synthesized literature findings
There are not enough literature to support the fact that that exercise regimens are
effective in supporting elderly people, who are more prone to falls. In most of the papers, yoga
has demonstrated a slight decrease in the rate of falls. They show positive changes for balancing
pain and life. It has already been mentioned in the case study, that the patient had already
suffered from fall before and that this is her third fall. It has been found that the bone mineral
density in women decreases with age. The gradual loss of the tissue of the bone and the lessened
bone density makes the bones very fragile and they break under slightest strain. According to
Berry et al., (2016), there is a strong association between the change in the bone mass density
over 4 years and the risk of hip as well as non-vertebral fractures. The impact of BMD loss on
the risk of non vertebral fracture can be more in people without a history of falls. Again, it
should be noted that anesthesia used at the time of the surgery can cause lightheadedness in the
patient, which h increases the rate of fall. Hypotension is common after anesthesia, causing
syncope in patient increasing the chance of fall. Again, Mrs. Brooker have to take many

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Case Report: What Does the Research Say?
medications at a time due to the presence of her comorbidities. Dizziness can occur as a side
effects of many medicines. Fainting due to hypothyroidism can be seen. Severe hypothyroidism
can cause AV block leading to syncope. Elderly patients mostly suffers from fall due to fainting
(Chen, Wu & Hsia, 2014). In this case Mrs. Brooker can be recommended with small scale of
incident exercises.
Case summary
Mrs. Brooker has been suggested with mild to moderate exercise regimen. Mrs. Brooker
has been provided with all prevention brochure. The occupational therapist has provided a Chair
Rise exercise handout. It can be predicted, that Mrs Brooker can is suffering from lack of bone
mineral density. Again presence of hypothyroidism can be related to fainting related to falls.
Hence, it necessary to emphasize on her diet and should be provided with Vitamin supplements.
Since, the patient had undergone a major surgery, it is necessary to keep a close
supervision for preventing falls. The patient can be taught with some basic incidental exercises.
It is also necessary that the patient is provided with correct dosages of medications, such that no
contrandindications occur. Although none of the studies could not validate the effective of
exercises in fall prevention, however mild exercises can be initiated to improve her balance ,
cardiac health and hypothyroidism.
Proposed solutions
Some of the fall prevention interventions that can be proposed are prior assessment of the
fall risks, followed by strategies like, maintaining a constant awareness of the environmental
safety, elimination of the slipping and the tripping hazards, keeping the bed at a proper height at

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Case Report: What Does the Research Say?
the time of the transfer, using vitamin D supplementation. One of the most important
intervention is the introduction of the exercise regimen for the prevention of falls. Exercises like
stretching exercises, walking exercises, medication and relaxation exercises can be effective for
preventing falls. Tai Chi and Yoga exercises have been found to be more effective than normal
walking exercise. There are reviews that have also compared the effectiveness of yoga with the
other type of exercises in improving gait and balances. Shier, Trieu and Ganz, (2016) have stated
that some simple exercises like toe curls, knee curls, leg extension, stretching of the legs and
other activities can be helpful to increase muscle strength of the patients.
Conclusion
In conclusion, it can be stated that although a large number of studies have suggested that
physical exercises are effective in preventing fall. The absence of proper clinical trials keep a
scope of future research where such trials are needed. However, it cannot be denied that physical
exercises are useful for the overall health and wellbeing of elderly patients.

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Case Report: What Does the Research Say?
References
Berry, S. D., McLean, R. R., Hannan, M. T., Cupples, L. A., & Kiel, D. P. (2014). Changes in
bone mineral density may predict the risk of fracture differently in older adults according
to fall history. Journal of the American Geriatrics Society, 62(12), 2345-2349.
Cameron, I. D., Dyer, S. M., Panagoda, C. E., Murray, G. R., Hill, K. D., Cumming, R. G., &
Kerse, N. (2018). Interventions for preventing falls in older people in care facilities and
hospitals. The Cochrane database of systematic reviews, 9(9), CD005465.
doi:10.1002/14651858.CD005465.pub4
Chen, M. C., Wu, H. H., & Hsia, C. P. (2014). Syncope Due to Impending Cardiac Tamponade
in Hashimoto's Thyroiditis. Acta Cardiologica Sinica, 30(3), 253–255.
Edwards, M. H., Jameson, K., Denison, H., Harvey, N. C., Sayer, A. A., Dennison, E. M., &
Cooper, C. (2013). Clinical risk factors, bone density and fall history in the prediction of
incident fracture among men and women. Bone, 52(2), 541–547.
doi:10.1016/j.bone.2012.11.006
Morris, M. E., Taylor, N. F., Watts, J. J., Evans, A., Horne, M., Kempster, P., ... & Menz, H. B.
(2017). A home program of strength training, movement strategy training and education
did not prevent falls in people with Parkinson’s disease: a randomised trial. Journal of
physiotherapy, 63(2), 94-100.

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Sherrington, C., Michaleff, Z. A., Fairhall, N., Paul, S. S., Tiedemann, A., Whitney, J., ... &
Lord, S. R. (2017). Exercise to prevent falls in older adults: an updated systematic review
and meta-analysis. Br J Sports Med, 51(24), 1750-1758.
Shier, V., Trieu, E., & Ganz, D. A. (2016). Implementing exercise programs to prevent falls:
systematic descriptive review. Injury epidemiology, 3(1), 16.
Solloway, M. R., Taylor, S. L., Shekelle, P. G., Miake-Lye, I. M., Beroes, J. M., Shanman, R.
M., & Hempel, S. (2016). An evidence map of the effect of Tai Chi on health outcomes.
Systematic reviews, 5(1), 126.
Youkhana, S., Dean, C. M., Wolff, M., Sherrington, C., & Tiedemann, A. (2015). Yoga-based
exercise improves balance and mobility in people aged 60 and over: a systematic review
and meta-analysis. Age and ageing, 45(1), 21-29.