Exercise-based Interventions to Reduce Falls in Older Adults: Findings and Recommendations

This presentation discusses the effectiveness of exercise-based interventions in reducing falls in older adults living in residential care facilities. It highlights the relevance and significance of the problem, key messages for undergraduate nursing students, and recommendations to address gaps in research.

Recommendations to address gaps
The number of participants need to be increased and the duration
of training sessions also need to be elongated. These changes
can reinforce the credibility of the evidence and ultimately make it
applicable among a wider patient population.
In regards to the fourth study, there is need to increase the
number of participants and also increase the number of follow up
durations in order to enhance the credibility of the findings. In
such cases, there is need to monitor the daily fall rates with more
participants in order to strengthen the evidence.
Future studies need to indicate the level of intensity of virtual
reality exercises as well as the duration such exercises on a daily
basis. There is also need to demonstrate the effectiveness of
these exercises on a long term basis. Finally, studies need to
illustrate the effects of these exercises on reducing fall related
injuries. Available evidence only indicates that such exercises
reduces the risk of falls but not the associated injuries such hip
fractures.
Background
The rate of falls among the elderly population in Australia is bound to increase by
more than 10% if efficient risk prevention programs are not implemented. The
number of falls in various environments affecting the older adults above the age
of 65 is significantly increasing thereby hampering their physical as well as
emotional wellbeing. Most worryingly is the fact that fall related injuries are one of
the leading causes of death among this population (Sherrington et al, 2016, p. 2).
Exercise based interventions have been touted as the most effective paradigm to
resolve this issue. In such programs, evidences suggest that focus should not
only be placed on balance but also on strength in order to reduce fall related
injuries.
Relevance and significance of the problem
As a public health issue, the risk of falls is costly and increases the level of
dependence among the elderly, or in some cases, it can also be fatal. Studies
have also indicated that falls can result in life threatening injuries, reduce the
level of confidence and demoralize individuals from continuing with physical
exercises that enhances their postural control. Thus, there is dire need to institute
initiatives that are specifically tailored to meet the needs of this population and
most importantly, reduce the risk of falls. Virtual reality programs are significantly
important to the elderly primarily because they enhance postural control,
motivation, functional movement patterns and cognitive development factors
which basically foster balance among the elderly and also improve their muscle
strength. To rectify such deficiencies, a program that focuses on balance,
endurance, flexibility and additional strengthening particularly within the knee
area is therefore necessitated. As a prevention program for the risk of falls, VRs
are therefore crucial in reducing the number of falls among the elderly population.
Research question
What is the effectiveness of exercise-based interventions in reducing falls in older
adults living in residential care facilities?
Five Key Messages
The first study investigates the efficacy of exercise programs in reducing the risk
of falls among the aged. The study illustrates that a complex exercise with
virtual reality (CEVR) consisting of a series of exercises such as endurance,
flexibility, balance and strengthening is superior and effective compared to
balance exercise with virtual reality (BEVR) (Lim et al, 2017, p. 64).
The second study indicates that mobility related disability such as lower limb and
pelvic fractures arising from falls can be managed through self-management
interventions that primarily focus on exercises. Also, exercises and fall
prevention self-management intervention reduces the incidences of falls and
associated disability to the elderly population (Sherrington et al, 2016, p. 9).
The third study focused on measuring the efficiency of Virtual Reality Balance
Games (VRBG) in lessening the threat and distress of falls. From the 56
participants in this study, the findings indicated that the practice of VRBG
significantly reduces the risk of falls among women (Singh et al, 2012, p. 239).
The fourth study emphasizes that aside from regular group exercises, there is
need to incorporate additional training sessions that comprises of jumping,
stretching, strength and aerobic exercises in order to increase stability, and
decrease fall risks.
Also, the findings of this study indicate that such programs can improve the value
of life and reduce despair among older people in nursing care homes.
Disseminating Results for Target Audience
Clinicians
Clinicians understand that for the elderly population, falling is a serious health issue with muscle
weaknesses and balance deficits identified as the main risk factors. As such, clinicians should look to
implement prevention programs comprised of training sessions that encompass various exercises that
strengthens an individual’s body, enhances their functional performance and, bolster their flexibility and
endurance. Furthermore, this initiative has the capability of exposing participants to a virtual world
where they get to experience realistic situations and limited amount of space. (Lim et al, 2017, p. 65).
Current clinical practice should therefore be guided by optimal content of rehabilitation programs that
are exercise intensive.
Relatives
In many cases especially for the elderly residing at home, relatives are the primary caregivers to this
population. With their diverse health needs coupled with the risk falls, relatives are faced with high
levels of caregiver stress (Singh et al, 2012, 239). Hence, learning the benefits and effectiveness of
virtual reality exercises is pivotal in relieving such stress. Aside from increased dependence, relatives
are likely to incur high costs in the rehabilitation process of their relatives (Lim et al, 2017, p. 65).
Exercise-based interventions therefore present a less costly alternative and also an efficient to improve
the relative’s stability thereby reducing their level of dependency.
Patients
Patients are adversely affected with the risk of falls. Notably, patients incur high costs and are at high
risk of facing fall related injuries some of which may be fatal. Evidence indicates that falls’ injuries are
leading causes of death among the elderly. Life threatening injuries such as hip fractures usually last for
long periods since most survivors do not fully recover and may not regain their former levels of mobility
or activity. Also, for patients funding their own medication, they are likely to incur high costs in surgery of
these injuries (Sherrington et al, 2016, p. 4). Therefore, exercise prevention programs could ultimately
prove to be beneficial for fracture survivors.
Undergraduate Nursing Students
In long term residential homes, nurses are tasked with providing care to the elderly population.. Older
adults living in nursing care homes have increased frailty compared to their home dwelling counterparts
thereby presenting caregiver stress. Studies indicate that the fall rates in residential care facilities are
three times compared to the fall rates occurring within the community. Caregivers in these facilities are
therefore presented with an additional challenge to protects the wellbeing of this patient population
(Cakar et al, 2010, 59).To counter such challenges exhibited in their area of practice, there is need to
incorporate evidence-based practice to improve the quality of life of the elderly as well as reduce the
risk of falls with their associated dire consequences.
In such cases therefore, the findings from Cakar et al (2010) indicates that caregivers such as nurses
need to institute appropriate exercise regimens in order to reduce the fall risks and associated fall
related injuries. In this light, regular exercises can be combined with additional jumping, stretching and
aerobic exercises which will increase balance, enhance the quality of life and reduce the risk of falls as
well as depression status of their patients. Ideally, jumping maximizes osteogenic responses of the
lower extremities which ultimately reduces bone related fractures and osteoporosis. Hence, such
programs can prove to be beneficial to the nurses since they enhance postural stability and reduces
problems associated with balance (Cakar et al, 2010, p. 60). Hence, such positive effects can go a long
way in ensuring that the risk of falls are reduced in these facilities and that the patient’s quality of life is
also enhanced.
Name/ID here
Assignment 2: Findings of the Research Project
Four Primary Research References
Cakar, E., Dincer, U., Kiralp, M. Z., Cakar, D. B., Durmus, O.,
Kilac, H., & Alper, S. 2010. Jumping Combined Exercise
Programs Reduce Fall Risk and Improve Balance and Life
Quality of Elderly People who Live in a Long-Term Care Facility.
European Journal of Physical and Rehabilitation Medicine, 46(1),
pp. 59-67.
Lim, J., Cho, J., Kim, J., Kim, Y., & Yoon, B. 2017. Design of
Virtual Reality Training Program for Prevention of Falling in the
Elderly: A Pilot Study on Complex Versus Balance Exercises.
European Journal of Integrative Medicine, 15, pp. 64-67.
Sherrington, C., Fairhall, N., Kirkham, C., Clemson, L., Howard,
K., Vogler, C., & Lord, S. 2016. Exercise and Fall Prevention Self-
Management to Reduce Mobility Related Disability and Falls after
Fall-Related Lower Limb Fracture for Older People: Protocol for
the RESTORE Randomized Control Trial. BMC Geriatrics,
16(34), pp.1-10.
Singh, D. K., Rajaratnam, B. S., Palaniswamy, V., Pearson, H.,
Raman, V. P., & Song, P. S. 2012. Participating in a Virtual
Reality Balance Exercise Program can Reduce Risk and Fear of
Falls. Maturitas, 73, pp. 239-243.
What still needs to be known (gaps)
These studies fail to indicate the optimal content of rehabilitation,
that is, the duration and the level of intensity of these exercises.
Also, the number of participants is relatively small to warrant the
generalization or rather the application of such interventions to
the entire elderly population.
Disparities exist in the population groups that should be subjected
to the intervention programs. Whereas some studies emphasize
that the appropriate group to be involved in these programs
should comprise of individuals above the age of 65, other studies
illustrate that they are most effective for post menopausal
women. Additionally, findings on the success of exercise based
mediations on reduction of fall related injuries is also lacking.

Part B 2018 Assessment 2 Poster Template
Nurses are tasked with providing first line care in various practice settings. In this critical task, nurses are required to exhibit critical thinking skills and be able to make timely decisions
that are essential in protecting the lives of the patients. Furthermore, developing strong patient-centered care that is grounded on evidence-based knowledge is essential in the
clinical practice (Curtis et al, 2016, p. 862). Ideally, nurses should be equipped with the knowledge and expertise to disseminate findings of evidences by researchers in the nursing
field and apply such knowledge in their practice and particularly in the clinical decision making (Kristensen, Nymann & Konradsen, 2016). To achieve such goals nurses need to achieve
certain key objectives including; demonstrating awareness of the available literature applicable to their practice domains, be able to acknowledge the research and also
critique the same literature using alternative evidences, apply the findings of these studies in their practice areas, and contribute to the available research by conducting their own
independent research.
Also, while providing care to their patients, nurses need to exercise self-compassion and encourage self-care among patients. This notion is grounded on the fact that nurses are
required to provide holistic and quality care to their patients. As such, they need to empathize with their patients a factor which should ideally guide their action plans (Curtis et al, 2016,
p. 870). By doing so, nurses can ensure that they provide quality care that is specifically tailored towards improving the patient’s quality of life or alternatively improving their physical
and emotional wellbeing.
To foster a conducive working environment, nurses need to peacefully coexist with their colleagues and collaborate or alternatively work as a team for the benefit of the patients. This
objective requires that nurses be aware and appreciate the different cultural backgrounds that are existent within the clinical practice environment. As such, they need to respect the
diverse cultures of their colleagues and patients as well Furthermore, nurses need to be resilient characterized by their ability to get along with others and observe the workplace
culture that influences positive and quality patient outcomes (Hezaveh, Rafii & Seyedfateni, 2016, p. 217). Resilience also implies that nurses need to recognize that they are in a
continuous learning process and as such, they have to look up to their supervisors and always be willing to learn new things and accept the input being given by their colleagues
(Nesbitt & Barton, 2014, p. 4). Similarly, such traits also builds up to collegial trust. Ideally, for nurses to thrive in clinical settings, there is need for developing formidable relationships
that are based on trust. In doing so, nurses are required to operate as a team and always be willing to acknowledge the need for help when necessitated. This quality will provide
the grounds for which trust can be built among nurses. On this note also, nurses need to identify the key contacts both in the workplace and outside the workplace (Peterson
et al, 2014, p. 61). This group of individuals can provide critique or an alternative way of thinking that can beneficial to the nurses’ clinical work.

Reference List
Curtis, K., Fry, M., Shaban, R. Z., & Considine, J. 2016. Translating Research Findings to Clinical Nursing Practice, Journal of Clinical Nursing, 26(5), pp.862-872.
Hezaveh, M. S., Rafii, F., & Seyedfateni, N. 2014. Novice Nurses’ Experiences of Unpreparedness at the Beginning of the Work. Global Journal of Health Science, 6(1), pp. 215-22.
Kristensen, N., Nymann, C., & Konradsen, H. 2016. Implementing Research Results in Clinical Practice: The Experience of Healthcare Professionals. BMC Health Services Research,
16(48).
Nesbitt, J., & Barton, C. 2014. Nursing Journal Clubs: A Strategy for Improving Knowledge Translation and Evidenced Informed Clinical Practice. Journal of Radiology Nursing, 33(1), pp.
3-8.
Peterson, H., Barnason, S., Donelly, B., Hill, K., & Whiteman, K. 2014. Choosing the Best Evidence to Guide Clinical Practice: Application of AACN Levels of Evidence. The Journal for
High Acuity, Progressive, and Critical Care Nursing, 34(2), pp. 58-68.