Effectiveness of Exercise-Based Interventions in Reducing Falls in Older Adults Living in Residential Care Facilities

NURS 3046 Nursing ProjectAssignment 1 (2000 words 45%)
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Background
The prevention of falls among older adultsis an urgentpublic health issue in Australia and
internationally (Nyman & Skelton 2017; Gillespie et al. 2012). The proportionof Australians aged 65 years
and over is predicted to increase from 14% (3 million people) in 2010 to 23% (8.1 million people) by 2050
(Intergenerational Report 2010).By 2051, the Australian total annual health costs from fall-related injury are
predicted to increase almost threefold to $1.4 billion (Moller 2003). Approximately 30% of adults aged 60
and older will fall during the period of a year (Tinetti 2003; Resnick 1999).Falls by older adults are a
common occurrence and a leading cause of dependence (Stevens et al. 2006). Falls can result in injuries,
reduced confidence, isolating social consequences, and a reluctance to continue physical activity that, not
surprisingly, can be a precursor to other health-related complications. Nearly 30% of people over the age of
65 will sustain a fall every year in residential care facilities, and fall-related injuries are the leading cause of
mortality and morbidity (Cakar et al.2010). Notably, three quarters of injuries to older adults that require
hospitalization are the result of falls (AIHW: Bradley 2013)The rate of falls by older adults in residential
aged care facilities is nearly three times higher than the rate of falls in other settings (Shi 2014).
There is compelling evidence that physical activities to enhance balance and strength are among
the most promising exercise-based interventions to prevent falls and fall-related injuries in older adults
(Gillespie et al. 2012). Moreover, ‘widespread implementation of exercise as a single intervention seems to
be the best approach to falls prevention’ (Sherringtonet al. 2011, p. 78).Balance and strength training and
lower limb resistance training is known to reduce falls in older adults (Sherrington et al.2008). However,
less than 10% of older people routinely engage in strength training and even less in activities that
strengthen their balance (Clemson et al. 2012).
ResearchQuestion:What is the effectiveness of exercise-based interventions in reducing falls in older
adults living in residential care facilities?
This research question is relevant for evidence-based clinical practice and professional knowledge.
If exercise-based intervention programs have positive effects on reducing falls among older people, then
this approach could change the way older adults are cared for in residential care facilities.This research
question could generate evidence to inform person-centred care planning regarding effective exercise-
based interventions for falls prevention and targeted education for older adults living in residential care
facilities(NMBA 2016). Findings could inform strategies that target audiences such as managers, nurses
and families could implementto improve holistic care for older adults living in residential care facilities.
Nurse educators could also use the evidence to teach effective strategies in the undergraduate nursing
curriculum. The research question is therefore highly relevant to clinical practice and has wider implications
for the provision of quality care and encouraging older adults to adopt effective self-care practices.
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SUMMARY ANALYSIS OF FOUR (4) PRIMARY RESEARCH ARTICLES (1200 words)
Select four (4) primary research articles (from the 8 articles provided) that provide relevant evidence to
answer the research question. Write a 300 wordsummary of each primary research article using the three
step format learned in Topic 2.
Paper 1
Lim, J., Cho, J.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, vol. 15, pp.64-67.
According to Lim et al. (2017) falls result in serious health concerns among the elderly population, as a
result of balance deficits and muscle weakness. Virtual reality exercise has been under scrutiny for its
effectiveness as a program that can prevent falls in the elderly. The aim of the present research was to
carry out an investigation of the effect of complex exercise with virtual reality (CEVR) such as muscle
strength, endurance, flexibility, and balance exercises on dynamic postural ability and isokinetic knee
muscle strength in the elderly. The research undertaken had the study design of single-blinded,
randomized, comparative trial which was carried out over five weeks. The study participants were twenty
individuals aged over sixty-five years, who were divided into a balance exercise with virtual reality (BEVR)
group and a complex exercise with virtual reality (CEVR) group. The focus of BEVR was solely on balance
exercise, whereas the focus of CEVR was on balance, endurance, flexibility and strengthening. Isokinetic
peak torque and total work of knee muscles was measure prior to the sessions as well as after the one
hour sessions with the help of a dynamometer. Evaluation of dynamic balance was done with the help of
the ‘Timed Up & Go (TUG) test’. The results indicated that knee extension peak torque had been
significantly enhanced for only the CEVR group (p < 0.05). However, there was no difference among the
groups. Dynamic balance showed significance improvement for both the groups when measurement wad
done with TUG after completion of the training sessions. Nevertheless, greater improvement was shown by
the CEVR group as compared to the BEVR group (p < 0.05). It was therefore concluded from the research
that virtual reality training when demonstrated in the form of complex exercise program produces superior
results for improvement of muscle strength and balance in elderly. It was recommended that a virtual reality
program can be implemented for strength, endurance, balance, and flexibility enhancement and preventing
falls in elderly across settings
Paper 2
Sherrington, C., Fairhall, N., Kirkham, C., Clemson, L., Howard, K., Vogler, C., Close, J.C., Moseley, A.M.,
Cameron, I.D., Mak, J. & Sonnabend, D., 2016. Exercise and fall prevention self-management to reduce
mobility-related disability and falls after fall-related lower limb fracture in older people: protocol for the
RESTORE (Recovery Exercises and STepping On afteR fracturE) randomised controlled trial. BMC
geriatrics, vol. 16, no. 1, p.34.
Sherrington et al. (2016) stated that disability and further falls are costly and common problems faced by
older individuals after suffering pelvic and lower limb fractures as a result of falls. It has been noted that
exercise interventions can bring in rapid improvement in the mobility of individuals after they have suffered
falls, thereby reducing the risks of further falls. Nevertheless, there is no much clarity regarding the optimal
approach that can be considered for rehabilitation of pelvic and lower limb fracture after falls. The
researchers outlined a randomized control trial with the aim of evaluating the impact of a self-management
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and exercise fall prevention intervention on mobility of older people who have been disabled as a result of
falls. The cost effectiveness of the intervention was also to be investigated. The research paper focused on
outlining the protocol for RESTORE (Recovery Exercises and Stepping On after fracture) randomized
control trial. It was articulated that the randomized control trial would be conducted with concealed
allocation and assessor blinding. Performance tests and intention-to-treat analysis would be considered.
The participants would be three hundred and fifty individuals of age 60 years and above how have suffered
pelvic or lower limb fracture as a result of falls. These individuals are to lie in low care residential aged care
facility and must have previously undergone active rehabilitation. The participants are to be divided into two
groups of intervention or normal care for one year. The physiotherapist would be visiting the intervention
group for a total number of ten times for prescribing an individualized exercise program along with
motivational interviewing. Fall prevention education would also be given through individualised advice at
the group based “Stepping On” program which would be seven group sessions of two hours each. While
the primary outcomes would be mobility-related disability and falls, secondary outcomes would include
measures of balance and mobility, nutrition, falls risk, walking aid use, frailty, physical activity, pain, mood,
falls efficacy, positive and negative effect, quality of life, assistance required, hospital readmission, and
health-system and community-service contact. It was highlighted that the results attained from the study
would be helpful for designing and implementing interventions for fall prevention in older adults.
Paper 3
Singh, D.K., Rajaratnam, B.S., Palaniswamy, V., Pearson, H., Raman, V.P. & Bong, P.S., 2012.
Participating in a virtual reality balance exercise program can reduce risk and fear of falls. Maturitas, vol.
73, no. 1, pp.239-243.
In the paper of Singh et al. (2012) it has been mentioned that near about one third of older adults living in
the community are likely to suffer at least one fall in a year. Research indicates that women are twice likely
to suffer falls in old age as compared to men of the same age group. Virtual reality exercise games can act
as a reliable rehabilitation tool for empowering adults to carry out exercises in a regular and independent
manner. The aim of the present study was to carry out an evaluation of the effectiveness of taking part in
six weeks long VRBG program as determined by reduction in risk of falls among postmenopausal women.
Thirty six women with age above 56 years were recruited for the study and divided into two groups,
experimental with exercises using VRBG and control with conventional balance exercises, on a random
manner. The sessions were carried on for six weeks, twice a week, for one hour. Measurement of fear and
risk of falls was done using Activity Specific Balance Scale (ABC-6) and Physiological Profile Approach
(PPA). Examination of differences on pre and post intervention stages was considered using two way
repeated measures ANOVA. The results of the study indicated that both conventional and VRBG balance
exercise groups demonstrated significant decrease in PPA (p < 0.001) and ABC-6 (p < 0.01). There was
however no significant effects between the groups in PPA (p = 0.18) and ABC-6 (p = 0.25). It was
concluded from the study that taking part in VRBG enables a noteworthy increase in confidence related to
balance among older women in community. The utility is that such program is capable of providing
feedback to the individuals and therefore promotes engagement in physical activity on a regular basis.
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Paper 4
Cakar, E., Dincer, U., Kiralp, M., Cakar, D., Durmus, O., & Soydan, F. et al. 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, vol. 46, no.1, pp. 59-67.
According to Cakar et al. (2010) falls is a significant health concern among elderly population and fall rates
of individuals living in residential care units is three times more than that of community dwelling individuals.
The burden of falls on healthcare workers is immense, leading to their fatigue. The researchers considered
carrying out a research for determining the usefulness of combined exercise program when taken up on a
regular basis in relation to fall risk, balance improvement, enhancement of quality of life and depression.
Such programs consider stretching, strength and aerobic exercises along with jumping training. The trial
considered 78 168 participants who were assigned to combined exercise program (COM) including
aerobic, strength and stretching exercise, and COM plus jumping (COMpJ) program. The six weeks long
programs considered sessions three times in a week. The maximum time for the total exercises was 45
minutes. For assessing fall risk and dynamic balance, Biodex Balance system and Berg balance tests were
considered. Short Form-36 was used for assessing quality of life. Lastly, depression status was assessed
through Geriatric Depression Scale. The results indicated that reduction in fall risk and improvement in
balance ability were improved in both the groups. Nevertheless, statistical significance was found in the
COMpJ group. Further, quality of life in relation to health was better in both COMpJ and COM groups. The
main inference drawn from the study was the group exercise program when carried out in a regular basis,
can be effective in long term care process for elderly individuals. The benefits brought about are
multifaceted and include balance improvement, enhancements in quality of life and fall reduction.
Discussion (600 words)
Compare and contrastthe findings of the four (4) primary research articles using the approach learned in
Topic 3. Ensure the analysis explains how the findings answer the research question. Identify any existing
gaps in knowledge or practice. Discussion may be supported by additional relevant additional literature.
The above section on review of articles aimed at understanding the effectiveness of exercise-based
interventions in reducing falls in older adults living in residential care facilities. The results of all the four
studies aimed at addressing the research question in an appropriate manner. The study of Lim et al. (2017)
and that of Singh et al. (2012) had considered evaluating the efficacy of virtual reality exercise program in
promoting prevention of falls in elderly. The studies however had certain limitations, the key ones of the first
study being small sample size and short duration of study. As opined by Parahoo (2014) larger sample size
in research aids in generalizability of the study findings, thereby adding value to the research undertaken.
The limitation of the second study was that there was no measurement undertaken of the physical activity
level of the study participants at baseline. The results might have therefore been influenced considerably.
The limitation of short duration of study was also marked for the study conducted by Cakar et al. (2010).
The study further had limitation of using a computerized fall risk assessment device. Nevertheless, the
findings of the all the four studies were pragmatic.
The implications of implementing complex exercise with virtual reality (CEVR) were understood from the
research of Lim et al. (2017), while the study of Singh et al. (2012) focused on reality balance games
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