Comprehensive Analysis of RCT Trial: Fall Assessment in Older Adults

This report critically analyzes a randomized controlled trial (RCT) focused on fall assessment and prevention in older adults. The study, conducted in a care home setting, investigated the effectiveness of environmental assessments and modifications in reducing falls. The report describes the trial's methodology, including participant selection, intervention groups (non-occupational therapy led environmental assessment, trained assessor, and control group), and outcome measures (fear of falling, falls, quality of life). The findings revealed that while the intervention did not significantly impact fear of falling, there were differences in quality of life and adherence to the trial among the groups. The report also discusses the strengths and limitations of the study, implications of the interventions, and suggests follow-up research. The analysis includes comparisons with other relevant studies and a conclusion summarizing the key findings and their significance for fall prevention strategies in older adults.

Running head: RCT TRIAL OF OLDER ADULTS FOR FALL ASSESSMENT
RCT TRIAL OF OLDER ADULTS FOR FALL ASSESSMENT
Name of the Student
Name of the University
Author note

1RCT TRIAL OF OLDER ADULTS FOR FALL ASSESSMENT
Table of Contents
Introduction..........................................................................................................................2
Description...........................................................................................................................2
Strength and limitation of the assignment...........................................................................3
Implications of interventions...............................................................................................4
Two more sources to follow up, why the team need to follow these..................................5
Conclusion...........................................................................................................................5
References............................................................................................................................6

2RCT TRIAL OF OLDER ADULTS FOR FALL ASSESSMENT
Introduction
Fall is a devastating and a very common issue in the older age affecting a broad array of
older adults across the world. Falls causes highest amount of morbidity and mortality in the older
people and is one of the prime reasons for primary nursing care admission rates. These falls are
associated with different recognizable risk factors such as confusion, weakness, high dose
medication, unsteady gait and so on (Muir, Gopaul & Montero Odasso, 2014). There are several
cost effective fall reduction programs such as fall risk assessment program, targeted
interventions, exercise program and hazard-reduction program. Medical evaluation of the risk
associated with falls and applied interventions are challenging because the nature of falls are
different and involves interdisciplinary collaborations to assess and apply innovative
interventions to treat such falls. Particular attention need to be given to the applied interventions
such as exercises, medical conditions environmental and hazard control (Mirelman et al., 2012).
In this following assessment, the thorough discussion of the topic
‘Environmental Assessment and Modification to Prevent Falls in Older People” by (), will be
done. Furthermore, the description of the paper, its strengths and limitations, implication of the
interventions and further two more sources to follow up will be given.
Description
The project pilot, after receiving ethical approval from the Airedale National Health
Service Trust in Yorkshire, England, a process of randomized control trial (RCT) has been taken
for the assessment. The care home did not had any specific fall service and they used to name the
fall events as an unexpected event. The age group that has been selected for the study are of old
people aged 70 or more. The reason for the selection was the risk of falling associated with these
kind of aged people. However, people living in this old age home and having applied non

3RCT TRIAL OF OLDER ADULTS FOR FALL ASSESSMENT
occupational therapy on them to deal with the risk of falling were excluded (Ambrose, Paul &
Hausdorff, 2013). As the rat of people, falling in that old age care center was 50 percent in the
year, and if all those people were included in the study, 960 people need to be assessed. Hence,
the researchers decided to carry out the research using falls as the secondary outcome and the
fear of falling as the primary outcome. Participants then was assigned to three groups randomly.
These groups were non-occupational theory led environmental assessment, environmental
assessment in the presence of a trained assessor and finally a usual care control team. Results
were obtained at the end of the trial and FES-1 was used to represent the fear of fall EuroQol was
used to assess the secondary outcome that is falls, quality of life of those participants and the
Barthel index. Baseline or first measures of this research were taken and further results were
obtained in 3, 6 and 12 months interval using surveys and self-report questionnaires. All these
data were analyzed at the end of baseline, three, six and twelve months interval and those three
test groups were analyzed. 66 % of all the participants fell during the research process. The
control group was exactly similar to the group under trained assessor and the OT group ontai9ns
highest amount of participants falling during the research process. Whereas, the other attributes,
quality of life was better in assessors group and adherence to the trial was maximum in the OT
group (Pighills et al., 2013).
Strength and limitation of the assignment
 The assignment did not had a significant effect on fear of falling among old aged
person. This pilot was the very first RCT to compare between occupational
therapist and trainer assessors.
 Number of falls in this one year of trial was significantly high and the primary
reason was not properly assessed in the research article.

4RCT TRIAL OF OLDER ADULTS FOR FALL ASSESSMENT
 This RCT study was not properly designed to detect any statistically significant
data on falls in old aged people. However, the people who left the intervention at
the end of one year was very less, 238 people from the trial reported 668 falls.
 There was a statistically significant difference in Eurokol scores. This difference
was between trained assessor groups and the control group, the finding was not
very specific.
 This pilot did not assessed the cognition of the participants.
The dimension of this variable would have demanded direct contact with every co
ntributor, increasing cost. As there is a strong relationship between dementia and
fall, the falling incidences can be enhanced due to dementia.
 These results of the study are applicable to community dwelling older adult and
was convinced to single center and may not be generalized to other settings.
Implications of interventions
The Westmead Home Safety Assessment (WeHSA) was applied to guide the intervention
in the positive way. This intervention represented a systematic approach to identify different
hazards. A training program for the staff was developed that includes a half-day workshop on the
basis of the content of the WeHSA manual. The staff also scored a video of an older person
doing tasks at home and practices those WeHSA and practical using assessment tools at home.
Interventions were guided using standard protocols only (Stone & Skubic, 2015).

5RCT TRIAL OF OLDER ADULTS FOR FALL ASSESSMENT
Two more sources to follow up, why the team need to follow these
The first paper by Gillespie et al. (2012), they used different interventions to assess the
fall management in the older adults. The intervention applied by them to reduce the number of
fall was making the participants aware of the risk factors associated with every consequences.
The participants became fearless about the fall and implemented all those ideas to improve their
quality of life. Pighills et al. (2014), did not used this intervention hence, this need to be followed
up.
Another research showed the process to assess the fall in older adults. They used falls as
the primary outcome and other environmental factor as the secondary outcome. Hence, these two
papers need to be followed up to determine the process (Clegg et al., 2014).
Conclusion
In this critical analysis, a proper discussion of the paper has been done. Falls in the older
adult is nowadays major reason to hospital admissions. There are several risk factors associated
with it. Hence, the detailed discussion of the paper was needed. In critical assessment assess the
description and methods of the process and compared it with two other articles to rationalize the
data found.

6RCT TRIAL OF OLDER ADULTS FOR FALL ASSESSMENT
References
Ambrose, A. F., Paul, G., & Hausdorff, J. M. (2013). Risk factors for falls among older adults: a
review of the literature. Maturitas, 75(1), 51-61.
Clegg, A., Barber, S., Young, J., Iliffe, S., & Forster, A. (2014). The Home-based Older People's
Exercise (HOPE) trial: a pilot randomised controlled trial of a home-based exercise
intervention for older people with frailty. Age and ageing, 43(5), 687-695.
Gillespie, L. D., Robertson, M. C., Gillespie, W. J., Sherrington, C., Gates, S., Clemson, L. M.,
& Lamb, S. E. (2012). Interventions for preventing falls in older people living in the
community. The Cochrane Library.
Mirelman, A., Herman, T., Brozgol, M., Dorfman, M., Sprecher, E., Schweiger, A., ... &
Hausdorff, J. M. (2012). Executive function and falls in older adults: new findings
from a five-year prospective study link fall risk to cognition. PloS one, 7(6), e40297.
Muir, S. W., Gopaul, K., & Montero Odasso, M. M. (2012). The role of cognitive impairment in
fall risk among older adults: a systematic review and meta-analysis. Age and
ageing, 41(3), 299-308.
Pighills, A. C., Torgerson, D. J., Sheldon, T. A., Drummond, A. E., & Bland, J. M. (2011).
Environmental assessment and modification to prevent falls in older people. Journal of
the American Geriatrics Society, 59(1), 26-33.
Stone, E. E., & Skubic, M. (2015). Fall detection in homes of older adults using the Microsoft
Kinect. IEEE journal of biomedical and health informatics, 19(1), 290-301.