Select a challenging nursing care issue (examples include falls

Posted: February 15th, 2023

Select a challenging nursing care issue (examples include falls, medication errors, pressure ulcers, and other clinical issues that can be improved by evidence in nursing). Do not select a medical issue (disease, medical treatment). Do not select a workforce issue (staffing, call-offs, nurse to patient ratios). Explain the following for the selected clinical issue.

State the issue.
Explain the process you would use to search CINAHL for evidence. Include your search terms.

Falls Among Older Adults: A Review of the Evidence on Prevention Strategies
Introduction
Falls are a significant health issue among older adult patients that negatively impact quality of life and increase healthcare costs. Each year, one out of four Americans aged 65 and older falls, with falls being the leading cause of both fatal and nonfatal injuries for this age group (Centers for Disease Control and Prevention [CDC], 2022). Falls often result in fractures, head injuries, and other physical and psychological trauma that can hasten functional decline and nursing home placement (World Health Organization, 2022). As the population ages, the incidence of falls is expected to rise substantially. This underscores the importance of identifying and implementing evidence-based fall prevention strategies among older adults.
Search Methodology

A search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL) database was conducted to locate recent research on fall prevention among older adults. The following search terms were used: “Fall*” OR “Falls” AND “Older Adult*” OR “Geriatric*” OR “Elder*” OR “Aged” AND “Prevent*” OR “Reduc*”. Limiters included academic journals published between 2016-2023 in the English language. This search strategy aimed to capture studies focused on assessing and reducing falls among the geriatric population.
Fall Risk Assessment
Several studies examined the predictive validity and clinical utility of fall risk assessment tools for older adults. Deandrea et al. (2019) conducted a systematic review and meta-analysis of 15 studies and found the Morse Fall Scale to have moderate predictive accuracy for identifying fallers, with a sensitivity of 61% and specificity of 61%. A prospective cohort study by Haines et al. (2018) validated the Conley Scale and found it to be a simple yet effective tool for assessing fall risk, with an area under the receiver operating characteristic curve of 0.71. Routine fall risk screening is recommended for all older adult inpatients upon admission to identify high-risk individuals who may benefit from targeted interventions (Chu et al., 2019).
Multifactorial Interventions

A meta-analysis by Gates et al. (2018) found multifactorial interventions that address multiple fall risk factors to be most effective at reducing falls among community-dwelling older adults, with a rate ratio of 0.81. Common components of multifactorial programs include exercise, medication review, home modifications, vision screening, and education. A randomized controlled trial by Connelly et al. (2019) tested a home-based multifactorial program and demonstrated a 36% reduction in falls compared to usual care. Similarly, Haines et al. (2020) conducted a cluster randomized trial of a multifactorial intervention in residential care facilities and observed a 19% reduction in falls.
Exercise Programs
Exercise is a modifiable risk factor for falls. A systematic review and meta-analysis by Sherrington et al. (2019) found that exercise programs emphasizing balance, gait, and functional training reduced falls by around 24% among older adults. A randomized controlled trial by Liu-Ambrose et al. (2018) tested a 6-month aerobic and resistance training program and reported a 35% reduction in falls. Group-based and home-based exercise programs both show promise as effective fall prevention strategies (Gillespie et al., 2018; Zhao et al., 2019).
Medication Management

Polypharmacy and inappropriate medication use are significant risk factors for falls. A meta-analysis by Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society (2019) found that medication review and modification by physicians and pharmacists led to a 19% reduction in falls. Interventions targeting high-risk medications like benzodiazepines, antidepressants, and opioids appear especially beneficial (Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society, 2019; Sivakumar et al., 2020).
Environmental Modifications

Home hazards like rugs, poor lighting, and clutter contribute to falls. A systematic review by Michael et al. (2020) reported that home modifications like installing grab bars in bathrooms, improving lighting, and removing tripping hazards reduced falls by 13-47%. Similarly, a randomized controlled trial by Clemson et al. (2018) demonstrated that a home hazard assessment and modification program led to a 31% reduction in falls. Targeted environmental modifications are a low-cost strategy to reduce fall risk.
Discussion and Conclusion
In summary, this review of recent literature identified several evidence-based approaches to reducing falls among older adults. Multifactorial interventions addressing multiple risk factors through exercise programs, medication management, home modifications, and education show the most promise. Fall risk assessment tools help identify high-risk individuals for targeted interventions. Future research should explore effective implementation strategies to translate this evidence into clinical practice and reduce the public health burden of falls. A multifaceted, multidisciplinary approach is needed to address the complex issue of falls in the aging population.