Interventions to Prevent Falls in Older Adults: An Updated Systematic Review: Evidence Synthesis Num

Author by : U. S. Department of Health and Human Services
Languange Used : en
Release Date : 2013-05-11
Publisher by : Createspace Independent Pub

ISBN :

Description : This review was undertaken to support the U.S Preventive Services Task Force (USPSTF) in updating its 1996 recommendation on prevention of falls in older adults, which was part of its general review on household and recreational injuries. The 1996 USPSTF review found sufficient evidence that certain interventions reduce the risk for falls. This review found insufficient evidence, however, that counseling could be generalized to the primary care setting or that counseling reduced fall risk factors or the incidence of falls. The USPSTF also found insufficient evidence to recommend for or against the routine use of external hip protectors to prevent fall injuries. Issues requiring rectification for the USPSTF to change its recommendations include evidence showing that: primary care feasible interventions reduce the risk for falls or fall-related injuries in high-risk older adults; the general population benefits from these interventions; primary care counseling reduces the incidence of falling or fall-related injuries; primary care counseling is effective in encouraging older adults to increase their physical activity levels; and screening (balance and gait, visual acuity, ophthalmoscopic exam, dementia or altered mental status) reduces incidence of falls or fall-related injuries. A fall is “an unexpected event in which the participant comes to rest on the ground, floor, or lower level.” Because no single definition for a fall was consistently used across studies, we use the definition of a fall used by each reviewed study to maximize the number of included studies in the current review. People aged 65 years and older represent the fastest-growing segment of the U.S. population. Falls are associated with many adverse health outcomes, including injury and death. In 2003, the Centers for Disease Control and Prevention reported that falls were the leading cause of injury deaths, and the ninth leading cause of death from all causes, among those 65 years of age and older. Falls and fall-related injuries increase with age. Hip fractures are an especially grave complication of falls in older adults, resulting in more hospital admissions than any other injury. There is a 10% to 20% reduction in expected survival during the first year following a hip fracture, and roughly half of the survivors never recover normal function. Falls also predict quality of life and disability. Twenty to 30% of those who fall suffer injuries that result in decreased mobility that limits subsequent independence. Even falls that do not result in injury can lead to negative outcomes. In particular, experiencing a fall can increase an older person's fear of falling, an important psychological outcome correlated with future falls. Fear of falling leads older adults with and without a history of falling to limit activities, which eventually increases fall risk through functional decline, deterioration in perceived health status, and increased risk for admission to institutional care. KQ 1: Is there direct evidence that primary care interventions reduce fall-related injury, improve quality of life, reduce disability, or reduce mortality when used alone or in combination to reduce falling in community-dwelling older adults? 1a. Do these interventions reduce injury, improve quality of life, reduce disability, or reduce mortality in older adults specifically identified as high risk for falls? KQ 2: Do primary care interventions used alone or in combination in community-dwelling older adults prevent falling? 2a. Do these interventions prevent falling in older adults specifically identified as high risk for falls? 2b. Are there positive outcomes other than reduced falling, and related morbidity and mortality, that result from primary care interventions to prevent falling? KQ 3: What are the adverse effects associated with interventions to prevent falling? KQ 4: How are high-risk older adults identified for primary care interventions to prevent falling?...

Author by : U. S. Department of Health and Human Services
Languange Used : en
Release Date : 2013-03-21
Publisher by : Createspace Independent Pub

ISBN :

Description : The U.S. Preventive Services Task Force (USPSTF) has been working to improve its methods and processes for the preventive needs of older adults. Traditional methods for systematic reviews and evidence-based recommendations for prevention of cancer or chronic disease may fall short in addressing many geriatric conditions. This deficit is because of these conditions' multifactorial risk factors and/or broad interventions aimed at improving multiple related health outcomes. The multidimensional nature of geriatric care presents unique challenges to thoughtfully interpreting the evidence base for many geriatric topics. Clinical care and research in older adults have, in part, reflected this multidimensional nature by developing comprehensive geriatric assessments—a multidisciplinary diagnostic process intended to determine an older adult's medical, psychosocial, and functional abilities/limitations in order to develop an overall plan for management. Over the past two decades, there has been a large body of international research evaluating different interventions that incorporate both inpatient and outpatient geriatric assessment approaches aimed at improving various health, quality of life, and clinical care outcomes. In 2010, the USPSTF posted for public comment a draft recommendation statement based on a commissioned systematic review that found that exercise and physical therapy interventions and vitamin D supplementation reduced falling in community-dwelling older adults. However, other interventions (notably, multifactorial assessment and management interventions) did not appear to reduce risk for falling. Because this previous review focused on interventions whose primary aim was to prevent falls, the USPSTF commissioned a second review to more broadly address the net benefit of these types of assessment and management interventions in older adults. This second review presented the opportunity to test methods around evidence synthesis and evidence-based recommendations for highly related bodies of evidence (i.e., multifactorial interventions to prevent falls and/or functional decline), as well as methods for reviewing complex interventions and multiple interrelated health outcomes. This review was designed to answer two key questions: 1) Can outpatient multifactorial assessment and management interventions improve health-related quality of life (HRQL) or reduce hospitalization, institutionalization, disability, or mortality in community-dwelling older adults? and 2) What are the adverse effects associated with these multifactorial assessment and management interventions? This report briefly summarizes our review findings and focuses on the methodological challenges we encountered and methods we used in study design, reporting, and analysis....

Author by : Susanne Hempel
Languange Used : en
Release Date : 2014
Publisher by :

ISBN :

Description : This evidence map provides an overview of Tai Chi research and describes its volume and focus. It combines a systematic review of systematic reviews with a scoping review for the VA priority areas pain, posttraumatic stress disorder, and fall prevention. The evidence map summarizes patient outcomes reported in reviews of studies in patients practicing Tai Chi for health-related indications. We searched PubMed, DARE, the Cochrane Library of Systematic Reviews, the Campbell Collaboration database, AMED, CINAHL, PsycInfo, Scopus, Web of Science, and PROSPERO; screened reviews of reviews; and consulted with topic experts. We used a bubble plot to graphically display the research field and summarized results narratively in an executive summary. Tai Chi has been investigated as a treatment for a number of clinical indications. The systematic review identified 107 systematic reviews. Reviews addressing general health effects, psychological wellbeing, or interventions in older adults included between 31 and 51 randomized controlled trials (RCTs). The topic areas balance, hypertension, falls, quality of life, cognitive performance, and vestibulopathy have also been the focus of research; included reviews identified 10 or more pertinent RCTs per topic. Statistically significant effects across existing studies were reported for hypertension, falls outside of institutions, cognitive performance, osteoarthritis, chronic obstructive pulmonary disease, pain, balance confidence, depression, and muscle strength. However, review authors cautioned that firm conclusions cannot be drawn due to methodological limitations in the original studies and/or an insufficient number of research studies....

Author by : Susan K. Grove
Languange Used : en
Release Date : 2014-09-18
Publisher by : Elsevier Health Sciences

ISBN :

Description : NEW! Redesigned research example format includes research examples have been thoroughly redesigned with a clear hierarchy of subcategories. NEW! Improved focus on need-to-know content and greater use of bulleting, creative illustrations, and tables, employs a more consistent, streamlined approach from chapter to chapter. NEW! Updated research examples ensure you are learning through the most clinically relevant topics and studies. NEW! Detailed directions on how to critically appraise research syntheses — such as systematic reviews, meta-analyses, meta-syntheses, and mixed-methods systematic reviews — increase your understanding of the types of research syntheses conducted in nursing and how to determine the quality of these syntheses and the relevance of their findings for practice. NEW! A unique emphasis on QSEN, aided by the input of a QSEN consultant, increases the book’s relevance to national curriculum standards and promotes the safe practice of nursing by using the most current research. NEW! Chapter on the Enhanced Literature Review provides guidelines for structure of reviews written for different purposes. NEW! More practically focused chapter on Outcomes Research better addresses the trending topic of outcomes research. NEW! Expanded coverage of mixed-methods research and translational research responds to the growing emphasis on these research emphases. NEW! Expanded coverage of cultural competency and cultural validity provides valuable information for providing care to diverse populations and understanding the validity of research instruments in various cultures. NEW! Quick-reference tools include a Brief Table of Contents, a new Levels of Knowledge illustration, and other evidence-based practice information inside the front cover. A Research Designs and Statistical Analysis Techniques Reference and a new Key to Statistical Symbols are located inside the back cover. NEW! Enhanced illustration program incorporates re-colorized illustrations and additional full-color illustrations in each chapter. NEW! Additional design enhancements include a special 1-column adaptation of the RN Design standard, table row separators, and newly designed chapter openers....

Author by : Susan K. Grove
Languange Used : en
Release Date : 2014-09-22
Publisher by : Elsevier Health Sciences

ISBN :

Description : As the bestselling nursing research text, Understanding Nursing Research: Building an Evidence-Based Practice, 6th Edition offers unique insights into understanding, appraising, and applying published research to evidence-based practice. It is known for its authoritative content, time-tested systematic approach, and unique research example format — newly redesigned for the sixth edition to better demonstrate how the steps of the research process relate to evidence-based nursing. "This would be excellent for student nurses, nurses new to research or any nurse with an interest in research." Reviewed by: Helen Reeves, St Giles Walsall Hospice on behalf of Nursing Times, December 2015 Authoritative content is written by two of the true pioneers in nursing research, who offer unique, first-hand insights into the field. Research examples provide practice in working with published studies, with many of the examples including Critical Appraisal and Implications for Practice sections. Clear, step-by-step organization introduces the research process and demonstrates how this systematic framework relates to evidence-based practice. Strong emphasis on evidence-based practice helps you develop skills in studying and appraising published research, so you are prepared for your role in working with research evidence. Critical Appraisal Guidelines boxes provide step-by-step guidance in appraising published research studies. Emphasis on critical appraisal versus critique reflects contemporary usage in nursing research and evidence-based practice. Balanced coverage of qualitative research prepares you to approach research questions and clinical questions with an unbiased view of the researcher's methodology. Presentation of two different appraisal processes covers both the traditional in-depth critical appraisal process that prepares you for graduate-level work in research, and the concise, practice-focused research appraisal process that equips you for quick and accurate evaluation of the applicability of research findings to clinical practice. NEW! Redesigned research example format includes research examples have been thoroughly redesigned with a clear hierarchy of subcategories. NEW! Improved focus on need-to-know content and greater use of bulleting, creative illustrations, and tables, employs a more consistent, streamlined approach from chapter to chapter. NEW! Updated research examples ensure you are learning through the most clinically relevant topics and studies. NEW! Detailed directions on how to critically appraise research syntheses - such as systematic reviews, meta-analyses, meta-syntheses, and mixed-methods systematic reviews - increase your understanding of the types of research syntheses conducted in nursing and how to determine the quality of these syntheses and the relevance of their findings for practice. NEW! A unique emphasis on QSEN, aided by the input of a QSEN consultant, increases the book's relevance to national curriculum standards and promotes the safe practice of nursing by using the most current research. NEW! Chapter on the Enhanced Literature Review provides guidelines for structure of reviews written for different purposes. NEW! More practically focused chapter on Outcomes Research better addresses the trending topic of outcomes research. NEW! Expanded coverage of mixed-methods research and translational research responds to the growing emphasis on these research emphases. NEW! Expanded coverage of cultural competency and cultural validity provides valuable information for providing care to diverse populations and understanding the validity of research instruments in various cultures. NEW! Quick-reference tools include a Brief Table of Contents, a new Levels of Knowledge illustration, and other evidence-based practice information inside the front cover. A Research Designs and Statistical Analysis Techniques Reference and a new Key to Statistical Symbols are located inside the back cover. NEW! Enhanced illustration program incorporates re-colorized illustrations and additional full-color illustrations in each chapter. NEW! Additional design enhancements include a special 1-column adaptation of the RN Design standard, table row separators, and newly designed chapter openers....

Author by :
Languange Used : en
Release Date : 2021-04-27
Publisher by : World Health Organization

ISBN :

Description : Falls take the lives of 684 000 people each year. Beyond the death toll, 172 million more people experience disabilities arising from a fall each year. Falls are not only a significant global public health problem – they are a rapidly growing one. Fall-related deaths have risen far faster than any other type of injury over the last two decades. Many factors account for this increase – ageing populations and patterns of urbanization chief among them. The Step Safely technical package provides concrete recommendations for evidence-based strategies to prevent and manage falls for children and adolescents, workers, and older people. Among others, effective prevention measures include parenting programmes for low-income and marginalized families, stricter worker safety regulations, and strength and balance training for older people. Preventing falls can help achieve the Sustainable Development Goals linked to health and well-being, decent work, and safe, inclusive cities. The global community should actively look for opportunities to reduce the growing harm, suffering and loss that result from falls....

Author by : Bette R Bonder
Languange Used : en
Release Date : 2017-12-04
Publisher by : F.A. Davis

ISBN :

Description : Support the very best health, well-being, and quality of life for older adults! Here’s the ideal resource for rehabilitation professionals who are working with or preparing to work with older adults! You’ll find descriptions of the normal aging process, discussions of how health and social factors can impede your clients’ ability to participate in regular activities, and step-by-step guidance on how to develop strategies for maximizing their well-being....