Introduction
Falling is one of the most common reasons for injury in elderly patients. Typically, it results in minor injuries, such as bruises, lacerations, and pulls. However, over 30% of falls result in temporary or permanently debilitating injuries, such as cranial injuries, and fractures (Shim et al., 2014). Hip fractures constitute less than 1% but are the most difficult to treat. Elderly patients typically have weaker bodies and a more fragile bone structure, which makes recovery long and hard. The majority of fall-related death in elderly patients results from cranial injuries.
Elderly patients are prone to falling more than other age groups for several specific reasons. As people age, they become less agile. Their muscles become weaker and less responsive to various stressors and stimuli. The majority of patients that are 65 years or older have limited mobility and do not perform regular exercise. They are more likely to lose balance on uneven terrain or have a motion-related accident.
It is my duty as a nurse to help improve the quality of life and care for geriatric patients. The purpose of this paper is to analyze the available literature and provide support for the proposed physical exercise intervention. My chosen PICO question is as follows: In patients aged 65 years or older (P), does specialized therapeutic exercise (I) compared to a standard discharge protocol (C) improve the patients’ balance and stability (O)?
Methods
To find relevant academic sources, several online medical databases have been used. These include Medline, Cochrane Library, Pubmed, and CINAHL. Over 100 articles have been reviewed to pick the five most relevant to the case. Inclusion and exclusion criteria for the articles are:
- The articles must be less than 5 years old.
- Peer-reviewed academic studies.
- The subject is relevant to the PICO question.
Results
There is a reported correlation between various kinds of exercises in association with falling as well as fear of falling. Shin et al. (2014) have performed a study, where the proposed intervention was whole-body vibration exercise in the horizontal direction. Patients were using a WBV platform 3 times a week, for 6 weeks. The researchers report significant improvements in balance among patients as well as lower limb power and muscle strength increases. In addition, the patients have become more confident in themselves, which improved the speed and quality of decision-making during movement, making them more agile and less prone to falling as a result. The study is reliable, as it provides quantitative results. However, it has a relatively small sample.
Another prospective intervention method is proposed by Celletti et al. (2015), who sought to improve muscle strength in patients by stimulating quadriceps tendons by applying vibratory stimulation through an electromechanical transducer. The exercise was performed on mechanical support fixated to the floor, with an electronic device attached to provide the stimulation. The intervention lasted for 10 minutes 3 times a week for a period between 30 to 180 days. The results have shown significant improvements in neuromuscular functionality and balance. This study has a larger sample, but one of its weaknesses is it is including females only.
The third article, written by Huang, Chung, Chen, Chin, and Wang (2015) researched the effectiveness of cognitive-behavioral intervention in addition to exercise. The cognitive-behavioral approach sought to reduce the fear associated with falling, whereas the exercises were used to improve mobility and muscle strength. The intervention was implemented in six nursing homes in Taiwan. As a result, there were significant improvements in the test group when compared to the control group. The sample included 98 subjects aged 65 or older, which is enough for this kind of study. However, one of the study’s weaknesses is associated with the representation. All subjects were Taiwanese, meaning that the results of the intervention cannot be fully extrapolated to other ethnicities and races.
The fourth article by Olsen and Bergland (2014) also highlights the importance of exercise in conjunction with fear-reduction techniques. In their intervention, they have used mobile-intensity circuit exercises for elderly female patients with osteoporosis. The total number of patients constituted 42, which is a relatively small sample. The researchers report that although both interventions have proven reasonably effective, they took time to achieve full effect. The effect size at 3 months was small (0.4), and at 12 months was moderate (0.7) (Olsen & Bergland, 2014). The weakness of this research is its small size and no representation of the male sex.
The last article was produced by Mesquita, de Carvalho, Freire, Neto, and Zangaro (2015), who performed a comparative analysis of two exercise protocols and their effectiveness on postural balance in elderly women. Their sample size and target population were similar to Olsen and Bergland (2014), estimating 63 elderly female participants, many of whom were suffering from osteoporosis. The two techniques used for comparison were Pilates vs. neuromuscular facilitation.
The study involved three groups, one of which was the control group. According to the research, neuromuscular facilitation showed significantly better results in comparison to Pilates. However, Pilates proved superior when compared to the control group, especially in the Berg Balance Scale scores and TUG scores. The article does not provide fully conclusive results due to the convenience sampling method used to find volunteers.
Discussion
The majority of studies examined in the course of this analysis involved only female participants, as it is stated that elderly women are more vulnerable to falling than men. However, such a premise is based on old and inconclusive data. The proposed PICO intervention will aim to treat both genders in accordance with their physical and psychological needs. All five sources highlighted the importance of reducing the fear of falling in addition to exercise interventions.
In some cases, exercise alone serves as a psychological motivator that helps reduce fear in patients. However, a dedicated cognitive-behavioral program should be included in the proposed research. Two types of exercises are predominantly available – gymnastics-based exercises like Pilates and medical exercise with the use of vibrations controlled muscle stimulation and neuromuscular facilitation. The latter is more efficient, but also more expensive. Depending on the resources available, gymnastics-based exercise may be preferable.
Conclusion
Falling is a significant health hazard for elderly patients, which needs to be treated preemptively. Should a person fall, they are 30% likely to break limbs that may leave them temporarily or permanently debilitated. Interventions that affect a person’s balance and overall physical state tend to reduce the risk of falling. Fear plays a significant psychological role in the equation. The proposed intervention seeks to reduce the chances of falling by focusing on a physical exercising regimen.
References
Celletti, C., Fattorini, L., Camerota, F., Ricciardi, D., La Torre, G., Landi, F., & Filippi, G. M. (2015). Focal muscle vibration as a possible intervention to prevent falls in elderly women: A pragmatic randomized controlled trial. Aging Clinical and Experimental Research, 27(6), 857–863. Web.
Huang, T.-T., Chung, M.-L., Chen, F.-R., Chin, Y.-F., & Wang, B.-H. (2015). Evaluation of a combined cognitive-behavioural and exercise intervention to manage fear of falling among elderly residents in nursing homes. Aging & Mental Health, 20(1), 2–12. Web.
Mesquita, L. S. de A., de Carvalho, F. T., Freire, L. S. de A., Neto, O. P., & Zângaro, R. A. (2015). Effects of two exercise protocols on postural balance of elderly women: A randomized controlled trial. BMC Geriatrics, 15(1), 1-9. Web.
Olsen, C. F., & Bergland, A. (2014). The effect of exercise and education on fear of falling in elderly women with osteoporosis and a history of vertebral fracture: Results of a randomized controlled trial. Osteoporosis International, 25(8), 2017–2025. Web.
Shim, C., Lee, Y., Lee, D., Jeong, B., Kim, J., Choi, Y., … Park, D. (2014). Effect of whole body vibration exercise in the horizontal direction on balance and fear of falling in elderly people: A pilot study. Journal of Physical Therapy Science, 26(7), 1083–1086. Web.