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.
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 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.
- 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 contributor, 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).
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).
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.
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.