Clinical Governance And Practice Improvement For Falls Prevention Among Older Adults

Discuss about the Clinical Governance and Practice Improvement.

Falls prevention is the type of actions taken to reduce the amount of accidental falls that are suffered by the aged people. Injuries related to falls are the most common and serious medical problems that are experienced by the aged population. It is evident that annually, the incidence of falls among the older population is one-third and half of them are known to fall more than once (Haines et al. 2014, pp.136-144). The Australian Commission of Safety and Quality in Healthcare has taken quite a number of national initiatives for reducing the incidences of falls and prevention of the associated harm. It has been recognized by the commission that falls are the largest harm-causing incident in the country for healthcare and is a national priority for quality and safety, as it is responsible for the fifth common cause of death in the older adults (Safetyandquality.gov.au 2016). Resources have been developed for reducing the incidence of falls that are experienced by the aged people and the associated harm endured. In 75% of the cases of hip fracture, the overall health deteriorates as the recovery is incomplete. According to WHO, about 28-35% of the aged population over the age of 65 years is becoming prone to falls by 32-42% every year and it is increasing worldwide. The average cost per fall in Australia per year is AUS$ 6500 and this causes serious repercussions on the lives of the friends and families of the patient as well (World Health Organization 2016). Several government bodies in Australia provide online support for management and prevention of falls for the carers, general practitioners, health professionals and the public. From these aspects, it can be stated that fall prevention is an important issue of healthcare that has to be considered and this assignment will explore the issue through relevant literature. The assignment will critique the searched articles and summarize the findings and synthesize them by the application of a critical appraisal tool.

A summary table has been framed for succinctly and accurately summarizing the relevant information from the searched research articles and represents the various parameters of critical analysis. The summary table has been provided below.

Table 1: Research Articles Summary Table

For critiquing the literature, CASP (Critical Appraisal Tools Program) tool was used for enquiring the study validity, investigation of the results and determination of the usefulness and relevance. The tool was implemented for appraising the articles and determining which was the rigorous and accurate study method and design (Nadelson & Nadelson 2014, pp.344-346). According to the study conducted by Haas and Haines (2014, pp.283-292), the study design was qualitative and the method implemented was making a move program which was an initiative for falls prevention including an educational and exercise program. The study conducted by Stephenson et al. (2015, p.113) was a quantitative study that was based on the intervention of patient and staff education. The study conducted by Church et al. (2012, pp.241-248) was qualitative and the applied method was Markov model of intervention which has been designed to prevent falls whereas the study conducted by Johansson et al. (2015, p.153) was a quantitative study and the falls prevention program was implemented that was client centered and multi disciplinary. The study conducted by Khong et al. (2015, p.1) was qualitative and the applied method was a two-stage constant comparative design. All these studies had different designs and methodologies for falls prevention among older adults. The study conducted by Stephenson et al. was limited to the patients of the hospital and did not consider the broader aspect of the community in fall prevention. The study conducted by Church et al. was a better attempt to provide cost effective fall preventions strategies but all the parameters were not appropriately verified for its implementation in the community. The study conducted by Haas and Haines had a small study sample which was not enough to determine the change in behavior in the entire community dwellers of older adults. The study conducted by Johansson et al. was individual dependant and the subjective experiences were found to vary. Therefore, the objective and subjective experiences were not measured which is essential for determining the efficacy of the program. Finally, the study conducted by Khong et al. was found to be the most rigorous of all as the peer educators are considered to possess the potential for effective delivery of the fall prevention education among the older adults of the community in two stages. The researchers conducted a thorough background study and found that 26% of the older adults receiving peer education on fall prevention have exhibited significant reduction in their falling risks. Some of the studies even revealed that after the uptake of actions for falls prevention, there was no significant reduction in the falls. The authors identified a gap in the relationship and role of the peer educators and their associated coordinating organization. Therefore, the authors took up the study for exploring the perspectives of a peer educators group regarding their role in delivering education on falls prevention that are peer led for the community dwelling adults. This study had the intention of preventing falls which was much interactive when compared to other studies as it involved peer led education.

Literature Critique

Study findings from the study of Stephenson et al. there was no differences which were statistically significant between the various settings which revealed that the fall rates remained unchanged despite the practice improvements whereas the study of Haas and Haines found that the participation and completion of the falls prevention program were inconsistent. The findings of the study by Johansson et al. stated that no statistical differences were observed between the two groups and the subjective experiences had limited effects whereas the study by Church et al. found that Tai Chi was the most cost-effective intervention for falls prevention. The findings from the study by Khong et al. stated that the development of an optimal peer connection is essential for educating the audience, considering the various factors. Therefore, on a comparative note, it can be said that the studies by Church et al. and Khong et al. had the findings that can be implemented in an effective and cost-effective manner in the community for falls prevention.

References

Australian Commission on Safety and Quality in Health Care 2009 , Guidebook for Preventing Falls and Harm from Falls in Older People , viewed 29^th  August 2016,

<https://www.safetyandquality.gov.au/search/fall#Guidebook-for-Preventing-Falls-and-Harm-from-Falls-in-Older>

Church, J., Goodall, S., Norman, R. and Haas, M., 2012, ' The costâ€Âeffectiveness of falls prevention interventions for older communityâ€Âdwelling Australians', Australian and New Zealand journal of public health, vol 36, no. 3 , pp.241-248.

Haas, R. and Haines, T.P., 2014, ' Twelve month follow up of a falls prevention program in older adults from diverse populations in Australia: A qualitative study' , Archives of gerontology and geriatrics, vol 58, no. 2 , pp.283-292.

Haines, T.P., Day, L., Hill, K.D., Clemson, L. and Finch, C., 2014, ' Better for others than for me: A belief that should shape our efforts to promote participation in falls prevention strategies' ,  Archives of gerontology and geriatrics, vol 59, no. 1, pp.136-144.

Johansson, E., Dahlberg, R., Jonsson, H. and Patomella, A.H., 2015, ' Does a Falls Prevention Program Impact Perceived Participation in Everyday Occupations? A Pilot Randomized Controlled Trial ' , OTJR: Occupation, Participation and Health,  p.153.

Khong, L., Farringdon, F., Hill, K.D. and Hill, A.M., 2015, ' We are all one together”: peer educators’ views about falls prevention education for community-dwelling older adults-a qualitative study ', BMC geriatrics, vol 15, no.1 , p.1.

Nadelson, S. and Nadelson, L.S., 2014, ' Evidenceâ€ÂBased Practice Article Reviews Using CASP Tools: A Method for Teaching EBP ',  Worldviews on Evidenceâ€ÂBased Nursing, vol 11, no.5 , pp.344-346.

Stephenson, M., Mcarthur, A., Giles, K., Lockwood, C., Aromataris, E. and Pearson, A., 2015,    ' Prevention of falls in acute hospital settings: a multi-site audit and best practice implementation project ', International Journal for Quality in Health Care, p.113.

World  Health  Organization  2016,  Falls Prevention in Older Age, viewed 29^th August 2016, <https://www.who.int/ageing/projects/falls_prevention_older_age/en/ >