1. Give a 3-4  lines detailed summary of the 6 articles attached . TOPIC: PREVENTION OF FALLS IN THE ELDERLY IN THE HEALTHCARE SETTING

1A. In 3-4 lines, Discuss one strength and one weakness for each of these six articles on why the article may or may not provide sufficient evidence for your practice change. (based on the practice change topic: PREVENTION OF FALLS IN THE ELDERLY IN THE HEALTHCARE SETTING)

2. A.Name two different methods for evaluating evidence. B.Compare and contrast these two methods.

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Independent Nurse: Professional – Fall prevention – Reducing
falls among the elderly
Author: Sarah Wild
Date: June 17, 2005
From: GP
Publisher: Haymarket Media Group
Document Type: Article
Length: 1,539 words

Full Text:
A new intergenerational approach is encouraging older people to overcome their fear and talk about falls, writes Sarah Wild.

An elderly person dies every five hours in the UK as a result of falling, and statistics show that a third of people over the age of 65 fall
at least once a year.

In addition to the pain and suffering experienced by these patients, it puts a heavy burden on hospitals and emergency services,
costing the NHS three times the budget allocated for primary care, mental health and CHD combined.

Positive steps to reduce the number of falls have, however, been taken by proactive organisations such as Northumberland Care
Trust, one of 21 sites selected to take part in a one-year programme co-ordinated by the National Falls Collaborative.

Innovative ideas

This has led to the development of some imaginative schemes that are designed to reduce falls in Northumberland by 30 per cent.
Other goals set by the trust in 2003 included creating a falls register and increasing the number of elderly people who receive a
personal and environmental risk assessment.

In response to these targets, falls registers have been implemented in four GP practices involved in the programme and a risk
assessment screening tool tried out in A&E, the community and by individuals.

Falls prevention cards (pocket-sized checklists) have been circulated to home carers across Northumberland, and educational
sessions offered to care home staff, for example ‘podiatry upskilling’ and ‘low-vision training’.

In addition

Applied Nursing Research 57 (2021) 151392

Available online 26 November 2020
0897-1897/© 2020 Elsevier Inc. All rights reserved.

Promoting older adult fall prevention education and awareness in a
community setting: A nurse-led intervention☆

Tiffani Chidume, DNP, RN, CCRN, CHSE *

Auburn University School of Nursing, United States of America


Fall prevention
Older adult
Fall awareness
Fall safety
Fall education


Background and objectives: Falls are costly and one of the most expensive medical conditions to treat. The
implementation of fall prevention toolkits (FPTs), such as fall risk screenings and fall prevention education (FPE),
have become progressively important in reducing fall incidences. Nurses have a greater role and responsibility to
care for the aging population. The purpose of this project was to implement a FPT to adults age 65 and older that
attended mobile IPE community clinics.
Research design and methods: This project used quantitative pretest-posttests and an open-ended participant
feedback survey. The Missouri Alliance for Home Care 10-question survey and components of the CDC’s Stopping
Elderly Accidents, Deaths, and Injuries (STEADI) FPE were used to assess and educate participants on fall risks
and fall prevention. An initial baseline fall assessment and fall education score was obtained at the mobile IPE
clinics. Follow-up assessments occurred one month after the initial assessment and compared to the initial fall
assessment and fall education scores with an additional open-ended participant survey.
Results: In both fall risk assessment tools, lower scores indicated a lower fall risk; both fall risk assessment tool
mean scores decreased over the one-month period.
Discussion and implications: Future FPE implementation projects should consider providing needed resources the
participants may need so there is no delay in increasing fall prevention and safety measures. The follow-up time
period should also be increased to fortify FPE and keep participants engaged in fall prevention safety.

1. Identification of the problem

“I’ve fallen and I can’t get up,” a memorable quote from a 1989 Life
Alert commercial, is still recited with updated versions being aired daily.
Though used to promote various emergency medical alert devices, it also
highlights the dangers and incidence of falls in the older population.
Bergen et al. (2016) reported one in four older adults, ages 65 and older,
fall each year. In 2017, unintentional falls in persons age 65 and older
were the leading cause of nonfatal injuries in the United States (US),
accounting for 63.3% of the total number of unintentional falls (National
Center for Injury Prevention and Control (NCIPC), 2017a). For the same
time period and population, falls were the most co

Age and Ageing 2006; 35-S2: ii65–ii68 © The Author 2006. Published by Oxford University Press on behalf of the British Geriatrics Society.
doi:10.1093/ageing/afl083 All rights reserved. For Permissions, please email: [email protected]


The role of medical assessment and intervention
in the prevention of falls

Department of Health Care of the Elderly, King’s College School of Medicine, London, UK

Address correspondence to: C. G. Swift. Email: [email protected]


Evidence that falls amongst older people can be prevented now requires researchers and policy makers to elucidate the most
comprehensive and cost-effective approach to implementation. The syndrome of falls and fractures in later life ref lects the
combined age-associated influences of cumulative susceptibility to health problems and reduced adaptive reserve. The major
contribution of health factors to falling has long been recognised clinically and has also emerged clearly in epidemiological
studies of risk. A fall in an older adult, especially if recurrent, may be a key signal of unmet medical need and should accord-
ingly trigger an in-depth diagnostic process and clinical intervention by an appropriately skilled physician. Although well-
designed controlled studies specifying this approach as part of a multifactorial intervention are comparatively few, recent
published trials have conf irmed the anticipated substantial returns in fall prevention achieved for community-dwelling
patients with a history of falling. Larger-scale studies are now required, and further research is needed to achieve effective
prevention strategies in institutional care. Combined calcium and vitamin D may act via neuromuscular and skeletal mecha-
nisms in fracture prevention. The requirement for medical assessment has now appropriately been incorporated into national
and international guidelines.

Keywords: fall prevention, diagnosis, medical assessment, controlled studies, calcium and vitamin D


The strength of evidence that falls in later life can be pre-
vented has grown to the point where it can no longer be
ignored by health policy makers and providers. Across a
wide range of controlled intervention studies, the most
compelling results have been obtained from the application
of a multifactorial approach to those at high risk of falling
[1]. Consequently, organised health service delivery initia-
tives to deal with this major public health issue amongst
older people are now strongly indicated. Inevitably, there is
disparity in the range of service models being proposed, and



Virtual Reality Rehabilitation and Exergames—Physical and
Psychological Impact on Fall Prevention among the
Elderly—A Literature Review

Joanna Piech 1,2,* and Krzysztof Czernicki 2


Citation: Piech, J.; Czernicki, K.

Virtual Reality Rehabilitation and

Exergames—Physical and

Psychological Impact on Fall

Prevention among the Elderly—A

Literature Review. Appl. Sci. 2021, 11,

4098. https://doi.org/10.3390/


Academic Editors: Youngho Lee and

Elena Amaricai

Received: 24 March 2021

Accepted: 27 April 2021

Published: 30 April 2021

Publisher’s Note: MDPI stays neutral

with regard to jurisdictional claims in

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Copyright: © 2021 by the authors.

Licensee MDPI, Basel, Switzerland.

This article is an open access article

distributed under the terms and

conditions of the Creative Commons

Attribution (CC BY) license (https://



1 Faculty of Health Sciences, Jagiellonian University Medical College, 33-332 Krakow, Poland
2 Department of Rehabilitation, Lesser Poland Orthopedic and Rehabilitation Hospital, 30-224 Krakow, Poland;

kczern[email protected]
* Correspondence: [email protected]

Abstract: The present review is aimed at the effectiveness of virtual reality (VR) and exergames in the
prevention of falls among the elderly. Falls become a significant problem in the aging population and
lead to psychological, social, and physical impairment. Prevention of falls is crucial to the well-being
of the elderly population and is one of the challenges of contemporary rehabilitation. Recently, in
view of the threat of the SARS-CoV-2 pandemic, contactless methods of rehabilitation, including
telerehabilitation, appear as valuable rehabilitation tools. This review is based on the PRISMA
guidelines and was carried out in five databases: PubMed, Medline, Web of Science, Scopus, and
PEDro. Twenty-one randomized controlled trials, focused on the application of VR and exergames in
the prevention of falls, were included. This review suggests that VR training in rehabilitation appears
to be a promising complement to traditional techniques of physiotherapy to improve specific physical
outcomes. VR and exergames could be considered as a complement of standard physiotherapy and
its possible continuation at home for elderly. However, further high-quality studies, with carefully
designed protocols and proper b

주요어: 허약노인, 낙상, 교육, 운동, 근력
이 논문은 제1저자 홍차화의 2019년도 석사학위논문을 수정하여 작성한 것임.

This manuscript is a revision of the first author’s master’s thesis from Pusan National University. Year of 2019.

Address reprint requests to : Lee, Haejung

College of Nursing, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan 50612, Korea

Tel: +82-51-510-8344 Fax: +82-51-510-8308 E-mail: [email protected]

Received: August 20, 2020 Revised: January 11, 2021 Accepted: March 8, 2021 Published online April 30, 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0)

If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

70세 이상 시설거주 허약노인의 낙상예방을 위한 교육단독중재와
교육운동복합중재 효과 비교


· 이해정

· 이미순

부산대학교 간호대학,

창신대학교 간호학과

Comparison of the Effects of Education Only and Exercise Training Combined with Education on
Fall Prevention in Adults Aged 70 Years or Older Residing in Elderly Residential Facilities

Hong, Chahwa
· Lee, Haejung

· Lee, Misoon


College of Nursing, Pusan National University, Yangsan

Department of Nursing, Changshin University, Changwon, Korea

Purpose: To compare the effects of education only and exercise training combined with education on fall knowledge, fall efficacy, physical ac-

tivity, and physical function in adults aged 70 years or older residing in elderly residential facilities. Method: A three-group pre- and post-

test design was utilized: education only (EO; n = 23), education and TheraBand (ET; n = 22), and education and walking (EW; n = 22).

Fall education was provided for all three groups. In addition, TheraBand exercise training was provided for the ET and a walking exercise

for the EW. Data were collected from November 1st, 2017 to February 15th, 2019 and analyzed with χ2 test, paired t-test, and one-way
ANOVA using IBM SPSS/WIN ver. 22.0. Results: Compared with the EO, the ET and the EW were more effective in terms of fall efficacy,

physical activity, and lower extremity muscle strength. The EW showed higher improvement in walking abilities than the EO and the ET.

Conclusion: Exercise training combined with education is more effective in preventing falls among community-dwelling adults aged 70

years or older. When considering fall prevention programs for older adults, both TheraBand and walking exercise training combined with

education can be chosen based on the participant’s physical status. Aggressive strategies to impro


Role of physical activity in the prevention of falls
and their consequences in the elderly

Catarina L. N. Pereira & Peter Vogelaere &
Fátima Baptista

Received: 30 July 2007 /Accepted: 14 January 2008 /Published online: 23 February 2008
# EGREPA 2008

Abstract This work aims to provide an inventory of the risk
factors and consequences of falling in the elderly, namely
fractures, and to identify strategies to prevent falls and
minimise their effects. Falls in elderly people are a major
cause of injuries, leading to a general fear of falling, poorer
quality of life and even death. The increase in life expectancy
brought by developments in the medical and health sciences
has not always brought enhanced quality of life. More elderly
people live with reduced functional capacities resulting in a
higher prevalence of falls and associated problems for
themselves and for society. Risk factors for falling, commonly
resulting from normal aging processes, have already been
identified through multiple studies. Exercise may play an
important role in fall prevention and their consequences.
Although, effective strategies are usually multi-disciplinary
and focus simultaneously on several risk factors. However,
only large-scale prevention programmes can have significant
effective social impact. To minimise occurrence and con-
sequences of falls, policies to systematically implement
prevention programmes should be established.

Keywords Falls . Risk factors for falling . Elderly.

Fractures . Physical activity

Problems of falls

Falls are a major health problem among the elderly. Thirty
percent of people aged 65 and older living in community fall
at least once a year [127], and this rate increases with age
[108]. As life expectancy increases, there is a higher number
of less healthy and less fit elderly people living longer with
their infirmities [46, 89, 107]. Consequently, the risk of falls
and their consequences is now greater than before [78, 129],
as is illustrated by statistics from Finland [75].

Falls are the major cause of death related to mechanical
injuries in the elderly, and the mortality rate increases when
the individual fall rate increases [41, 45, 112]. According to
Rubenstein et al. [119], about 4% of falls result in fractures
and about 11% result in other serious injuries such as head
trauma, soft tissue injuries and severe lacerations. Those
who survive falling commonly restrict their activities due to
soft tissue injuries and fractures [15, 80]. Besides injuries
and more evident physical consequences, psychological
consequences must also be considered: the fear of falling
leads to a large percentage of the elderly individuals
restricting their activities [22, 48, 130, 137]. Both of these
reasons for loss of functionality can result in the “post-fall
anxiety syndrome.” Less confidence in the ability to w