Page 210 - Encyclopedia of Nursing Research

FALLS n 177

interventions with sufficient research evi- Multifactorial interventions were devel-
dence to recommend their use. oped with the assumption that the more risks
In more than 30 years of research, envi- that are targeted, the greater the reduction F
ronmental, physical, and pharmacologic risk of falls. Most of these interventions address
factors for falls are well understood and have environmental and personal risk factors but
been used to design a comprehensive clini- often include exercise. Those with an exercise
cal assessment of fall risk. Clinically, this component were the most effective although
assessment is critical for identifying those not appreciably better than exercise alone
at risk for falls and targeting interventions. (Gillespie et al., 2009). Although most mul-
Comprehensive assessment interventions tifactorial interventions are not effective in
with clinical follow-up reduced the risk of the community (Gates et al., 2008; Gillespie
falls when direct care was provided but et al., 2009), they reduced falls by 27% in hos-
were not effective if the person was referred pitalized older adults (Cameron et al., 2010).
to their health care provider for follow-up In spite of this lack of research support, the
or provided information about falls (Gates, Centers for disease Control recommends that
Fisher, Cooke, Carter, & Lamb, 2008). community fall prevention programs include
risk factors for falls drove the devel- exercise, education, medication, visual assess-
opment of other interventions. reduction ment and management, and reduc tion of
of environmental hazards emerged first home hazards.
because of the many diverse hazards asso- Notwithstanding extensive falls
ciated with falls. On the basis of a meta- research, strong explanatory theoretical
analysis of studies in community-living models for fall prevention have not emerged.
older adults, a reduction of home environ- Clinically, comprehensive assessment for fall
mental hazards is not effective in reducing risk and targeted interventions are essential
falls or their risk (Gillespie et al., 2009). yet, to high-quality health care (Tinetti, 2008).
these hazards have been included in many The diversity of the single and multiple fall
multifactorial interventions. prevention programs with research evidence
recent Cochran reviews found that of their effectiveness provides challenges
exercise interventions reduced falls in com- to development of widely accepted and
munity-living older adults (Gillespie et al., standardized clinical protocols. Successful
2009), but not consistently in extended care implementation within specific types of clin-
facilities(Cameron et al., 2010). In a meta- ical settings requires quality control and
analysis of 44 randomized clinical trials supporting resources. Large-scale multisite
(Sherrington et al., 2008), exercise reduced falls translational research of well-developed and
by 17%, but walking had no significant effect. standardized fall prevention programs is
Moreover, exercise had a larger effect in pro- needed to determine the effectiveness, feasi-
grams with greater frequency and duration. bility, and cost-effectiveness as they would be
Exercise that challenged the balance control implemented in community and institution-
mechanisms had the largest effects. Tai chi ally based settings without stricter research
is an exercise that significantly challenges controls. The findings from this research are
motor skills and balance and has been found critical for health policy, public and private
to prevent falls and reduce fall risk (Gillespie funding, and insurance benefits that support
et al., 2009). In a large randomized clinical fall prevention programs and provide access
trial, tai chi significantly prevented falls and to older adults, whose numbers are expected
reduced their relative risk, even though clas- to increase significantly as the baby boomers
ses were only once a week and local instruc- move into older adulthood.
tors taught different styles (Voukelatos,
Cumming, Lord, & rissel, 2007). Beverly L. Roberts