Falls Intervention and Reduction in Elderly People

Falls Intervention and Reduction in Elderly People

Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research.



Full APA formatted citation of the selected article. Article #1 Article #2 Article #3 Article #4
Barban, F., Annicchiarico, R., Melideo, M., Federici, A., Lombardi, M. G., Giuli, S. & Chiusso, M. (2017). Reducing fall risk with combined motor and cognitive training in elderly fallers. Brain sciences7(2), 19.  https://doi.org/10.3390/brainsci7020019 Li, F., Harmer, P., & Fitzgerald, K. (2016). Implementing an evidence-based fall prevention intervention in senior community centres. American journal of public health106(11), 2026-2031. https://doi.org/10.2105/AJPH.2016.303386 Fahlström, G., Kamwendo, K., Forsberg, J., & Bodin, L. (2018). Fall prevention by nursing assistants among community‐living older adults. A randomized controlled trial. Scandinavian journal of caring sciences32(2), 575-585.



Seijo-Martinez, M., Cancela, J. M., Ayán, C., Varela, S., & Vila, H. (2016). Influence of cognitive impairment on fall risk among elderly nursing home residents. International psychogeriatric28(12), 1975-1987. DOI: https://doi.org/10.1017/S1041610216001113
Evidence Level *

(I, II, or III)


The evidence level of this article is II because even though it is evaluated and information acquired from reputable sources, the evidence used in this research is insufficient and more research is crucial to strengthen deworming evidence to result to mobility evidence. The article evidence is one and consist of up to date and relevant information. The information and search provided trustworthy, adequate and reliable evidence information that critically appraise the article for its reliability and application to make sure it is relevant to clinical use. It consists of experiments and meta-analysis, which makes the item evidence-based.


The evidence for this article is I because the information in this article is recent, up to date, and the data used is reviewed and acquired from well-known sources. The report has precise experiments, with meta-analysis and is systematically reviewed, providing evidence-based information.


This article evidence level is also 1 with information from recent, relevant, and up to date. The content of the article is evaluated and reviewed to make sure it within the required standards. The information available in the section is relevant, reviewed and experimental studies conducted to provide required meta-analysis information.


Conceptual Framework


Describe the theoretical basis for the study (If there is no one mentioned in the article, say that here). **


The theoretical basis of this research is a synthesis based on the concept of executive control. The investigations systematically review available analyses by revisiting a pool of knowledge about reducing fall risk among the elderly using the combination of motor and cognitive training among the elderly to increase their balance to reduce fall rates. The Intervention

Strategies that may arise to successful rehearsal in line with Cochrane systematic review process to avoid infections.

The theoretical basis of this article is combined with Boolean and Proximity operators to acquire the relevant results of reduced falling risk among the elderly. The article study implements evidence-based practice as an intervention measure among the elderly in the community.  The concept of interest was teaching nursing on how the requirements and context of EBP in their education and how they can apply this evidence information to reduce falls among the elderly. This literature review in this article used concepts that transform actual information into text and context which is useful in the search strategy to create an understanding of evidence-based practice when dealing with the elderly and their high risk of falling due to body weakness and lack of evidence. The conceptual framework for this article explains the chronic kidney disease to enhance assess to chronic immunosuppressive required for therapeutic help to improve long-living.  This article extracts information from evidence-based literature. The concept of this article is to explain the function of health care providers to prevent and reduce falls among older adults in the community. The .home based concept establishes the ability and possibility of avoiding falls using working home-based models of care. The theoretical analysis of this article is systematic reviews which are crucial to enhance improvement in the quality of nursing in practice (Seijo-Martinez et al., 2016). The research involved analysis in sustaining nursing activities. The healthcare institution reduces cognitive fall risk among the elderly to avoid the severity of cognitive impairment.


Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).

The study design of this research article was stratified, double-blind and controlled to randomly to make sure every participant was allowed to participate in the research. It involved a review of evidence-based and relevant literature systematically and used direct measures to review and directly investigate the impact of recent literature on the fall risks among the elderly. The combination of text and Medical Subject Headings was also used to evaluate the available evidence-based information. The design method used in this research article is active Intervention and post-intervention follow-up design. The systematic literature research for this article used Academic searches to collect required and relevant information. The evaluation of the evidence-based program is essential to make sure the intervention methods are crucial. The elderly in the community requires applicable and evidence care which makes sure they are safe and healthy. The information from different sources is used by healthcare providers’ adequate and individualized services to avoid falls among the elderly in the community. This article uses a randomized controlled trial study design method which explains how the study was done. The article reports using a systematic review of existing research to focus on kidney transplantation as measures to improve living quality for the patients. The design method for this study is a conceptual design which makes sure the home care program is crucial to help the elderly gain strengths through walking and standing to avoid fall. The systematic review of this article is essential to make sure the report focuses on preventing fall among the elderly in the home-based care setting. In this article, an integrative review study method that uses thematic synthesis. Qualitative and quantitative analysis of the researches and studies was done to deduct the information. The adoption of information is essential because it is then disseminated to others in the community.


The number and characteristics of

patients, attrition rate, etc.

A sample of 481 older adults at risk of falls was used for this article using a multicenter randomized trial. The effectiveness of a motor and non-motor treatment enhances cognitively among the elderly to make sure they have the cognitive ability to prevent falls. The sampling in this article also included observational, experimental studies with five cases used in these research articles. The sample consists of a small number of participants to make sure the targeted population of the elderly in the community is reached.  The participants included of community-dwelling older adults who were 65 years and above and have the physical mobility such as walking of small distance without assistance from the healthcare providers or family, and also the participants are were restricted to the elderly without severe cognitive deficits. The participants. The participants should have clearance to make sure they are fit enough to take part in the research process.


The sample size calculation was based on the assumption of Intervention that nurse should adopt to reduce the incidents of fall among the elderly by a 15% prevalence rate. The samples consist of 170 participants with 55& of the participants put in the controlled group to calculate the falling risk and 40& of participants in the intervention group. They have higher chances of experiencing more top risk fall. The sample consists of a total of 1167 nursing home residents as a sample for this research article. Their mean age is 81 years, and a percentage of 66 are women, and 34 are men (Seijo-Martinez, 2016). The participants experienced different levels of falls which can be mild, moderate and severe, causing various impairments.
Major Variables Studied


List and define dependent and independent variables.

The dependent and independent variables: are the cognitive and motor training instruction to make sure the elderly maintain strength and balance to avoid falling.


Independent Variables:  The independence variables for this research are small.

The dependent variables:

The population of participants assessed were the elderly in the community who were healthy enough to participate in the research.

Independent Variables: The  independent variables are satisfactory

The dependent variables: these are unsatisfactory factors that increases fall risks among the elderly in the home care setting.


The dependent variables were grouped into four domains: (1) demographic, medical, and medication risk; (2) moo and behavioural risk; (3) functional and motor risk; and (4) neuropsychological risk.

The independent variables in this research are predictors, and dependent variables are outcomes.




Identify primary statistics used to answer clinical questions (You need to list the actual tests done).

The measurement which confounds and linked to malnutrition is associated with high risk falls among the elderly. The measures show lack of follows up by the elderly in their training which hinders their ability to prevent fall. Training the elderly makes sure the elderly gains practical ability, strengths and balance to enhance motor and cogitative training among the elderly to avoid falls. This study suggests the effectiveness of motor treatment empowered by training in reducing the fear of falling. The method consists of six qualitative phases based on Braun and Clarke’s six phases to thematically analyses and critically appraise the research. The literature analysis conducted uses a deductive approach to clearly explain the implementation of evidence-based methods and procedures that are used to prevent falling and reduce the risk of falls among the elderly in the community. The narrative text explains the statistical that arises to acquire relevant information. The measurements in these articles are group-based interventions which train healthcare providers to be proactive and reactive in reducing falls among the population. The measurement consist of finding a balance and strength through slow walking among the elderly population to make sure the assessment is measurable and the information is in depended and collected over time. The measurement strategy is crucial to identify the fear of falling among the elderly. Measurements are essential for preventing fall in older people which results in health complications, and body fractures. Analysis of this article literature which was done between 2007-2009 in different regions among the community based elderly population who have experienced a fall in their lifetime. The measurement approach in this article is the statistical measurement produces clinical results.  The analytical results are sixty falls which are 34% of the NCI participants and a total of 417, which is 43% among the older people with cognitive impairments in the nursing home. Therefore, the elderly with a higher level of impairment experienced many falls. Also, the statistic shows that elderly with low functionality and mobility have a higher fall risk and prevalence.
Data Analysis Statistical or

Qualitative findings


(You need to enter the actual numbers determined by the statistical tests or qualitative data).

Statistical analysis: the data from the study shows that participants hardly competed for their training to enhance motor and cognitive abilities to maintain balance and prevent falls. The article review calculated descriptive statistics to get a percentage of the elderly who participated and completed or did not complete the training program. Multiple imputation analysis techniques were uses to test the hypothesis of the training among the elderly and its effectiveness. The data analysis enhances evaluation to provide the effectiveness of the training to reduce fall incidence rate among the elderly.


The PRISMA analysis identifies 46 community-based centres that are available for these articles to provide safe care services to the elderly using EBI to avoid falls. Ten care centres were eliminated because they were inadequate, remaining with 36 centres which were adopted for this research. Different articles were clearly screened before choosing this article which was analyzed in to make sure it focuses on different EPB teaching and practice strategies to enhance student knowledge and skills to make sure they are efficient and effective when preventing fall risks among the elderly. The research used criteria that involved qualitative and quantitative analyses and studies that were conducted and published in English in 2011 in a specific study area among the elderly. This was the original research which indicated research on evidence based-practice training for nurses in their nursing education. Statistical analysis:  This research article uses descriptive-analytical to compare data from the two groups of participants to summarize different factors that increase fall risks and various factors that can be used to reduce fall risk. The study analysis consists of cross-sectional surveys, s researches post-test researches were experimental. The data analysis for this article contains raw information that explains statistical analysis. The data analysis identifies fall risk in the elderly with or without cognitive impairment. English related articles were analyzed, which consisted of qualitative and quantitative information to achieve required results. Descriptive analysis for this article was done using a large number of participants with specific characteristics.
Findings and Recommendations


General findings and recommendations of the research

Findings from this research suggest that motor and cognitive treatment is useful to avoid and prevent falls among the elderly.  Motor and cognitive treatment train the elderly to achieve a balance and enough strength, which are crucial to prevent falls. The training focuses on functions that result in favourable morbidity to improve stability. Practice creates confidence and helps the elderly to avoid a situation that increases their chances of falling. Cognitive training concentrate son behaviours of the elderly that causes falling. It is crucial in solving such expressions and encouraging the elderly to adopt healthier and stronger practices that prevent falling. The studies were conducted using different criteria that had minimum restrictions to make sure there was a maximum reach to a large number of the elderly population. It was found out that the data was done through many methods of studies, and it mostly involved students. By so doing research and observation skills are instilled in the learners. The themes were discussed in details and ensured that the nursing students understood and related each of the items. They included interactive teaching strategies, clinically and interactive, integrated teaching strategies, learning outcomes and barriers. The implementation of evidence-based approaches to be active and well-maintained to make sure there were fewer cases of falls among the elderly. Findings in this article suggest that there is a greater need for health and care for the elderly in the community to reduce the fall among the elderly population. It is therefore essential for the person to seek immediate attention when they experience a fall because there may eventually require medical care in case of a fracture or therapy to reduce the effects of the fall.  The elderly in the community should adhere to exercise programs provided by the community health care nurses such as walking Intervention and increasing daily activities to intervene in strengthening the elderly to reduce the risk of falls.   The elderly should be provided with a quality healthy life to make sure there is health to reduce bodily pains which reduces fall risk.  Healthcare transition from home care setting to hospital healthcare setting is crucial to improve Intervention to reduce falls because the excellent health makes the body stronger to avoid falls. This has article has described the risk assessment models to identify the fall risk among the elderly may increase or decrease the prevalence risk of fall due to impairment leads to loss of efficiency, resulting from falling hazards. The elderly are prone to falling risk; hence medication helps to provide independence among the elderly and reduce fall risks. This research demonstrates factors and activities that help to reduce fall risks among the older adult population without and with cognitive impairment to identify the severity of the causes.
Appraisal and Study Quality



Describe the general worth of this research to practice.


What are the strengths and limitations of the study?


What are the risks associated with the implementation of the suggested practices or processes detailed in the research?


What is the feasibility of use in your practice?

The research provided high quality, reasonable and much-generalized research. The study gives better insight into the importance of cognitive and motor training to enhance strength and balance among the elderly to avoid falling. This part of the research was proved by continued follow-up, and high-quality assessment was done. Moreover, single and multiple training procedures were tested and used to determine that cognitive and motor training prevent falling. The research gave the best final results because there was the availability of data and publicity on this research. Being public meant that follow up would be easy and fast. This article was written in improved and high methodological quality, understanding the differences between the qualitative and quantitative methods. This research provided high and consistence quality. It was able to explain which teaching strategies were used to instil knowledge and skills in nursing students to be able to take care of the elderly in the community.  Some of the weaknesses this research faced were the illiteracy skills and the challenge of knowing too much or too little. Also, there was inadequate and irrelevant information available which was confusing when dealing with the elderly. The elderly are always ignored, and therefore, the research was crucial to make sure they are included in healthcare provision. This research article concentrates on the fall prevention program and how such prevention programs can be effectively and successfully implemented and integrated with the elderly communities to avoid fall risks.  There should be available information and flexibility to make sure the elderly requires adequate space and well-equipped home care settings to prevent falls. The study provided excellent quality and consistent results. The papers reviewed interventions that are used by healthcare providers to reduce falls among the elderly in the community. The elderly in the city with a higher rate of falling should be provided with steep measures that reduce the risk of falling by making sure they are healthy and robust enough to maintain a balance.  When these interventions were provided and adopted, there was a report of few and reduced falls among the elderly. The home-based programs of care results in positive changes because they increase balance among the elderly preventing falls.  Also, increased activities and exercises such as walking reduce fractures and health complication when an older person falls because their body is healthier to withstand the fall.  The healthcare providers enhance increased cautions when dealing with the elderly to reduce risk of falls.  This article explains that healthcare providers encourage the elderly to avoid situations that put them at risk of falling. The feasibility of this research article is adherence to the exercise routines by the elderly to achieve the set goal. This article was written in improved and high quality and is able to explain the theme issue on the fall risk among the elderly adult population in nursing home care. It also explains how to prevent the fall from making sure the elderly are safe. It has helped to find risk factors that increase chances of fall. The ill elderly population has resulted in an increased risk of fall. Although there was a lot of articles reviewed, only a few among them clearly showed how cognitive impairment is a risk factor for falls in the elderly while in a home care setting. The article has enough evidence that supports the risk of fall among the elderly, making this article valuable. It consists of enough evidence to support this conclusion which is a great advantage for this article.  The major disadvantage is that the research was done and based on the single locality where the study was done, and the sample used, which does not represent the entire elderly population.


Key findings




Throughout this research, the paucity of quantifiable evidence of something measures changes in falls is achieved. The training is, therefore, vital as it provides balancing because cognitive and motor training is a fundamental approach to reduce falls. More knowledge about cognitive and motor is required because it is known to lower the mortality rate among the elderly from fractures and health complications after falls. The elderly fall risks are clearly described based on the specific review questions that were asked. They arrived at a conclusion after reading and re-reading the issues asked that the elderly requires well maintained and spacious places of care with adequate healthcare professionals and equipment to prevent falls.  In the first phase, each healthcare providers should familiarize themselves with the research by carefully reading it. In the second phase, the first author carried out systematic and manual information which led to reduced falls. The third phase involved searching for adequate information which is applied to the care setting for the elderly. The fourth phase entailed the review of these phases, whereas the fifth phase ensured defining the steps. To be able to reach a final decision of preventing fall risks among the elderly in the community. This research article has clearly explained the measure that can be used to reduce and prevent the risk of falling among the elderly in the community.  Positive interventions contribute to greater caution, reports and measures to avoid falling.  The exercise and participating in more activities is an important measure described in this article to increase strength and balance, which is an excellent way to personal risks of falling.  Healthcare providers visit the elderly in the community to provide treatment in case of falls and also to provide measures to prevent falls.  Home-based exercise program reduces the risk of injuries and side effects that arises of the fall using the best prevention intervention strategies. The program is a workable model which is simple to adopt Many more articles were found out which are similar to this research. Also, the elderly face a memory risk which is associated with higher fall risk. Dementia is a risk factor. Therefore, each and every person must be responsible for making sure the elderly are taken care. It is hypocritical that most people don’t care about the elderly in society, which is one of the risks of factor that causes their health problems. The speed of the elderly is a risk factor, especially among those people with cognitive impairment who are unable to walk fast, or else they increase their fall risk.

This article defines different ways to prevent fall among the elderly by making sure the clinical professionalism charge monitor the population and make sure they are safe and well protected.







Finally, in this article, lack of recently collected data to inform an individual knowledge of motor and cognitive studies to show effectiveness as an intervention measure of reducing fall risks among the elderly. Effectiveness of cognitive and motor training focuses primarily on executive exercises to explain the importance of combining engine and cognitive treatment to maximize the results of reducing fall risks. In this article, students explained that through writing, they were able to understand the research process. This is by being able to choose the topics they had developed an interest. Through evaluation, analytical and increased awareness was identified. Through research, the learners were able to deeply understand the critical role of nursing in reducing the risk of fall among the elderly. Using the research and the system tools, there was an expansion of the study.  The significant outcomes from this research are the reduced number of falls among the elderly. The fall reduced every month over the period during which this research study was conducted. A fall, according to this article, is an intentional come to the ground, causing or not causing bodily harm.  Another outcome is health consumption from the health care providers, especially nurses, who provide home-based care to the elderly population in the community. There was increased health consumption among the elderly provided by nurses which reduced the falling risks. Health consumption increase strength, walking, increased activities and, strength among the elderly, which is the best way to cut a fall. In this article, the review shows different risk factors that increases fall risks among the elderly. The risks can be modified to make sure the elderly with functional dysfunction, which positively influences and decreases the probability and prevalence of falls among the elderly population.






Barban, F., Annicchiarico, R., Melideo, M., Federici, A., Lombardi, M. G., Giuli, S. & Chiusso, M. (2017). Reducing fall risk with combined motor and cognitive training in elderly fallers. Brain sciences7(2), 19.  https://doi.org/10.3390/brainsci7020019

Li, F., Harmer, P., & Fitzgerald, K. (2016). Implementing an evidence-based fall prevention intervention in senior community centres. American journal of public health106(11), 2026-2031. https://doi.org/10.2105/AJPH.2016.303386

Fahlström, G., Kamwendo, K., Forsberg, J., & Bodin, L. (2018). Fall prevention by nursing assistants among community‐living older adults. A randomized controlled trial. Scandinavian journal of caring sciences32(2), 575-585.


Seijo-Martinez, M., Cancela, J. M., Ayán, C., Varela, S., & Vila, H. (2016). Influence of cognitive impairment on fall risk among elderly nursing home residents. International psychogeriatrics28(12), 1975-1987. DOI: https://doi.org/10.1017/S1041610216001113

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