Research Questions (Qualitative)/Hypothesis (Quantitative)
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|3: Satisfactory (79.00%)
|4: Good (89.00%)
|5: Excellent (100.00%)
|Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article
|Author, journal (peer-reviewed), and permalink or working link to access article section is not included.
|Author, journal (peer-reviewed), and permalink or working link to access article section is present, but it lacks detail or is incomplete.
|Author, journal (peer-reviewed), and permalink or working link to access article section is present.
|Author, journal (peer-reviewed), and permalink or working link to access article section is clearly provided and well developed.
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|Article Title and Year Published
|Article title and year published section is not included.
|Article title and year published section is present, but it lacks detail or is incomplete.
|Article title and year published section is present.
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|Research Questions (Qualitative) or Hypothesis (Quantitative), and Purposes or Aim of Study
|Research questions (qualitative) or hypothesis (quantitative), and purposes or aim of study section is not included.
|Research questions (qualitative) or hypothesis (quantitative), and purposes or aim of study section is present, but it lacks detail or is incomplete.
|Research questions (qualitative) or hypothesis (quantitative), and purposes or aim of study section is present.
|Research questions (qualitative) or hypothesis (quantitative), and purposes or aim of study section is clearly provided and well developed.
|Research questions (qualitative) or hypothesis (quantitative), and purposes or aim of study section is comprehensive and thoroughly developed with supporting details.
|Design (Type of Quantitative, or Type of Qualitative)
|Design (type of quantitative, or type of qualitative) section is not included.
|Design (type of quantitative, or type of qualitative) section is present, but it lacks detai
Cent Eur J Nurs Midw 2018;9(2):832–839
© 2018 Central European Journal of Nursing and Midwifery 832
PHARMACOTHERAPY AS A FALL RISK FACTOR
Ivana Bóriková, Martina Tomagová, Katarína Žiaková, Michaela Miertová
Department of Nursing, Jessenius Faculty of Medicine in Martin, Commenius University in Bratislava, Slovakia
Received October 6, 2017; Accepted March 3, 2018. Copyright: This is an open access article distributed under the terms of the Creative
Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/
Aim: To determine the correlation between pharmacotherapy and high risk of fall based on the Morse Fall Scale (MFS score
≥ 45) in acute and long-term care settings. Design: A quantitative cross-sectional descriptive correlation study. Methods: The
study was conducted at a University Hospital in Martin (UHM) and a selected long-term care facility (LTC) in Martin
(Slovakia) June–October 2016. The pharmacotherapeutic data were obtained from the health documentation of the
respondents. The fall risk was assessed by using the MFS screening tool within 24–48 hours of admission to the facility.
Results: For the group of UHM patients (n = 63), the mean MFS score for fall risk was high (60.6 ± 22.4), and the correlation
(p = 0.030) between the number of medications administered in 24 hours and high risk of fall was significant. For the group o f
LTC patients (n = 89), the mean MFS score for fall risk was moderate (35.4 ± 15.9). The correlations were not significant.
Conclusion: Pharmacotherapy is an important fall risk factor; therefore, it is necessary to determine it within the assessment of
overall fall risk. The risk management of pharmacotherapy is an effective and important multifactorial intervention in
programmes of fall prevention in acute and long-term care.
Keywords: fall, hospital, long-term care, Morse Fall Scale, pharmacotherapy, screening, senior.
According to the Joint Commission Centre for
Transforming Healthcare, an analysis of falls with
injury reveals several common factors that increase
the number of falls, including, among others,
inadequate assessment of risk by patients (Joint
Commission, 2015). It is the assessment and
identification of individual amenable fall risk factors
that facilitates selection and implementation
of preventive interventions, significantly reducing the
Characteristics and fall experiences of older adults with and without fear of falling
Tracy Chippendale and Chang Dae Lee
Department of Occupational Therapy, New York University, Steinhardt School of Culture, Education, and Human Development, New York, NY, USA
Received 15 November 2016
Accepted 17 March 2017
Objective: Using a theoretical model that combines an ecological perspective and Bandura’s theory of
self-efficacy as a guide, we sought to compare experiences and characteristics of community dwelling
older adults with and without concern about falling outdoors.
Method: A survey of randomly selected community dwelling older adults across NYC (N = 120) was
conducted using the outdoor falls questionnaire. Descriptive quantitative analyses of participant
characteristics were conducted for all participants and for those with and without concern about
falling outside. Conventional content analysis using two coders was employed to examine outdoor
fall experiences for each group. A mixed methods matrix was used to integrate qualitative and
Results: Some participant characteristics were more common among those with a concern about
falling outside such as decreased functional status, female gender, and number of prior outdoor falls.
As per descriptions of outdoor fall experiences, participants with concern were more likely to report a
fall while climbing stairs or stepping up a curb, describe an intrinsic factor as a cause of their fall, use
an injury prevention strategy during the fall, sustain a moderate to severe injury, seek medical
attention, have had an ambulance called, require help to get up, and describe implementation of a
behavioral change after the fall.
Conclusions: Differences exist in participant characteristics and outdoor fall experiences of those with
and without concern about falling outside. The proposed model can be used to understand fear of
falling outdoors and can help to inform the target population and content of intervention programs.
Fear of falling; outdoor falls;
Falls are a significant public health concern due to their high
prevalence rates and serious consequences for the health and
well-being of older adults (Center for Disease Control, 2016).
Although risk of falls increases with age, there is evidence to
suggest adults in late mid-life are also at risk (Verma, Willetts,
Marucci-Wellman, Lombardi, & Courtney, 2016). Outdoor falls
are just as common as indoor falls and are just as likely to
result in serious injuries. However, they are associated with
different risk factors. Examples of risk factors for indoor falls
include slow gait speed, impaired balance and strength,
impaired cognition, multiple medication, and limitation in
activities of daily living to name a few. Conversely, male gen-
der, younger age, having a fast g
Manual Therapy, Posturology & Rehabilitation Journal. ISSN 2236-5435. Copyright © 2017. This is an Open Access article
distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-
commercial use, distribution, and reproduction in any medium provided article is properly cited.
PHYSICAL ACTIVITY LEVEL, FUNCTIONAL MOBILITY AND FALL
RISK IN THE ELDERLY
Raesa Andrade da Silva1, Glaudson Sá Brandão2, Anderson Soares Silva3, Jessica Julioti Urbano3,
Ezequiel Fernandes de Oliveira3, Luis Vicente Franco Oliveira3, Aquiles Assunção Camelier4,5, Glauber Sá Brandão1,4.
Introduction: Low levels of physical activity and functional mobility lead to greater difficulty in performing activities of daily living
and are directly proportional to mortality in the elderly. Thus, there are the need to create mechanisms linked to the maintenance of
the functional capacity, which assure the elderly autonomy and self-confidence. Objective: To verify the level of physical activity and
functional mobility in the elderly and if this functional mobility suffers interference of the age group and physical activity. Methods: The
study involved the elderly aged 60 and over, living in Senhor do Bonfim (BA), in the northeastern region of Brazil, from February to July
2015. The evaluation of the subjects occurred in a single session, with physical and general clinical evaluation, as well as the collection of
sociodemographic, anthropometric and self-reported morbidities through the application of questionnaires. It was also carried out the
Timed Up and Go test (TUG) to verify the levels of functional mobility and level of physical activity with application of the International
Questionnaire of Physical Activity (IPAQ) adapted for the elderly. Results: In this study, 127 patients were studied, predominantly
female (87%) and mean age of 68 ± 7 years, and the majority of the elderly corresponded to the age group of 60 to 69 years. The elderly
belonging to the group considered inactive (IPAQ up to 150 min/weekly) presented the execution time of TUG higher than the elderly in
the group considered active (IPAQ > 150 min/weekly), with averaging time for carrying out the test of 10.5±2 minutes and 8.9±2 minutes
respectively, with a statistically significant difference of p<0.01. And the execution time of TUG increased proportionally to the increase
of the age group. Conclusion: Elderly with lower level of physical activity and belonging to the higher age groups present a higher risk of
falls. Strategies should be developed to stimulate increased physical activity level and functional mobility of this population, especially
among the older ones, reducing the incidence of falls and providing greater autonomy.
Keywords: motor activity, accidental falls, aged.
Corresponding Author: Glauber Sá Brandão. Rua Visco
Falls resulting in health care among older people with
intellectual disability in comparison with the general
A. Axmon,1,2 G. Ahlström2 & M. Sandberg2
1 Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University,
2 Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
Background Falls are common among older people
with intellectual disability (ID) and are also a major
contributor to injuries in this population. Yet, fall
characteristics have only been sparsely studied, and
the results are inconsistent. The aim of the present
study was to investigate type of falls, places where
they occurred and activities that caused them, as
well as health outcomes and health utilisation
patterns after falls, among older people with ID in
comparison with their age peers in the general
Methods We established an administrative cohort
of people with ID aged 55 years, or more, and alive
at the end of 2012 (ID cohort; n = 7936). A cohort
from the general population, one-to-one matched by
sex and year of birth, was used as referents. Data
regarding fall-induced health care episodes in inpa-
tient and outpatient specialist care were collected
from the National Patient Register for the period
Results With the exception of falls from one level to
another (i.e. fall on and from stairs and steps, ladder
and scaffolding; fall from, out of or through building
or structure; fall from tree or cliff and diving or
jumping into water; or other fall from one level to
another), people in the ID cohort were more likely to
fall and fall more often than those in the general
population cohort. Falls during a vital activity
(e.g. attending to personal hygiene or eating) were
twice as common among people with ID compared
with the general population. When falling, people
with ID were more likely to injure their head and legs
but less likely to sustain injuries to the thorax and
elbow/forearm. They were more likely to have super-
ficial injuries, open wounds and fractures but less
likely to have dislocations, sprain and strains.
Fall-related health care visits among people with ID
were more likely to be in inpatient care and be
unplanned. People with ID were also more likely than
those in the general population to have a readmission
within 30 days.
Conclusions People with ID are more likely to require
specialist care after a fall and also more likely to obtain
injuries to the head, compared with the general
population. This is important to consider when taking
preventive measures to reduce falls and fall-related
Keywords accidental falls, fractures, health services
research, intellectual disability, older adults, wounds
Correspondence: Anna Axmon, Division of Occupational and
Factors associated with falls in older adults with cancer: a validated
model from the Cancer and Aging Research Group
Tanya M. Wildes1 & Ronald J. Maggiore2 & William P. Tew3 & David Smith4 & Can-Lan Sun4 & Harvey Cohen5 &
Supriya G. Mohile2 & Ajeet Gajra6 & Heidi D. Klepin7 & Cynthia Owusu8 & Cary P. Gross9 & Hyman Muss10 &
Andrew Chapman11 & Stuart M. Lichtman3 & Vani Katheria4 & Arti Hurria4 & On behalf of the Cancer and Aging Research
Received: 16 January 2018 /Accepted: 13 April 2018 /Published online: 28 April 2018
# Springer-Verlag GmbH Germany, part of Springer Nature 2018
Background Falls in older adults with cancer are common, yet factors associated with fall-risk are not well-defined and may
differ from the general geriatric population. This study aims to develop and validate a model of factors associated with prior falls
among older adults with cancer.
Methods In this cross-sectional secondary analysis, two cohorts of patients aged ≥ 65 with cancer were examined to develop and
validate a model of factors associated with falls in the prior 6 months. Potential independent variables, including demographic
and laboratory data and a geriatric assessment (encompassing comorbidities, functional status, physical performance, medica-
tions, and psychosocial status), were identified. A multivariate model was developed in the derivation cohort using an exhaustive
modeling approach. The model selected for validation offered a low Akaike Information Criteria value and included dichoto-
mized variables for ease of clinical use. This model was then applied in the validation cohort.
Results The development cohort (N = 498) had a mean age of 73 (range 65–91). Nearly one-fifth (18.2%) reported a fall in the
prior 6 months. The selected model comprised nine variables involving functional status, objective physical performance,
depression, medications, and renal function. The AUC of the model was 0.72 (95% confidence intervals 0.65–0.78). In the
validation cohort (N = 250), the prevalence of prior falls was 23.6%. The AUC of the model in the validation cohort was 0.62
(95% confidence intervals 0.51–0.71).
Conclusion In this study, we developed and validated a model of factors associated with prior falls in older adults with cancer.
Future study is needed to examine the utility of such a model in prospectively predicting incident falls.
Keywords Neoplasms . Geriatric assessment . Accidental falls . Polypharmacy . Activities of daily living
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s00520-018-4212-3) contains supplementary
material, which is available to authorized users.
* Tanya M. Wildes
Translating a Functional Exercise Program for Fall Prevention
Among Diverse Older Adults in Urban Medically Underserved Areas:
A Mixed Methods Study
Yi-Ling Hu, Marian Keglovits, Emily Somerville, Makenna Snyder, and Susan Stark
The Lifestyle-integrated Functional Exercise Program (LiFE) is proven to have high adherence rates and can significantly reduce
falls, but it has not yet been implemented for diverse older adults residing in urban medically underserved (MU) areas. An
exploratory sequential mixed methods study was conducted to adapt LiFE and test the adapted program’s preliminary feasibility.
Focus groups with MU older adults and service providers were conducted to identify modifications. The new adapted program,
Diverse Older Adults Doing LiFE (DO LiFE), was then evaluated with older adults. Thematic analysis revealed health literacy
and lack of racial representation as barriers to implementing LIFE in this population. The pilot study showed that DO LiFE was
feasible with good retention (89%) and high adherence (81.27%) rates. DO LiFE demonstrated preliminary feasibility for diverse
MU older adults. Researchers should proceed to larger studies for translating DO LiFE from research to the community.
Keywords: habit formation, translational research, vulnerable population
Falls among older adults are a serious public health problem.
In 2014, falls caused seven million injuries, more than 27,000
deaths, and cost Medicare $50 billion (Bergen, 2016). Given these
severe consequences, a variety of fall prevention interventions have
been developed for community-dwelling older adults (Gillespie
et al., 2012; Moreland et al., 2003). Cumulative evidence in
systematic reviews indicates that exercise interventions that
address poor balance and decreased muscle strength are among
the most efficacious types of interventions to reduce falls (Chase,
Mann, Wasek, & Arbesman, 2012; Gillespie et al., 2012; Moreland
et al., 2003; Sherrington et al., 2019; Stevens & Burns, 2015). A
Cochrane review conducted by Gillespie et al. (2012) found that
group-based, structured exercise interventions could significantly
reduce the rate of falls (rate ratio [RaR]: 0.68–0.71) and the risk of
falling (risk ratio [RR]: 0.78–0.85). This strong evidence has driven
the American and British Geriatrics Societies to incorporate exer-
cise intervention into their clinical practice guidelines for fall
prevention (Panel on Prevention of Falls in Older Persons &
Society, 2011). For dissemination and implementation of fall
prevention programs, the Centers for Disease Control and Preven-
tion (CDC) also provides a list of evidence-based exercise
programs for healthcare providers to use in clinical practice and
community settings (Centers for Disease Control and Prevention,
2015; Houry, Florence, Baldwin, Stevens, & McClure, 2016).
Among the evidence-based programs, structured exercise pro-
RESEARCH Open Access
‘Around the edges’: using behaviour
change techniques to characterise a
multilevel implementation strategy for a
fall prevention programme
S. McHugh1* , C. Sinnott2, E. Racine1, S. Timmons3, M. Byrne4 and P. M. Kearney1
Background: Implementation strategies are needed to ensure that evidence-based healthcare interventions are
adopted successfully. However, strategies are generally poorly described and those used in everyday practice are
seldom reported formally or fully understood. Characterising the active ingredients of existing strategies is
necessary to test and refine implementation. We examined whether an implementation strategy, delivered across
multiple settings targeting different stakeholders to support a fall prevention programme, could be characterised
using the Behaviour Change Technique (BCT) Taxonomy.
Methods: Data sources included project plans, promotional material, interviews with a purposive sample of
stakeholders involved in the strategy’s design and delivery and observations of staff training and information
meetings. Data were analysed using TIDieR to describe the strategy and determine the levels at which it operated
(organisational, professional, patient). The BCT Taxonomy identified BCTs which were mapped to intervention
functions. Data were coded by three researchers and finalised through consensus.
Results: We analysed 22 documents, 6 interviews and 4 observation sessions. Overall, 21 out a possible 93 BCTs
were identified across the three levels. At an organisational level, identifiable techniques tended to be broadly
defined; the most common BCT was restructuring the social environment. While some activities were intended to
encourage implementation, they did not have an immediate behavioural target and could not be coded using
The largest number and variety of BCTs were used at the professional level to target the multidisciplinary teams
delivering the programme and professionals referring to the programme. The main BCTs targeting the
multidisciplinary team were instruction on how to perform the (assessment) behaviour and demonstration of
(assessment) behaviour; the main BCT targeting referrers was adding objects to the environment. At the patient level,
few BCTs were used to target attendance.
Conclusion: In this study, several behaviour change techniques were evident at the individual professional level;
however, fewer techniques were identifiable at an organisational level. The BCT Taxonomy was useful for describing
components of a multilevel implementation strategy that specifically target behaviour change. To fully and
completely describe an implementation strategy, including components that involve organisational or systems level
change, other frameworks may be needed.
Keywords: Implementation, Intervention content, Behaviour change, Fall prevention, Qualitative
Objective: Analysis of risk factors for falls through a detailed geriatric evaluation is essential. The aim of the present study was to analyze prognostic
factors for falls in elderly patients in Spain.
Materials and Methods: a) Initial phase (n=247): transverse observational study. Inclusion criteria: patients >80 years old living alone and/or with a
relative of similar age; b) Final phase (n=90): prospective cohort study of the previously enrolled patients. Variables analyzed included demographics;
clinical characteristics and results of timed up and go (TUG) (mobility assessment) and Lobo (cognitive assessment) tests; Lawton-Brody Instrumental
Activities of Daily Living scale and Barthel index (basic activities).
Results: Falls were significantly associated with changes in Lobo and Barthel test results during both phases. No association was found between falls
and comorbidities, number or type of treatment received and analytical variables studied. No statistical difference was observed in TUG test between
fallers and non-fallers in the initial phase. A significant deterioration was observed in Lobo, Lawton-Brody, Barthel and TUG evaluation tests during
the 4-year in between-period; male gender and a lower score in Lobo test were independent variables related to mortality. In the final phase, a TUG
cut-off value of 25 seconds (sensitivity=0.52; specificity=0.75), that differentiated fallers from non-fallers, was established.
Conclusion: Tests that evaluate cognitive ability and functional activities are predictors of falls in the elderly. The use of Lobo test to define the
cognitive state of elderly patients may contribute to predict their vital prognoses.
Keywords: Elderly, fall, risk of fall, time get up and go test, Lobo test, Lawton-Brody test, Barthel test
Functional Evaluation Tests as Prognostic Factors of Falls in
Eur J Geriatr Gerontol 2019;1(3):78-86
Javier Benítez1, Juan Manuel Ignacio1, Sofía Perea3, José Antonio Girón2
1La Laguna Health Center, Department of Internal Medicine, Cádiz, Spain
2Puerta del Mar University Hospital, Clinic of Internal Medicine, Cádiz, Spain
3Beth Israel Deaconess Medical Center, Department of Medicine, Boston/MA, USA
Falls in elderly patients are a daily concern that occurs in
almost half of them, with a wide range of consequences and
whose importance is not recognized neither by themselves, nor
their relatives, nor health professionals (1,2). They are seldom
accidental, but rather the result of an inadequacy between the
senior and his/her surroundings; hence the unawareness of the
risk factors associated with the falls contributes to an increase
in their incidence (3).
Extrinsic (environmental) as well as intrinsic (clinical factors)
In nursing practice, accurate identification and application of research is essential to achieving successful outcomes. The ability to articulate research data and summarize relevant content supports the student’s ability to further develop and synthesize the assignments that constitute the components of the capstone project.
The assignment will be used to develop a written implementation plan.
For this assignment, provide a synopsis of the review of the research literature. Using the “Literature Evaluation Table,” determine the level and strength of the evidence for each of the eight research articles you have selected. The articles should be current (within the last 5 years) and closely relate to the PICOT question developed earlier in this course. The articles may include quantitative research, descriptive analyses, longitudinal studies, or meta-analysis articles. A systematic review may be used to provide background information for the purpose or problem identified in the proposed capstone project.
While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
CAPSTONE TOPIC. PREVENTION OF FALLS IN THE ELDERLY IN HEALTHCARE FACILITY
the PIOCT statement (Remember to spell out your P-population of your focus; I- what is your intervention; C- compared to the current process/ old process; O- measurable outcome such as 10% at the minimum; T- it usually takes time for your Intervention to change the outcomes– data to be collected for 6 months to measure the outcomes of your project).
The project must be within the nursing scope of practice and focus on a single realistic project strategy. The supportive references must be (8) peer-reviewed articles and not from the following; .com, .org, CDC, or WHO, and product publications which can be used as supportive documents in addition to your peer-reviewed articles.