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Recommendation for an Evidence-Based Practice Change

Introduction

  • This presentation will explore the PICOT question related to the potential improvements in the quality of life of a target population.
  • The question calls for research on the best method of reducing fall-related injuries in adults 65 years old and older.
  • The answer to this question is synthesized by examining the evidence from several peer-reviewed articles regarding the alleviation of fall-related injuries among older people.
  • Additional details will be provided to prove the importance of the issue, the necessity of the comparison of selected methods of its solution, and the recommendations that stem from it.

Practice Issue

  • The primary issue in practice is the determination of the most suitable source of improvement of fall rates for an individual over 65 years old.
  • In practice, the reason behind falls can include both decreased bone density and side effects of drugs, making additional prescriptions potentially unviable as a method for issue resolution.

Practice Issue Importance

  • Falls constitute a high amount of reasons for traumas in older adults, leading to n excessive yet preventable healthcare expenses.
  • Further examination of this issue can reveal the most optimal set of recommendations for the target population that would reduce its severity.

PICOT Question

  • In adults older than 65 with the risk of falls (P), does the use of vitamin D (I), compare with equipment used to help movements (C), improve bone density and independence (O), in 6 months’ time?
    • P-Population and problem – The issue is prevalent in the older population, having the most prominent adverse effect on people of age 65 and older (Mansouri & Goher, 2016).
    • I–Intervention – Vitamin D is proven to alleviate the rate of fall incidents among older adults (Mansouri & Goher, 2016).
    • C–Comparison – Equipment that assists with maintaining static balance and movement possesses similar positive effects on the quality of life (Sampaio et al., 2017).
    • O–Outcome – Vitamin D supplements increase bone density and strength, reducing the chance of fractures in case of a fall (Hill & Aspray, 2017). Fall prevention measures examined in the articles are proven to increase independence in older adults (Moncada & Mire, 2017).
    • T–Time frame – The researchers have documented that positive changes occur after three months of treatment, although the recommended length of the fall prevention treatment is six months (Park et al., 2017).

Literature review

  • The issue raised by the PICOT question leads to a significant decrease in the quality of life of older people (Cheema & Chaudhry, 2016).
  • Literature review shows a prominent positive effect of Vitamin D and calcium supplements on bone density of older adults, which decreases the number of traumas from falls (Hill & Aspray, 2018).

Literature themes and concerns

  • All papers examine people of the age of 65 as the most susceptible to fall-related injuries.
  • Many of the articles explore the efficiency of Vitamin D, while several studies aim to compare various methods of alleviation of the issue.

Literature perspective

  • Controlled trials of the effects of Vitamin D on falls have revealed that the number of incidents after a 3-month treatment period has been reduced by approximately 50% (Cheema & Chaudhry, 2016).
  • Moreover, it has been determined that the use of assistive devices is less efficient due to its technical limitations (Sharif et al., 2018).

Recommendations

  • It is essential to combine all the suitable methods of fall reduction to achieve the best possible outcome.
  • Physical exercise is recommended for older people to keep muscle strength in addition to keeping high bone density with Vitamin D intake (Mansouri & Goher, 2018).
  • Nurses are encouraged to explore the topic to be able to determine the optimal dose of Vitamin D (Hill & Aspray, 2017).

Impact of Recommendations

  • Patients who have osteoporosis and use assistive devices are prone to chronic diseases related to gait and posture changes and would benefit significantly from Vitamin D supplements (Cruz et al., 2020).
  • Nurses and healthcare facilities will experience less strain due to the lower number of fall-related injuries.

Feasibility of Recommendations

  • The necessity of the optimal dosage comes from the adverse effects of inappropriate Vitamin D intake (Hill & Aspray, 2017).
  • A combination of suitable prevention measures can help a patient to avoid the adverse impact of a treatment that is non-vital for that individual (Cruz et al., 2020).
  • Patients will be able to have a higher level of independence (Mansouri & Goher, 2018).

Conclusion

  • Nurse practitioners are encouraged to include Vitamin D supplements as their primary recommendations for older people.
  • Studies reveal that it has the highest potential among potential solutions to the high rates of fall-related traumas.

References

  • Cheema, M. R., & Chaudhry, A. Y. (2016). Quality-of-life indicators and falls due to vitamin D deficiency. International Journal of General Medicine, 9, 21-25. Web.
  • Cruz, A. D. O., Santana, S. M. M., Costa, C. M., Gomes da Costa, L. V., & Ferraz, D. D. (2020). Prevalence of falls in frail elderly users of ambulatory assistive devices: A comparative study. Disability and Rehabilitation: Assistive Technology, 15(5), 510-514. Web.
  • Hill, T. R., & Aspray, T. J. (2017). The role of vitamin D in maintaining bone health in older people. Therapeutic Advances in Musculoskeletal Disease, 9(4), 89–95. Web.
  • Mansouri, N., & Goher, K. (2016). Walking aids for older adults: Review of end-user needs. Asian Social Science, 12(12), 109-119. Web.
  • Moncada, L. V. V., & Mire, L. G. (2017). Preventing falls in older personsAmerican Family Physician, 96(4), 240-247. Web.
  • Park, K.-S., Yoo, J.-I., Kim, H.-Y., Jang, S., Park, Y., & Ha, Y.-C. (2017). Education and exercise program improves osteoporosis knowledge and changes calcium and vitamin D dietary intake in community dwelling elderly. BMC Public Health, 17(1). Web.
  • Sampaio, L. V. P., Castilho, L. B., & Carvalho, G. de A. (2017). Development of an application for mobile devices to evaluate the balance and risk of falls of the elderly. Revista Brasileira de Geriatria e Gerontologia, 20(6), 805–813. Web.
  • Sharif, S. I., Al-Harbi, A. B., Al-Shihabi, A. M., Al-Daour, D. S., & Sharif, R. S. (2018). Falls in the elderly: Assessment of prevalence and risk factors. Pharmacy Practice, 16(3). Web.