Healthcare Policy Evaluation Interventions to Reduce Risk of Falls

World Health Organization reports falls as a major public health accident that causing unwarranted injuries and death among those above 60 years. Fall Prevention policies aim at identifying, preventing and management of factors identified to increase risk for falls. US Preventive Services Task Force (USPSTF) recommends a series of interventions prevent falls among community-dwelling adults, who are above 65 years of age and with increased risk for falls. These interventions include exercises, vitamin D supplementation and multi-factorial interventions (US Preventive Services Task Force, 2018).

The USPSTF program found significance evidence that exercises help in preventing falls among the community-dwelling adults (category B). In addition, the program also found that multi-factorial interventions had a small benefit in reducing falls. A realistic design used to identify the study group employed assessing history of falls, mobility difficulties and limited physical functioning. To measure the effectiveness of the recommendations, USPSTF reviewed 62 trials on utilisation of exercises, multi-factorial interventions, psychological interventions and vitamin D dieting to prevent falls.

Studies were grouped based on specific intervention applied, and results analysed statistically based on the evidence inferred. Evaluation of this policy, conducted by USPSTF, occurs after its implementation.

The program established evidence on effectiveness of exercises to reduce risk for falls (category B). Potential harms of exercises found included bruising and pain, with negligible evidence (Sherrington et al, 2016). Application of multi-factorial interventions was found to have minimal evidence in reducing risk for falls, while vitamin D supplementation was found to have adequate evidence towards not preventing falls.

Evaluation of exercises in risk prevention by USPSTF was conducted based on clinical trials that applied exercises, vitamin D supplementation or multi-factorial interventions. From the evaluation, exercises were found to be evidently efficacious that vitamin D supplementation and multi-factorial interventions (US Preventive Services Task Force, 2018). The policy offers significant benefits to community-dwelling adults at risk of falls. Practice of exercises as recommended reduces risk of falls among these adults, hence assuring safe stay.

Physical physiotherapists, caregivers, nurses, clinicians and nutritionists are involved in multidisciplinary application of multi-factorial interventions. These interventions could include medical management, dieting, physical exercises, psychological therapy and environmental adjustments. The fall prevention recommendation by USPSTF has showed significant effectiveness, with the use of exercises. Follow-up studies evaluating its effectiveness recommended exercise as an effective intervention in preventing falls among the elderly (Zhao et al, 2019; Ng et al, 2019).

Exercises help in muscle strengthening, establishing gait and balance, increasing bone mass and subsequently reducing risk of falls. This practice would therefore enormously improve quality of patient care at my workplace. Minimal risk for harm during exercises has been established. Nursing profession operates on science and art of human health. Nurses therefore operate along evidence-based practices, as they aim at providing safe care that is free from harm.

Nurses must therefore get involved in advocacy and implementation of policies that favour patient’s safety. During policy evaluation, nurses’ feedback is essential on effectiveness of the policy at the work place (Lukewich et al. 2019). In addition, adjustments, upgrading and improvements to the policy are also substantiated by the nurses during evaluation.

References

  • Lukewich, J. A., Tranmer, J. E., Kirkland, M. C., & Walsh, A. J. (2019). Exploring the utility of the Nursing Role Effectiveness Model in evaluating nursing contributions in primary health care: A scoping review. Nursing open, 6(3), 685–697. https://doi.org/10.1002/nop2.281
  • Ng, C., Fairhall, N., Wallbank, G., Tiedemann, A., Michaleff, Z. A., & Sherrington, C. (2019). Exercise for falls prevention in community-dwelling older adults: trial and participant characteristics, interventions and bias in clinical trials from a systematic review. BMJ open sport & exercise medicine, 5(1), e000663. https://doi.org/10.1136/bmjsem-2019-000663
  • Sherrington C, Michaleff ZA, Fairhall N, et al. . Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. Br J Sports Med 2017;51:1750–8. 10.1136/bjsports-2016-096547
  • US Preventive Services Task Force (2018). Interventions to prevent falls in community-dwelling older adults: Recommendation statement.  2018 Aug 15;98(4). https://www.aafp.org/afp/2018/0815/od1.html#:~:text=The%20USPSTF%20recommends%20that%20clinicians,to%20prevent%20falls%20is%20small.
  • Zhao, R., Bu, W. & Chen, X (2019). The efficacy and safety of exercise for prevention of fall-related injuries in older people with different health conditions, and differing intervention protocols: a meta-analysis of randomized controlled trials. BMC Geriatr 19, 341 (2019). https://doi.org/10.1186/s12877-019-1359-9