How older adults and their informal carers prevent falls: An integrative review of the literature

https://doi.org/10.1016/j.ijnurstu.2018.03.002Get rights and content

Abstract

Falls in older persons are prevalent and costly for the individual and the health system. Falls prevention guidelines have been developed from best evidence to minimise falls in older persons.

Aim

To synthesise the literature on falls prevention strategies used by community dwelling older persons and/or their informal carers and to compare the commonly adopted strategies with those recommended by falls prevention guidelines.

Data sources

Health sciences databases for full text articles published in English plus reference list searching of included articles.

Review method

An integrative review approach. Studies were included if they identified fall prevention management strategies used by community dwelling older adults and/or their informal carers. Quality appraisal was undertaken using appropriate Joanna Briggs Institute critical appraisal tools. Information relevant to the aim of the review were extracted and coded into categories then inductively sorted into sub-themes and themes.

Results

Of the seventeen studies included in the review, eleven identified older adults’ falls prevention strategies, two investigated fall prevention strategies used by carers, and four explored perspectives of older persons together with their carers, representing the perspectives of an estimated 501 older persons and 102 carers. Strategies used by older adults arose because of self-awareness about their changing physical ability, and advice and support mainly from family or friends. Carer fall prevention strategy was predominantly around protection of the older adult from falling by discouraging independence.

Conclusions

The fall self-management strategies adopted by older adults and their carers to prevent falls, in the main, do not align with international best practice fall prevention guidelines.

Section snippets

What is already known about the topic?

  • Falls are an ongoing issue for older adults, and are costly to the public health system.

  • Evidence based guidelines for falls prevention exist.

What this paper adds

  • Many fall prevention strategies adopted older adults and their carers are not in line with current recommended guidelines.

  • Older adults and their carers would like to be offered the opportunity to attend formal evidence based education about fall prevention guidelines.

  • Nurses are well placed to optimise uptake and adherence to falls prevention interventions because of their presence and role in primary care settings.

  • All healthcare professionals who work with older adults in community settings

Search strategy

Electronic database search (CINAHL, Pubmed, Ovid, PEDRO, ERIC, Medline, PROQUEST, SCOPUS, EMBASE and Google Scholar) was undertaken from inception to November 2016. Combinations of MeSH headings and keywords (Table 1) were used to find full text, English language studies of any design addressing the research question.

Reference lists of potential articles were also hand searched. Duplicates were removed before articles were title and abstract screened by two members of the research team

Description of studies

The search strategy yielded 1295 potential articles, with 17 studies remaining after duplicate removal, screening and quality appraisal (Fig. 1). A summary of data from the studies, their quality appraisal scores and their themes is displayed in Table 2. There were 14 qualitative and three mixed methods studies, undertaken in the United Kingdom (5), Sweden (3), America (3), Australia (2), Denmark (2), and one each in Canada and the Netherlands. Studies explored either the older adult fall

Discussion

The aim of this integrative review was to synthesise the published research regarding falls prevention strategies used by community-dwelling older adults and their carers and to compare these with internationally accepted evidence based guidelines for falls prevention. In the main, older adults used a strategy of self-awareness to manage falls risk, and carers’ strategy was to protect. Recommended evidence based guidelines for interventions to decrease falls risk in the older population

Conclusion

Falls are an ongoing issue for older adults, and are costly to the public health system. Our review investigated strategies used by community dwelling older adults and their informal carers to self-manage falls risk. Our review has shown that a variety of strategies were implemented by older adults and their carers to prevent falls. Some of these strategies are in line with current recommended guidelines, while others are not consistent with evidence or current best practice. The findings of

Conflict of interest

The authors declare no conflict of interest.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of contribution of authors

All authors made a substantial contribution to all phases of this review including analysis of the data and drafting of the manuscript, and have approved the manuscript for publication.

Acknowledgements

Thank you to the University of Otago, Christchurch Reference Librarians for assistance in database searching.

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