Research Critique and PICOT Statement-Falls and Dementia
Dementia entails a group of signs and symptoms that reflect diminished cognitive function. The cognitive abilities affected are thought comprehension and reasoning. The loss of these abilities interferes with routine activities conducted by the affected population. Older patients with dementia are prone to falls. This has been attributed to forgetfulness and unawareness of their surroundings. It is a significant clinical problem because it causes regular physical harm. This paper provides a critical appraisal of quantitative and qualitative research articles, provides a revision of my PICOT question, and proposes evidence-based practice change.
Nursing Practice Problem and PICOT Question
My nursing practice problem is falls and dementia. My PICOT question: For patients who suffer from dementia-related falls, does screening for prior history of falls, age, and visuospatial ability compared to screening for cognitive impairment level help predict and prevent subsequent falls over six months?
P: Patients who suffer from dementia-related falls
I: Screening for prior history of falls, age, and visuospatial ability
C: Screening for a cognitive impairment level
O: Predict and prevent subsequent falls
T: Six months
Background of Studies
Zhang et al. (2019) and Mehdizadeh et al. (2021) authored the two qualitative articles. According to Zhang et al. (2019) their study aims to conduct a literature review and develop a framework to guide fall prevention in older persons with dementia. The objective is to conduct a literature review and create a framework to drive programs to prevent falls in the target population. Two research questions can be formulated. The first question is: what is the impact of gait and cognitive impairment on falls among dementia patients? The second question: what are the risk factors for falls in older adults with dementia? The article’s relevance to nursing practice is underpinned by its research questions. Knowledge from the study will enable nursing personnel to emphasize gait and cognition when dealing with older adults with dementia. Nursing personnel can develop theoretical guidelines to help prevent falls in dementia patients.
The article by Mehdizadeh et al. (2021) focuses on predicting short-term factors that predispose a population with dementia to falls. Prior history of falls and the gait of participants are key risk factors for falls among people with dementia. The purpose of the study is to create a predictive model to identify the likelihood of short-term falls in the elderly with dementia. The study aims to identify factors likely to cause falls within thirty days in patients with dementia. The research question: What are the short-term risk predictors of falls in older adults with dementia? The study is relevant to nursing practice because it identifies factors likely to cause falls within thirty days in the target population. This can be used to formulate preventive measures for falls.
Oki et al. (2021) and Sharma et al. (2018) authored the two quantitative articles. According to Oki et al. (2021), the study aims to determine the main risk factors for falls in patients with Alzheimer’s disease. The study’s objective is to identify the impact of three risk factors for falls in Alzheimer’s patients with a fall history versus those without a fall history. Three research questions arise from the study. The first question: how does balance contribute to falls in patients with Alzheimer’s disease? Subsequently, the second question: what is cognition’s impact on falls in patients with Alzheimer’s disease? The third question: how does the visuospatial ability impact fall in people with Alzheimer’s disease? These research questions demonstrate the significance of the study to nursing practice. These results will enable nursing personnel to focus on the key indicators of falls and their mitigation strategies. This will help to reduce subsequent incidences of falls in the target population.
According to Sharma et al. (2018), the study aims to investigate the predictors of falls and associated fractures in patients with dementia. The objective is to conduct a representative cohort study and identify indicators of falls and fractures in patients with dementia. The research question: among patients with dementia, what are the predictors of falls and related fractures? Nursing practice will benefit abundantly from the results of this study. Information from the survey will enable nursing personnel to establish a framework for preventing falls in patients with dementia. Besides, it will allow them to educate patients’ caregivers and relatives on the predictors of falls. This will lead to a significant decline in falls and a better quality of life.
How the Articles Support the Nursing Practice Problem
According to Zhang et al. (2019), the risk factors for falls in people with dementia include a previous history of falls, vision, medical factors, and psychological factors are identified as risk factors for falls. Mehdizadeh et al. (2021) indicated that balance and fall history are key fall risk factors. Furthermore, close monitoring of gait stability helps predict the risk of falls. The two articles prove that vision, history of falls, and balance are vital predictors of falls. These findings will be used to answer the PICOT question because cognition is not identified as a critical indicator of falls.
The authors of both articles propose various interventions based on the risk factors. Mehdizadeh et al. (2021) report that assessing balance and vision is critical. Zhang et al. (2019) identified several predisposing factors, including gait and cognition. These interventions are similar to those identified in the PICOT question.
The research article by Oki et al. (2021) identifies the relationship between three key risk factors and falls in patients with Alzheimer’s disease. Accordingly, findings indicate that balance and visuospatial ability were critical predictors of falls in patients with a history of falls. Patients with a history of falls recorded lower scores for both parameters than their counterparts. Cognition did not predict the incidence of falls in both groups of patients with dementia. Sharma et al. (2018) identified a history of past falls, age, gender, and the environment as indicators of falls in people with dementia. Cognition and psychiatric manifestations of the patient are not essential indicators of the likelihood of falls. Therefore, information from both articles suggests that cognition is not likely to cause falls in patients with dementia. These will help answer the PICOT question by recommending screening for prior history of falls, age, and visuospatial ability.
The researchers in both articles propose various interventions. Both suggest that cognition should not be the point of focus. Oki et al. (2021) report the importance of screening for balance and visuospatial ability, whereas Sharma et al. (2018) propose screening for past fall history, age, and environment. Oki et al. (2021) use a comparison group of those without a history of falls. This is different from that used in the PICOT question. However, results from the study by Oki et al. (2021) incorporate the comparison group of the PICOT question.
Method of Study
Zhang et al. (2019) used a narrative review study, whereas Mehdizadeh et al. (2021) used a prospective observational study. The narrative review study involved thoroughly analyzing literature from systematic reviews and other studies. The prospective observational study involves collecting various indicators, such as demographic data. The narrative review has the advantage of providing insight, interrogation, and theory creation. A disadvantage of the method is the possibility of bias. The advantage of the prospective observational study is that it is accomplished within a short time frame and is less costly. Its limitation: it is subject to bias.
Oki et al. (2021) used a retrospective cross-sectional study, whereas Sharma et al. (2018) utilized a retrospective cohort study. The retrospective cross-sectional study assessed the three risk factors and their outcomes in a similar time frame. The retrospective cohort study collected data from patients over six years, from January 2007 to March 2013. A retrospective cross-sectional study can be used to authenticate the preexisting assumptions. Its demerit is the inability to analyze a factor over a long time. It focuses on a particular timeframe. A retrospective cohort study can be used to study multiple parameters and identify numerous outcomes. Its demerit: costly and time-consuming.
Results of Study
Mehdizadeh et al. (2021) identify balance and previous history of falls as essential indicators of the occurrence of falls in people with dementia. Similar findings are reported by Zhang et al. (2019). However, unlike Mehdizadeh et al. (2021), Zhang et al. (2019) identified cognition as a critical etiological factor. Furthermore, Zhang et al. (2019) report that intrinsic and extrinsic factors contribute to falls due to age and individual patients.
Oki et al. (2021) reveal that 46.8 percent of the participants had a history of falls. Balance and visuospatial ability were critical determinants of falls in people with a history of falls. The mean scores for balance tests were 19.5 and 2.5 for the Functional Reach Test and one-leg standing duration, respectively. The comparison group without a history of falls scored higher, 26.1 and 8, respectively. Mean scores for visuospatial ability were 3 for the fall group compared to 6 achieved by those without a history of falls. On the cognition test, people with a history of falls got a higher mean score, 16.7, than those without a fall history, 16.2. Sharma et al. (2018) reported similar results on cognition. Participants with a history of falls got a mean score of 19.9 on the cognition test, while their counterparts scored 19.5.
Results from the four studies are crucial to nursing practice. Three of the studies revealed that cognition has a diminutive impact on predicting the occurrence of falls. This will help nursing personnel shift focus toward screening for past fall history, visuospatial ability, balance, and age. Additionally, this will form the basis for advising the families and caregivers of people with dementia. These results will promote the reduction of the incidences of falls in patients with dementia.
The first ethical consideration is participant anonymity. This prohibits the identification of study participants. Data or information that can facilitate participant title should not be used. All researchers of the four articles upheld this by using expressions such as “individuals” and “participants” rather than giving names or any other identity. The second ethical consideration is to avoid harm. The study should not cause any harm to the participants. Damage can be physical, psychosocial, or legal (Fleming & Zegwaard, 2018). The researchers of the four articles upheld this ethical consideration. Appropriate authority was sought before conducting the studies. Review registration was done, and all reference materials are well cited.
I anticipate that screening for a prior history of falls, age, and visuospatial ability will help to predict and prevent subsequent falls over six months. Conversely, filtering for cognition will not help to predict and prevent subsequent falls over six months. These outcomes are in harmony with those of the researchers of three of the four articles. All but Zhang et al. (2019) reported that cognition is not a fall risk factor. The four researchers recognize the importance of the history of falls, visuospatial ability, and age as fall predictors. Therefore, the outcomes of the four articles are in concert with the results of my PICOT question.
Proposed Evidence-based Practice Change
The research articles aimed at identifying the risk factors for falls in people with dementia. They help to answer the PICOT question. Risk factors identified by the articles should be screened to help avert falls. The PICOT question recognizes the importance of screening the risk factors for predicting and avoiding falls. The PICOT question and research articles will help address the nursing practice problem of falls and dementia.
Evidence-based change: screening for past fall history, visuospatial ability, and age in patients with dementia-related falls. Findings from the four studies identify visuospatial ability, age, and past fall history as crucial risk factors for falls in patients with dementia. Therefore, identifying these factors will help predict and prevent dementia-related falls.
Falls are common in patients with dementia, particularly in the elderly population. In addition, falls are undesirable because they reduce a person’s quality of life. It is essential to identify risk factors for falls. Screening for the risk factors can help to avoid falls. Potential risk factors include balance, visuospatial ability, history of falls, and age. Filtering for past fall history, visuospatial ability, and age in patients with dementia-related falls should be implemented.
Fleming, J., & Zegwaard, K. E. (2018). Methodologies, Methods, and Ethical Considerations for Researching Work-Integrated Learning. International Journal of Work-Integrated Learning, 19(3), 205–213.
Mehdizadeh, S., Sabo, A., Ng, K. D., Mansfield, A., Flint, A. J., Taati, B., & Iaboni, A. (2021). I am predicting Short-Term Risk of Falls in a High-Risk Group With Dementia. Journal of the American Medical Directors Association, 22(3), 689-695.e1. https://doi.org/10.1016/j.jamda.2020.07.030
Oki, M., Matsumoto, M., Yoshikawa, Y., Fukushima, M., Nagasawa, A., Takakura, T., & Suzuki, Y. (2021). Risk Factors for Falls in Patients with Alzheimer Disease: A Retrospective Study of Balance, Cognition, and Visuospatial Ability. Dementia and Geriatric Cognitive Disorders Extra, 11(1), 58–63. https://doi.org/10.1159/000514285
Sharma, S., Mueller, C., Stewart, R., Veronese, N., Vancampfort, D., Koyanagi, A., Lamb, S. E., Perera, G., & Stubbs, B. (2018). Predictors of Falls and Fractures Leading to Hospitalization in People With Dementia: A Representative Cohort Study. Journal of the American Medical Directors Association, 19(7), 607–612. https://doi.org/10.1016/j.jamda.2018.03.009
Zhang, W., Low, L. F., Schwenk, M., Mills, N., Gwynn, J. D., & Clemson, L. (2019). Review of Gait, Cognition, and Fall Risks with Implications for Fall Prevention in Older Adults with Dementia. Dementia and Geriatric Cognitive Disorders, 48(1–2), 17–29. https://doi.org/10.1159/000504340
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Prepare this assignment as a 1,500-1,750-word paper using the instructor’s feedback from the previous course assignments and the guidelines below.
Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.
The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program).
In the Topic 2 and Topic 3 assignments, you completed a qualitative and quantitative research critique on two articles for each type of study (4 articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.
The completed analysis should connect to your identified practice problem of interest and your PICOT question’s basis.
Refer to “Research Critiques and PICOT Guidelines – Final Draft.” Questions under each heading should be addressed as a narrative in the structure of a formal paper.
Proposed Evidence-Based Practice Change
Discuss the link between the PICOT question, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanations and use that information to propose evidence-based practice changes.
You must cite at least three peer-reviewed sources to complete this assignment. References must be published within the last five years, appropriate for the assignment criteria, and relevant to nursing practice.
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the title before beginning the work to become familiar with the expectations for successful completion.
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