Effectiveness of nursing interventions in the prevention of falls in older adults in the community and in health care settings: A systematic review and meta-analysis of RCT

OBJECTIVE

To estimate the effectiveness of fall prevention programs in people aged 65 years and older involving nursing professionals.

METHODS

We included available full-text randomized clinical trials on nurse-led prevention of falls in the community in people over 65 years of age and reporting the incidence of such falls. An extensive search was performed in 14 databases covering the period 2016-2018 for publications in English, French, Portuguese and Spanish. The quality of the papers was assessed independently and blindly by reviewers working in pairs using the risk of bias dominios of the Cochrane Collaboration. The hazard ratio was used as a measure of the effect size of the incidence of falls. A random-effects model was assumed for statistical analyses. The influence of moderator variables of the studies on the effect sizes was performed using ANOVAs and its 95% CI for each moderator category.

RESULTS

A total of 31 randomized clinical trials were selected with 25,551 participants. The most frequent type of intervention was education (57.1%), followed by multifactorial models (37.1%). The probability of falling was significantly reduced by 13% in the intervention groups compared to the control groups (RR+=0.87). Multifactorial (RR+=0.89) and education-based (RR=+0.84) interventions significantly reduced the probability of falls by 11% and 16%, respectively.

CONCLUSIONS

Discarding publication bias prevention programs carried out by nurses produce a significant 10% reduction in falls. Education-based and multifactorial interventions are the most effective when conducted by nurses.

Living normally without being oneself: A qualitative study on the experience of living with advanced chronic kidney disease

The aim of the study was to describe and analyze the experience of people with advanced chronic kidney disease. Chronic kidney disease is a growing public health problem that is on the increase worldwideThe experience of living with this illness is paradoxical, as it can include feelings of dependent autonomy, distant connection, abnormal normalcy, and uncertain hope. Every chronic disease involves a biographical alteration from the onset. For those who suffer it, it implies a breaking down and reconstruction of their everyday life. Despite the prevalence of the disease and the increase in the number of qualitative research studies in recent decades, there has not been much research on the experience of people with Chronic kidney disease. This is a qualitative study that began in 2018 and concluded in 2021.Twenty-one people with advanced chronic kidney disease were interviewed. They participated voluntarily with informed consent Participants were selected by purposive sampling. Data analysis was guided by grounded theory procedures using the Nvivo 12 software. This study reveals that people with advanced chronic kidney disease do not feel the same as they used to because their control over their lives is limited; because they feel their health is in a continuous state of deterioration; and because of the changes in themselves and in their relationships with others. With chronic kidney disease, their identity is continually called into question. The normal lives of these people-their biographical constructions-are precarious and are continuously being remodelled by the effects of treatment and the inexorable course of this disease. This study contributes to an understanding of the experience of people with advanced chronic kidney disease. It can contribute to helping health care professionals effectively support these patients in their efforts to lead a normal life and in making decisions about their treatment.

The Low Voices: Quality, Ethics, and Reach of Qualitative Data

* Clarification. This article is based on the key-notespeech given by the author during the 9th Iberian-American Congress on Qualitative Research -Montevideo, Uruguay, 13-15 October 2021.

[The care in the prevention of falls in elderly people: Meta-summary of qualitative articles]

OBJECTIVE

To summarize the qualitative evidence on the role of care providers in the prevention of falls of persons over 65 years of age in centres and in the community.

DESIGN

Meta-summary of qualitative evidence following the aggregation method.

DATA SOURCES

Extensive manual search of 16 databases (CINAHL, Pubmed/Medline, Embase, PsycInfo, Cochrane Library, PeDRO, Opengrey (Reports), Cuiden, Cuidatge, Enfispo, Medes, Lilacs, Teseo, Dissertation and Thesis Global and Ibecs), in English, French, Spanish and Portuguese; no time limit.

SELECTION OF STUDIES

Selection and blind critical appraisal by pairs. A first relevance and relevance screening and a second critical appraisal screening were carried out. A total of 4170 articles were located; 41 qualitative articles were critically appraised and 31 were selected.

DATA EXTRACTION

Data regarding author, year, study design, location, participants (number, age, sex and occupation), study methods and findings were extracted.

RESULTS

The analysis revealed four major themes: precipitating factors, preventive models, feelings and decision-making process. It also highlights the difficult act of ethical balance, the role of the institution in prevention and the fragmentation of care, as keys to successful implementation.

CONCLUSIONS

The findings show the complexity of fall prevention and the need to incorporate care providers' opinions in preventive models.

[Fall prevention in older people and their families: a qualitative synthesis]

OBJECTIVE

To analyse and synthesize the evidence on fall prevention of people older than 65 years and their family care providers METHOD: Qualitative synthesis, which is a part of a convergent systematic integrative review. Forty-one qualitative studies were retained for full text scrutiny. Nine studies on family care providers were selected for this synthesis.

RESULTS

Care providing, and kinship relationships mediated family care providers' interventions to prevent falls in older people. The fall of the dependent relative constitutes a turning point in these relationships. Family care providers are vulnerable to having a fall themselves and therefore receivers of preventive interventions.

CONCLUSIONS

Taking into account the context of care and family relations will improve the effectiveness of preventive interventions and will facilitate adherence. Fall prevention policy and programmes must pay better attention to the health and wellbeing of family care providers.

Situating Preventive Action in a Moral and Clinical Context: A Qualitative Synthesis on Fall Prevention

The prevention of falls is an integral part of the safety culture of health institutions with mandatory fall prevention programs set within health care facilities. Care providers are key in identifying the risks of falls and in implementing strategic actions to prevent them. With the aim to better understand practices of fall prevention, we conducted a synthesis of qualitative evidence on care providers' practices to prevent older people from falling in health care facilities. This synthesis is part of an integrative review of the role of care providers in fall prevention of adults aged 65 years and above. Primary studies were synthesized with the emerging core category of "a complex decision" and described by four emerging conditions that make that decision complex: (a) permanent threat of a fall, (b) continuous flow of information, (c) lack of control, and (d) ethical dilemmas and moral issues over the course of action. The present synthesis shows that before implementing preventive actions, care providers consider the conditions in which they are immersed, in this way situating their preventive actions in a clinical and a moral context.

To manage a complex dependency: The experience of caregiving after a fall

AIM

To understand the experience of family members of an older relative who has had a fall which required medical attention.

BACKGROUND

There is abundant bibliography in caregiving, but little is known about the problems faced by caregivers and how family members cope when their older relative has a fall.

DESIGN

Qualitative study that used a symbolic interactionism perspective.

METHODS

Twenty-two people with older relatives, who had had a fall and contacted health services in Spain, participated in the study. Data were obtained via written accounts, focus groups, and semi-structured interviews between February 2014 - December 2015. Analysis was guided by grounded theory procedures.

RESULTS

With the fall, dependency becomes a complex issue for the family. To manage a complex dependency is the core issue that emerges from the data analysis. It depicts family efforts to assist their relative in gaining autonomy after a fall, in the best conditions they can provide. They do this with little guidance and support from healthcare professionals.

CONCLUSIONS

Guides and protocols for the care of a fragile older person, particularly after a fall, should not only include care but also support to caregivers. Health professionals and especially nurses need to be aware and respond to the family caregivers needs after a fall. To the fall prevention initiatives already in place, it must be added that those who support family members to cope with the care of an older person who has had a fall.

“Turning to One’s Own World”

Purpose: Although past research has focused on the coping strategies of family caregivers, how immigrant caregivers cope with the demands of caregiving remains unknown. This study examines the strategies immigrant caregivers use to relieve the burden of care. Method: A qualitative study based on 17 immigrant women caregivers using purposive and snowball sampling was done. Semistructured interviews and testimonies were obtained and analyzed using grounded theory procedures. Findings: Turning to one’s world describes how caregivers seek relief from the burden of care. They escape virtually, go to a private place, make those they care for their own, and decide to go home. These mechanisms enable them to escape from the world of caregiving in which they find themselves. Discussion and Conclusions: Findings reveal the significance of family connections and networks for immigrants to achieve burden relief. Implications for Practice: The importance of promoting positive working environments and raising awareness about immigrant caregivers’ need for rest.

Strategies for the relief of burden in advanced dementia care-giving

AIM

This paper is a report of a study conducted to uncover the strategies that women caregivers of relatives with advanced dementia use to rest from care-giving.

BACKGROUND

Respite consists of activities and situations that briefly take caregivers away from their care-giving responsibilities. Qualitative studies are focusing on respite as an outcome and are deepening our knowledge about the experience of caregivers' rest. The strategies that caregivers use to relieve the burden, however, are not fully known.

METHOD

A qualitative approach was used influenced by the work of Charmaz's constructivist grounded theory. Twenty-three female primary caregivers of relatives with advanced dementia participated in semi-structured interviews between November 2006 and March 2009 in Spain. Data collection was guided by the emergent analysis and ceased when no more relevant variations in the categories were found.

FINDINGS

Taking leave from the life of care-giving is the general strategy that caregivers use to rest from their caregivers selves. The key issue is to be able to connect with a different world from that of care-giving. Three strategies that participants use to leave the life of care-giving follow: (1) Connecting with one's own life, (2) building moments of life in common with the sick relative and (3) keeping in touch with care-giving.

CONCLUSION

To have respite from care-giving implies distancing oneself from the care-giving identity and reveals the caregiver's need for alternative selves to have true breaks from caring. Nurses are in a unique situation to foster respite as an inner experience.

Research protocol: a synthesis of qualitative studies on the process of adaptation to dependency in elderly persons and their families

Background

Dealing with dependency in the elderly and their families leads us to explore the life experience of those involved together with the processes of adaptation to this condition. A number of original studies have been published which, following a qualitative methodology, have dealt with both dimensions.

Methods/Design

Objectives: 1) To present a synthesis of the qualitative evidence available on the process of adaptation to dependency in elderly persons and their families; 2) to conduct an in-depth study into the experiences and strategies developed by both to optimise their living conditions; 3) to enable standards of action/intervention to be developed in the caregiving environment.

A synthesis of qualitative studies is projected with an extensive and inclusive bibliography search strategy. The primary search will focus on the major databases (CINAHL, MEDLINE, EMBASE, PsycInfo, PSICODOC, Cochrane Library, JBI, EMBASE, LILACS, CUIDEN, CUIDEN qualitative, CUIDATGE, British Nursing Index, SSCI). The secondary search will be conducted in articles taken from the references to studies identified in the articles and reports and the manual search in congresses and foundation papers. Article quality will be assessed by the guide proposed by Sandelowski & Barroso and data extraction done using the QARI data extraction form proposed by the Joanna Briggs Institute for Evidence-Based Practice.

The synthesis of the findings will be based on the principles and procedures of grounded theory: coding, identification and relationship between categories, and synthesis using constant comparison as a strategy.

Discussion

This synthesis of qualitative evidence will enable us to detect health needs as perceived by the receivers in their own interaction contexts.