Please answer all these questions according to the 3 article below.

• Choose fall in older adult a research study, QI article, or EBP DNP project and interpret at least one continuous demographic variable and one categorical variable.
• Differentiate between comparisons made using descriptive statistics (e.g., the mean and standard deviation) and comparisons based on inferential statistics (e.g., a t test).
• Compare and contrast the sample sizes used in the research study, the QI project, and the DNP project in terms of type 1 and type 2 errors.
• Explain the SIR rate, how it is developed, and how organizations use it.
• Using the same articles, pick one and differentiate between one descriptive and one inferential statistic used in any one of the three studies/projects.

Article #1

Abstract

Objective. To determine the relationship between hospital admissions for falls andhip fracturein elderly people and area characteristics such as socio-economic deprivation.

Study design.Ecological studyof routinely collected hospital admissions data for falls andhip fracturein people aged 75 years or over for 1992-1997, linked at electoral ward level with characteristics from census data.

Methods. In total, 42,293 and 17,390 admissions were identified for falls andhip fracture, respectively, from 858 electoral wards in Trent. Rate ratios (RRs) for hospital admissions for falls and hip fracture were calculated by the electoral wards' Townsend score divided by quintiles. RRs were estimated by negative binomial regression and adjusted for the ward characteristics of age, gender, ethnicity, rurality, proportion of elderly people living alone and distance from hospital.

Results. There was a small but statistically significant association at electoral ward level between hospital admissions for falls and the Townsend score, with the most deprived wards having a 10% higher admission rate for falls compared with the most affluent wards (adjusted RR 1.10, 95% CI 1.01-1.19). No association was found between hospital admission for hip fracture and deprivation (adjusted RR 1.05, 95% CI 0.95-1.16).

Conclusion. There is some evidence of an association at electoral ward level between hospital admissions for falls and socio-economic deprivation, with higher rates in deprived areas. No such association was found for hip fracture. Further work is required to assess the impact of interventions on reducing inequalities in hospital admission rates for falls in elderly people.

Introduction

Falls are a major cause of disability and the leading cause of mortality due to injury in people aged 75 years and over in the UK. Hip fracture is the most common serious injury related to falls in older people; following hip fracture, up to 33% of people will die in the following year. Community studies have estimated that about half of people aged 85 years and over will fall at least once a year and the incidence is rising.1., 2. Falls and hip fracture can also have a detrimental impact on function, quality of life and change in residential status; for example, up to 50% of older people who have a hip fracture are subsequently unable to live independently.3., 4., 5.

The National Service Framework for Older People²aims to reduce the number of falls that result in a serious injury. The NHS therefore needs to take action to prevent falls in populations of older people regardless of socio-economic status. Whilst we know that there are steep socio-economic gradients for hospital admissions for falls in children,⁶little is known about the population level factors related to high admission rates for falls in elderly people such as socio-economic status, type of housing, population density and urban or rural living areas. Such knowledge would clearly help to decide whether fall prevention programmes should be targeted to specific populations.⁷More is known about population level factors associated with hip fracture, although few studies have been conducted in the UK. There is substantial variation in the incidence of hip fracture between populations,⁸and fracture rates may⁹or may not be higher in urban compared with rural areas.¹⁰Low income is associated with higher hip fracture rates in some11., 12. but not all¹³studies.

The aim of this study was to determine whether rates of hospital admission for falls and hip fracture are related to material deprivation at the population level.

Article #2

Abstract

Background:Falls in older adults are a reasonably common occurrence and about 10% of these experience multiple falls annually. These falls may be serious and may cause significant morbidity and mortality. These can also threaten the independence of older people and may be responsible for an individual's loss of independence and socioeconomic consequences. These falls may add extra burden to the health care and to direct and indirect costs.

Methodology:An extensive search of literature was done on the important data bases of PubMed, SCOPUS, and Google Scholar on this topic and all the useful information was derived from the relevant articles for this review.

Results:We found that the falls in older individuals are often multi factorial and hence a multidisciplinary approach is required to prevent and manage these falls. The risk factors leading to the falls could be divided into extrinsic, intrinsic and situational factors. The commonest and serious injuries are to the head and fractures, due to fragility of bones.

Discussion:The falls in elderly are on rise and taking the shape of an epidemic. Prevention of these falls is far better than the management. Safe living environment of the elderly people helps in prevention of these falls. The management of the falls should focus on the causative factors, apart from treating the injuries caused by the falls.

Keywords:Fall; Fractures; Geriatrics; Older adults; Prevention; Risk factors.

Indian Orthopaedics Association 2020.

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Article #3

Abstract

Exercise intervention has a positive effect on reducing the fall risk in older adults. To investigate the effect of different factors of exercise intervention (type, duration, and frequency) on reducing the fall risk in older adults, a meta-analysis was performed in this study. According to the PRISMA, two researchers independently searched PubMed, Web of Science, and the China National Knowledge Infrastructure databases to assess the quality of the studies using the PEDro scale. A total of 648 subjects in 10 randomized controlled trials were included in this study, and the exercise interventions included integrated training (resistance training, core training, and balance training), balance training, core training, Pilates, Ba Duan Jin, and Tai Chi. These studies show that exercise intervention has a huge and significant impact on reducing the risk of falls of the elderly. In conclusion, an integrated intervention with a frequency of more than five times a week and a duration of more than 32 weeks are more effective in reducing the fall risk.

Keywords:exercise intervention, fall risk, older adults, meta-analysis

1. Introduction

Although falls can occur at all ages, older adults are more prone to injury due to physiological changes and delayed functional recovery caused by aging [1]. Currently, falls are the leading cause of injury and death in people over 65 years old [2]. It has been shown that among older adults aged 65-74 years, 25% experience a fall each year, rising to 29% among those aged 75-84 years and up to 39% in the older adults over 85 years old [3]. Falls in older adults can cause irreversible physical injuries [4], which may even lead to disability or death [5]. The disadvantages of falls affect their quality of life [6] and impose a heavy economic burden on the health care system [4]. In addition, older adults who experience falls also develop a significant fear of falling. Their social isolation and depression can increase the risk of falling, thus creating a vicious cycle [7]. Therefore, the prevention of falls in the elderly is of great significance, and it is urgent to study how to reduce the risk of falls in the elderly. However, the current design of the city is not conducive to the prevention of falls for the elderly to a certain extent, and has a negative impact on the well-being of the elderly, including the lack of access to daily services, and the buildings cannot provide enough space for the elderly and people with mobility impairments [8]. One way to solve the issues above and support the elderly to live a satisfied life is to build elderly-friendly cities and communities [9]. Studies have shown that communities with better street connectivity and daily life services tend to improve physical activities of the elderly [10], and communities roads with low-lying edges and barrier-free sidewalks will improve the travel independence of the elderly [11]. In addition, enhanced intra-city mobility (such as walking ability, use of public transportation) can enhance strengthen the abilities of the elderly in local communities [8]

The World Health Organization has classified fall risk factors into four categories: biological, behavioral, environmental, and socioeconomic factors [12]. The main biological factors of falls include decreased postural balance, sensory processing disorder, muscle weakness, and decreased agility [13]. Currently, the most common interventions that effectively reduce the fall risk are: improving the housing environment to reduce the probability of falls, stopping psychotropic medications, increasing exercise frequencies, and providing supplementation for older adults with vitamin D deficiency [14]. Among these interventions, exercise as a single intervention is considered to be effective and cost-efficient [15]. Many studies have been conducted to explore the effect of exercise interventions on reducing the fall risk in older adults. It has been demonstrated that skeletal muscles are sensitive to mechanical stimuli generated by strength training and are trainable. Older adults with muscle weakness can significantly reverse sarcopenia with strength training [16]. Exercise interventions that target balance, gait, and muscle strength increase can effectively prevent falls in older adults [16]. Among different interventions, the best ones are balance enhancement and lower-extremity resistance training [17]. Additionally, structured exercise interventions such as group exercise under guidance, home training, and Tai Chi can reduce the probability of falls [13]. Dance training, such as Thai traditional dance, can improve balance in older adults [18], and waist functional training can also improve balance and obstacle avoidance ability in older women [19]. A fall prevention program that includes strength and balance training and patient education can improve muscle balance and mental capacity in older women with a history of falls [20]. From a long-term perspective, the effects of exercise interventions on reducing the fall risk in older adults also require consideration of training durations and training frequencies [21].

There are several studies based on older people participating in physical training to reduce the risk of falls, such as: anticipatory control, dynamic stability, functional stability limitations, response control, and flexibility. However, the subject of our research is the risk of falls in the elderly through exercise. Sports include not only physical training, but also Tai Chi, Baduan Jin, yoga, Muay Thai dance and other events. However, our research includes as much exercise as possible [22]. Some scholars reported that compound exercises and Tai Chi are an evaluation of the effect of reducing the risk of falls in the elderly, but they did not mention the effect of the length of exercise intervention and the frequency of exercise on reducing the risk of falls in the elderly. In addition, the outcome indicator chosen in this study is the rate of falls, which is a less subjective. Many falls that did not cause serious injury are often missed by the elderly, so the reported fall rate will be much lower than the actual situation. However, our research chose more scientific outcome indicators, such as: PPA test score, Sensory Organization Test (SOT) test score, 30s chair stand (CS-30) test score, Tetra fall index, Morse Fall Scale (MFS), and fall risk score. These indicators have been proven to be effective objective predictors [23]. Studies have explored the impact of multi-factor interventions on reducing the risk of falls in the elderly. Multi-factor interventions include the following components: exercise, education, environmental modification, medication, walking aids, and vision and psychological management. Sport is only one aspect of it. Since it is difficult to use a multi-factor plan to explain the specific impact of each influencing factor on the results, we prefer to explore the impact of exercise on reducing the risk of falls in the elderly, rather than a multi-factor plan [24]. Compared with this study, there are more elderly people with dementia included in related studies. However, the focus of our discussion is on the elderly who can exercise on their own, excluding those with dementia. In addition, for elderly people with dementia, there are safer ways to reduce their risk of falling. If they are not taken care of by the nursing staff, exercise activities can easily cause them to be injured [25]. Studies have explained which dimensions of abilities of the elderly are improved by exercise, such as dynamic balance, static balance, participants fear of falling, balance confidence, quality of life, and physical performance. However, the study did not indicate which sports the elderly participate in can reduce the risk of falls in the elderly [26].

Although researchers have done a large number of studies investigating the effects of exercise interventions on reducing the fall risk in older adults, few studies have examined the specific effects of different types of exercise interventions. Some studies have pointed out that different forms of exercise have different effects on reducing the risk of falls, but this study only reports the effects of balance, functional exercises and Tai Chi exercises in reducing the risk of falls. It does not reduce the risk of falls for exercises such as resistance training, dancing or walking [16]. Therefore, the aim of this meta-analysis is to investigate the effect of different exercise interventions on reducing the fall risk in older adults.