Critical Appraisal: Caring for the Elderly

Critical Appraisal: Caring for the Elderly


As a nursing student, the care of the aged has been a focus area that I aim to explore both in academics and profession. Indeed, caring for the elderly is no mean task and requires a lot of commitment and sacrifice on ones end. Today, the number of elderly patients is increasingly high owing to reduced fertility rates and better healthcare meaning that people live longer (Stevens et al, 2006). However, the developments have come with challenges relating to the care of the elderly both bin hospitals and at their homes. Indeed, accidents related to falls are most prevalent types of incidents for the elderly and are increasingly related with mortality. Every year, half of the people aged above 80 years fall at least once with the frequency decreasingly slightly for people aged above 65 years.

In view of the researched statistics, many scholars have contributed to the literature revolving around falling among the elderly with almost similar findings (Tinetti & Speechley, 2009). This paper is a critical appraisal of two such research papers about falls among the elderly and the resultant care to prevent the same. Falls in old age: a threat to identity (Dollard et al, 2011) and older people’s perception of and coping with falling, and their motivation for fall prevention programmes (Host et al, 2011) are the two papers under review. The general theme in the two papers falls under the care of the elderly and the incidence of falling and its prevention. This paper analyzed the two research papers with a view of understanding the literature on falls among the elderly population. It is subdivided into five sections each detailing a certain aspect of the two research papers and the topic in general.

Choosing the papers

The choice of the two papers was largely dependent on the personal interest in nursing. At first, I undertook a literature review through the City Library A-Z database which turned out to be the most fruitful source of material. I accessed the EBSCO Host from where the searches were effectively conducted using CINAHL Plus. The nature of the platform was effective in bringing out the most desired results in part due to the fact that it entailed full-text searches.

In addition to the CINAHL Plus platform, other two platforms were used namely: Medline Complete and PsycINFO. The search was limited to papers that are peer reviewed research articles and only those published in English.  Moreover, the search was specific to the period between 2011 and 2016 to avoid instances of very old research materials that may be irrelevant ion today’s modern world. Moreover, a Boolean search engine was employed in the process to help combine keywords and thus capture a larger net of interest articles.

The first paper, otherwise referred to as paper A, was captured using the search terms of falls prevention in the elderly. The search term generated a total of twenty four results from which Paper A was number 12 out of the 24 papers retrieved. The second paper, paper B was also retrieved through a similar process using the search term ‘assessment and prevention of falls’. In the second search, a total of 51 articles were captured from which the second paper was sought. Paper B was number 26 out of the 51 papers that were captured in the search. However, the second search was different from the first one in that it did not include the PsycINFO search platform.

Critical Summaries

Paper A

The study aimed at understanding the perceptions of older people regarding their risk of falls and that of other older people. Through this research, the study aimed at increasing the understanding of why the elderly do not consider falls to be relevant to self. The research is motivated by increasing statistics of elderly people that fall every year as well as the perception among the old people that they are not personally vulnerable (Chang et al, 2004). In fact, the paper quotes the number of people that fall every year to be about one third of those that are aged above 65 years. In addition, many of the older people including those that fall do not have the motivation to engage in falls prevention programmes. The lack of enrolment to these programmes is based on the notion that they are not personally susceptible to the phenomenon of falling.

The results portray a general trend of negative perceptions towards falls among the elderly persons. In fact, most of the participants presented themselves as being outside the bracket of the type that fall. The falls among themselves or their friends were considered to be caused by factors that were outside their personal control. In other cases, the elderly considered the falls to be resulting from a lack of paying attention at the time of the falls. All the participants however agreed that they were not the type who falls and they all used the explanations to protect their identity as one of people that are physically competent.

Paper B

The second paper aims to ascertain the general perceptions of older people regarding falls and coping with the falls. In addition, an understanding of the motivations behind them joining similar falls preventions programmes is analyzed. Through the use of interviews that were conducted in a semi structured manner, the study collected data from 14 individuals. The identification of these individuals was based on their prior contact of an emergency department to report they had fallen. Ultimately, the use of phenomenological research tradition was effective in tracing the perceptions of older people on the subject of falling (Host et al, 2011). The study identified the individuals to be above the age of 65 years thus ensuring that they fell within the bracket of older people in society.

The results of the study heralded the emergence of five categories and fifteen sub categories from the interviews. Major categories included: falling has consequences; support from the social network; emotional perceptions of falling; motivation and demotivation; and coping with the situation of falling. Ultimately, the participants considered falling as a shameful and embarrassing incident. By associating falling with embarrassment, the dominant feeling among the older persons was the fear of falling. In the end, these people did not view falling as a risk factor that they should care about in their daily life (Scheffer et al, 2008). Rather, the older persons had an inclination of restricting their activities and in some cases stopping activities that they considered to be more prone to falling. The association of falling with embarrassment thus influenced the manner in which the older persons prevented future falls.

Appraisal of method

Paper A

The paper introduces the problem of falls among the elderly in a clear and concise manner. The use of statistics detailing the phenomenon at both the national and international level provides a good introduction into the problem. The problem identified is very much researchable in the fact that statistics are available to support the arguments while still questioning the affected people. Indeed, the problem in the research is very much important to my career in nursing because I am thrilled by taking care of the elderly. The daily activities of a nurse taking care of the elderly revolve around the prevention of the falls. I could not think of any other researchers who are best suited to undertake the research owing to their large experience in the field. Dollard for instance has many years of experience in researching the effectiveness of falls prevention strategies.

In the literature review, the researchers provide a wide array of literature in support of their research. Indeed, the relevance of the literature material cited in the paper is important in shaping the discussion around the area of falls prevention. The writers combine literature material from different researchers both at the national and international spheres thus bringing out a very comprehensive review. In addition, the sources used in the text are up to date relative to the year of publication. In fact, most of the sources used have a publication date of 2007 with a few exceptions dating back to 2000. As such, the relevance of the material used is up to date and reflects the true nature of the conditions under study. The research employs the correct APA referencing style and is consistently applied in the text thus showing a clear mastery of the style.

The paper further uses qualitative approaches in effectively underlining the relation between falls and threats to the identity of the elderly people. Indeed, the purposive sampling employed in the study ensured only the relevant information was sought. By selecting the sample purposively, the study ensured that only information relating to the older people was collected. Further, the study limited the sample size to people that surpassed the 65 year old bracket thereby ensuring that only factual information was collected (Dollard et al, 2011). However, the research fails in the use of clear presentations such as graphs, charts and tables thus failing to portray a clear picture of the results.

Towards the end of the paper, the research provides conclusions and recommendations in support of the results identified. The conclusions provided in the paper justify the results in the study and are based on the research objectives of the particular study. Essentially, the conclusions of the paper are linked to the purpose of the study and are approve the resulting findings. Further, the study provides recommendations for practical implementation in the field. In fact, all the recommendations provided in the study can effectively be practiced in the area of nursing since they are not theoretical. Moreover, the researchers provide for a section discussing the implications of the current findings on future research within the discipline of nursing. Finally, the limitations of the study are clearly outlined and the scope of the study pinpointed.

Paper B

The introduction section is clear in the presentation of the problem and quotes past studies in support of the problem identified. The paper identifies the problem as the perceptions of older people and the resulting motivation for falls prevention programs. In formulating the research problem, the study presents it in a researchable manner by providing important guidelines of the study. Therefore, the paper is adequate in the identification of gaps in the study of older people’s perceptions and poses the study vas a solution to the same. The problem as portrayed in the current study is highly relevant to the discipline of nursing which is my current career. In fact, part of the reasons for the selection of the paper was the interest I have in the care of the elder people. Moreover, the researchers have vast knowledge in the field of nursing with all of them having done past studies on the same. Ideally, therefore, they are the most suited candidates to undertake the study.

Although the paper has no clear section for the literature review, it does present evidence of a review of past literature in laying out the claims in the study. In fact, the researchers use the introduction section to lay out a comprehensive review of literature. Still, the paper also incorporates sources in the body of the research to support arguments and discard those that are not relevant in the study. The sources used in the study are up to date thus reflecting the true state of the conditions being studied. The style in use is the updated Chicago referencing style where footnotes are employed to explain the arguments.

In the methodology section, the researchers point out a clear overall design of the study followed by a discussion on the use of the same. Although there is no clear theoretical framework, the paper discusses the use of the methods in articulating the problem. The research hypotheses are clearly stated and the ethical considerations of the study discussed. Moreover, the intentions of the research are outlined with a description of the data collection method. In truth, focus groups are consistently used in the collection of data for analysis. The use of purposeful sampling is justified in relation to the importance of having a representative sample of the population under study.

In laying out the conclusions of the study, the researchers provide justifications for the specific statements made. In so doing, the conclusions are not mere generalizations based on emotions but clearly identified justifications ion support of the results. In addition, the purpose of the study is clearly evident in the conclusions and is the backbone of the recommendations made. The recommendations made are also not purely theoretical and have a basis for application thus improving their effectiveness. Further, the implications of the study on future research are outlined although not in a clearly identified section. Regardless, the implications are clearly manifested within the results and recommendations sections of the study. Still, the research identifies the limitations of the study in similar fashion by concealing them within the discussion section.

Synthesis of findings and reflection on practice

The findings in the two research papers show evidence of interrelatedness in terms of the results they depict. In essence, the two papers agree on the perceptions of the older persons regarding the phenomenon of falling in labeling it a negative incident. However, the application of the findings is somewhat different because they offer different solutions to the issue of falls prevention. While the first paper argues that falls prevention messages may be rejected when the older persons associate the message with negative identities, the second paper offers a different perspective. Indeed, the second paper infers the need to consider the needs of the older people as well as their perceptions towards falling in coming up with future falls prevention programmes.  Nevertheless, the two papers agree on the need for consideration of the perceptions of older persons and necessity of having programmes that appreciate their feelings. Ultimately, the studies point to a lack of awareness in understanding the different motivations that older people have in enrolling for such programmes.

The two papers, although conducted separately, provide similar results with respect to perceptions of older people as well as their motivations. These revelations are not only critical to the nursing profession but provide a strong background for future studies in the same field. The gaps and limitations identified in the two texts form strong points for studies in the area and can be used to pinpoint the various research needs in the subject. The rationale behind the selection of these papers is based on the personal interest I have held for a long time in taking care of the elderly. In particular, my interaction with the elderly at the Falls Prevention Clinic and the incidence of falls motivated me into delving into the subject. Perhaps, in part, the decision to delve into the falls of elderly persons is also attributable to the increasing statistics of older persons prone to falls and the realization that every one of us will eventually become old.

The implication of the studies on professional practice is wide and has occasionally been recognized in the text. The two papers have provided important aspects regarding the incidence of falls among the older persons and the perceptions they have towards the same. In the end, the material presented in each of the two papers is consistent in availing a different perspective of the field of falls among the elderly. Clearly, the motivations for enrolment to falls prevention programmes have been explored beyond the normal assumptions. In addition, the findings in the studies have provided immense knowledge to the information existing within the realms of my mind. Henceforth, I can boast of having wide knowledge on the care of the elderly with particular respect to falls prevention. In essence, therefore, I can adequately manage to come up with a similar programme to prevent falls among the older persons.

The studies are effective in painting an accurate picture of the future trends in the prevention of falls among the older people. It turns out therefore that falling among the older persons was a negative occurrence that was embarrassing and detrimental to their experiences (Simpson et al, 2003). The results in the study are attributable to the choice of research tradition and the methods used in the study. Ultimately, the results in the two papers point to similar outcomes regarding the perceptions of older persons towards the phenomenon of falling. The papers employed a qualitative approach in studying the perceptions that was guided by the tenets of grounded theory. By using a qualitative study, the researcher aimed to achieve the goal of having the most representative perceptions and thus gaining a factual understanding of the problem facing the elderly. Besides having a qualitative study, the researchers employed a purposeful sampling technique in the selection of the participants. The choice of this method of sampling was not only effective in getting the most informed participants but also helped in maintaining the high ethical standards expected of the researchers.

The studies provide clear insights into the new and often assumed motivations that drive older people to register for such programmes. By drawing a relationship between the association of falls with negativity and the enrolment to those programmes (Yardley et al, 2006), the papers have effectively helped in understanding the dynamics of such occurrences. In the future, therefore, professional practice is bound to incline towards the findings outlined in these studies including the consideration of individual perceptions. The results in these papers are important in my personal understanding of the necessity of caring for the elderly as well as the different parameters to consider in the course of my practice. However, the availability of this information is not in itself a breakthrough in the practice of falls prevention. Indeed, the difficulty in translating research results into practice is often wide and diverse resulting in a huge gap between research and development. It is important that policy makers consider new research findings in shaping and implementing new policy in this subject.

Ultimately, the two papers collectively reflect the general outcomes in the prevention of falls among the older persons. Indeed, they both agree on the results to the effect that they share similar findings on the perceptions of older persons. The second paper offers almost similar results with respect to the perceptions of older persons towards falls. Evidently, the older persons consider falling to be a negative occurrence thus leading to its association with embarrassment. The results in the paper can be used in understanding the different reasons why older persons may opt out of falls prevention programmes. The results identify the motivations behind enrolment in such programmes to be independence and competence of the elderly. While some of the participants considered falls to be natural and logical, other older persons viewed falling as something that they could not accept.



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Simpson, J.M., Darwin, C. and Marsh, N., 2003. What are older people prepared to do to avoid falling? A qualitative study in London. British journal of community nursing, 8(4), pp.152-159.



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