(3.10)--原文预医医学信息检索与利用.pdf
Int J Older People Nurs.2017; 2017 John Wiley&Sons LtdReceived:19May2016|Accepted:22February2017DOI:10.1111/opn.12151R EVIE W ARTIC LEOlder peoples experiences of falling and perceived risk of falls in the community:A narrative synthesis of qualitative researchSiobhan Gardiner RN,MA1|Margaret Glogowska PhD2|Catherine Stoddart MSc1,3|Sarah Pendlebury DPhil,FRCP4,5|Daniel Lasserson MD,FRCP,MRCGP5,6|Debra Jackson PhD,FACN1,3,7,81OxfordInstituteofNursingandAlliedHealthResearch(OxINAHR),Oxford,UK2NuffieldDepartmentofPrimaryCareHealthSciences,UniversityofOxford,Oxford,UK3OxfordUniversityHospitalsNHSFoundationTrust,Oxford,UK4StrokePreventionResearchUnit,NuffieldDepartmentofClinicalNeurosciences,JohnRadcliffeHospital,andtheUniversityofOxford,Oxford,UK5OxfordNIHRBiomedicalResearchCentre,JohnRadcliffeHospital,Oxford,UK6NuffieldDepartmentofMedicine,UniversityofOxford,Oxford,UK7DepartmentofNursing,OxfordBrookesUniversity,Oxford,UK8FacultyofHealth,UniversityofTechnology(UTS),Sydney,AustraliaCorrespondenceSiobhanGardiner,OxfordInstituteofNursingandAlliedHealthResearch(OxINAHR),Oxford,UK.Email:Funding informationNationalInstituteforHealthResearchAim:Toexaminequalitativeresearchexploringolderpeoplesexperiencesoffallingandtheperceivedriskoffallinginthecommunity.Thiswillcontributenewinsightsintohowfallingisperceivedbytheoldercommunity.Background:Fallsareamajorproblemforolderpeopleandhealthcareservicesacrosstheworld.Accidentalfallsinthecommunityareapersistentproblemthatisgenerallyrecognisedasanintrinsicriskofageing.Thisreviewprovidesanewsynthesisofevi-dencethatconsidersolderpeoplesperceptionoffallsinthecommunityasnewin-sightsareneedediftheincreasingproblemsoffallsaretobeaddressed.Design:SynthesisofthequalitativeliteratureemployingNoblitandHaresmethodofreciprocaltranslation.CINAHL,Medline,EMBASE,PsychINFOandBNIweresearched19992015.Methods:NoblitandHaresmethodofreciprocaltranslationswasusedtoconceivethismeta-ethnographicsynthesis.TheENTREQstatementwasemployedasatoolforre-portingthesynthesisofqualitativeresearch.ThePRISMAstatementwasusedforre-portingthedifferentphaseoftheliteraturesearch,andtheCriticalAppraisalSkillsProgrammequalitativeresearchchecklistwasusedasanappraisalframework.Results:Elevenpapersfittheinclusioncriteriaandrevealedaseriesofthemes.Thesewerefallsasathreattopersonalidentity,fallsasathreattoindependence,fallsasathreattosocialinteractionandcarefulnessasaprotectivestrategy.Conclusion:Manyolderpeoplerejectthelabelof“atriskoffalling”becauseoftheper-ceivedimplicationofdependencyandincompetence.Tobeconsidered“atrisk”offallingisperceivedasthreateningtheidentityofindividualswhoarecomfortablemaintainingtheirownindependence.However,therearealsothosewhoaccepttheriskoffallingandindoingsochoosecarefulnessasapersonalstrategytomanagetherisk.Forthemajorityofolderpeople,maintainingindependenceisthekeymotivatorinfluencingtheiractions.Independencetopursuesocialinteractionsafeguardsagainstlossofidentity,socialisolationandnegativefeelingsofdependency.Fallinginthecommunityisaprob-lemthatpersists,despiteinterventionoflocalhealthteams.Thisarticlecontributestoabodyofevidenceonolderpeoplesexperienceoffallinginthecommunitywiththeaimofprovidingnewinsightsfornursesastheyapproachtheissueswithpatients.Implications for practice:Managementoffallsriskimprovesthroughconstructive,proactivehealthbehaviour.Promotingapositiveattitudetowardslivingwellencour-agesolderpeopletoengageinhealthy,riskreducingbehaviours.Olderpeoplereject2|GARDINA Net Gal1|INTRODUCTIONFallsareamajorproblemforolderpeopleandforhealthandsocialservicesworldwide(Yoshida2007).IntheUnitedKingdom(UK),upto30%ofpeopleagedover65yearsoldfalleachyear,althoughonlyoneinfivefallsrequiremedicalattentionandlessthanoneintenresultsinafracture(Gillespieetal.,2009).InaGlobalReportonFallsPreventionfortheWorldHealthOrganisation,Yoshida(2007)reportedthatthefrequencyoffallsincreaseswithageandfrailty;mostoccurduringtheday,withonly20%occurringatnight.Menaremorelikelytofallwhilebeingactiveoutdoors,whilewomenaremorelikelytofallinthehome.Infact,womenare40%60%morelikelytofallthanmenandovertwiceaslikelytosufferfractures(Yoshida,2007).Recentdataonfallsincidencearelimited,althoughintheUK,fallscosttheNationalHealthServicemorethan2billionayear,andwiththenumberofpeopleagedover65yearsoldpredictedtoincreaseby2millionin2021,thereareconcernsthatthetrajectoryissettocontinueupwards(Tianetal.,2013).High-incomecountriesaccountfor25%ofthetotalnumberoffatalfallsworldwide,thehighestratesoccurringinEuropeancountries(Yoshida,2007).Asaresult,theUKNationalHealthServicehasinitiatedfallspreventionprogrammestomanagetheanticipatedrisktopeopleagedover65yearsofage.However,thereissomeevidencetosuggestthateffortsbyhealth-careprofessionalstointervenetoreducetheriskoffallsarepoorlytakenupandoftenrejectedbythepopulationstheyareaimingtosupport(Nyman&Ballinger,2007;Yardley,2005).Thegeographicalaspectmaycausedifficultiesinsomecommunitieswherethelocationofagroupinterventionmaycausedifficultiesforolderpeoplewillingtoattend.Alternatively,fallspreventionadviceisregardedasusefulinprinciple,butthecommon-senseadviceofferedmaynotbeperceivedasrelevantorappropriate(Yardley2005).While a large body of quantitative evidence exists including thecauses,numberandtreatmentoffalls,thereisratherlessliteratureontheexperiencesandperspectivesofolderpeoplethemselves.Inorderfornursestoinfluencehealthybehaviourstheyneedtounderstandtheper-ceptionofthepeopletheyarecaringfor.Thus,thefocusofthisreviewistogaininsightintotheexperienceofolderpeoplewhofallinthecommu-nityandindoingsoassistnursesdecision-makingfortheirpatients.Theevidenceexaminedincludestheperceptionoffallingortheriskoffallingbythoseconsideredatriskbythehealthcareprofession.Thisarticlehasgatheredinformationtocreateasynthesistoassistnursesintheirunder-standingoftheissuesfacedbyolderpeople.Thisunderstandingwillaidthemintheireffortstoplacetheappropriateserviceswiththeirpatients.What does this research add to existing knowledge in gerontology?Thisreviewcontributestothebodyofevidencebyhigh-lightingtheperceptionsofolderpeopleinthecommunityconsideredatriskoffalling.Fallsareaproblembeyondphysicalharm,threateningpersonalidentity,independ-enceandsocialinteraction.Fallsarenegativelyassociatedwithageingwiththeresultthatmanyolderpeopledenytheirfallsorriskoffalling.Theterminologyoffallspreventionisviewednegativelybyolderpeopledenyingtheirfallsorriskoffalling.Asaresult,theydonotengageinfallspreventionmeasurestoreducetheriskoffalls.Despitemultiplepreviousreviewsonthetopic,theprob-lempersistsmeaningnewinterpretationsarerequired.What are the implications of this new knowledge for nurs-ing care with older people?Management of falls risk could be portrayed more acceptablyifitisthroughconstructive,proactivehealthbehaviour.Bycreatingamorepositiveattitudetowardslivingwell,olderpeoplewillbemorelikelytoengageinhealthy,andthereforeriskreducingbehaviours.Manyolderpeoplerejectthelabelof“atriskoffalling”becauseoftheperceivedimplicationofdependencyandincompetence.Asaresult,olderpeoplefailtoengagewith the interventions put in place to assist them in reducingtheirriskoffalling.How should the findings be used to influence practice or research?Understandingolderpeoplesreluctancetoengagewithfallspreventionschemesshouldencouragenursestocon-sideralternativestrategiestoencouragethispopulation.Researchisneededtounderstandtheperceptionoffallsinolderpeoplewithdementialivinginthecommunity.Inthesameway,weneedtounderstandtheissuesfacedbyolderpeoplelivinginthecommunity,therewillbeissuesspecifictothosewithdementia.Theseissueswillneedtobeunderstoodbynursessothattheappropriateservicesmaybeengaged.thedesignationof“atriskoffalling”duetoaperceivedassociationwithdependencyandincompetence.Thenegativeassociationisabarriertoengagingat-riskpopula-tionswithfallpreventioninterventions.K E Y W ORDScommunity,falls,nursing,olderpeople,qualitativemethods,reciprocaltranslation|3GARDINA Net Gal2|METHODS AND METHODOLOGYThisarticleemploysthe“Enhancingtransparencyinreportingthesyn-thesisofqualitativeresearch(ENTREQ)Statement”(Tongetal.,2012)asaguideforreportingthesynthesisofqualitativehealthresearch.Allofthestudiesidentifiedsharethemesandconceptsoffallingastheyareperceivedbyolderpeoplelivinginthecommunity;therefore,therearethemesthattranslateacrossstudies.Thesimilaritiesinthestudiesenabletheuseofreciprocaltranslationasamethodofsynthe-sis(NoblitandHare1988).This review employed a preplanned sensitive search strategythatcombinedthepopulationandcontextwasemployedtosearchforevidence,relatingtofalls,experienceandqualitativemethodol-ogy.Thesearchwasnotexhaustive.CINAHL,MedlineandEMBASEweresearchedusingtheexplodedtermsACCIDENTALFALLSORFALLINGANDFRAILELDERLY.PsychInfoandBNIweresearchedusingtheexplodedtermsFALLSORHEALTHIMPAIRMENTSAND“elder*”andBNIwithexplodedtermELDERLY:ACCIDENTSAND“fall*”AND“qualitative”.A comprehensive report of the differentphasesofthesearchstrategycanbeseeninthePRISMAflowchart(seeFigure1).Paperswere included if theywerewritten in English,published19992015andincludedolderpeoplesperspectivesoffallsorfallinginthecommunity.Theinitialsearchyielded628articles.Articlesexcludedwerethosenotofaqualitativeresearchdesignorthosethatwereirrel-evanttotheresearchobjectiveandwerediscardediftheyweredupli-catedacrossdatabases,inalanguageotherthanEnglish,opinionpiecesorsystematicliteraturereviews.Studieswereexcludediftheytookplaceinhospitalsorothercaresettings,iftheywereinvestigatingtheimpactofaspecificinterventionorpreventionprogrammeoriftheywereevaluatingassessmenttools.Thesearchprocesswasconductedbythefirstauthorandauditedbyahealthlibrarian.Elevenpaperswereidentifiedasfittingtheinclusioncriteria(seeFigure1),althoughtwowerereportsfromthesamedataset(Roeetal.2008,2009).Elevenpaperswereexaminedtoevaluaterigour,credibilityandrelevance,usingtheCriticalAppraisalProgramme(CriticalAppraisalSkillsProgramme2013)forqualitativeresearchandconductedinde-pendently by the author.Findings were tabulated into a table ofevidence(seeTable1).Eachpaperwasreviewedtodeterminetheperceptionsofolderpeopletowardsfalling,andthemescentraltotheperceptionsoffallingandriskasgivenbytheinformants.Allarticlessharetheinterestinthephenomenaofolderpeoplesperceptionoffallinginthecommunity.Thistypeofreciprocaltransla-tionsynthesis(NobiltandHare1988)requiressimilarstudiesthatcanbe“added”together.Itenablesamoreholisticunderstandingofhowfallsareperceivedbytheolderpopulationand,inturn,guidenursestowardsthemostappropriatemeasuresintheirapproachtofallspre-vention.Theauthorreadeachpaperseveraltimesfocusingoncon-ceptsandthemestheauthorsemployedtodescribetheirparticipantsexperience of falls in the community.The themes identified were“translated”acrossthestudies.(SeeTable2).Allinterpretationsweregroundedinthearticlessynthesised.Whentheconceptsandthemeswereidentifiedfromallpapers,asecondauthor(DJ)discussedthedescriptivethemestofurtherdevelopthethemesfordiscussion.Thesynthesisedthemesandtheirapplicationtoolderpeoplesperceptionoffallingwillbereviewedinthesynthesisoffindings.2.1|Synthesis of findingsThisarticlepresentstheevidencethataccidentalfallsintheoldercommunityisrecognisedasaworldwideproblem;however,itisonethatpersists.Thisimpliesthathealthcareprofessionalsrequirenewwaysofunderstandingtheissuesrelevanttotheoldercommunitywherefallsmaybearisk.ExaminationoftheliteraturerevealedthatFIGURE1Literaturereviewflowchart4|GARDINA Net Galfallshavemultipleeffectsonthosefallingwellbeyondanyimmediatephysicalharms.Complexsequelaewererevealed.Thesewerefallsasathreattopersonalidentity,fallsasathreattoindependence,fallsasathreattosocialinteractionandcarefulnessasaprotectivestrategy.Thesethemesarediscussedindetailbelow.2.2|Falls as a threat to personal identityFallingaffectedconfidencesoseverelythatitrepresentedathreatto personal identity.Acceptance of being at risk undermined anindividualsstatusascompetentandindependentandassumedanacceptanceofbecomingoldandinfirm.Theimportanceofidentityisthefocusoftwoofthearticlesexaminedinthisreviewinresponsetotheevidencethatsomequalitativeresearchidentifiedolderpeo-pledistancingthemselvesfrombeinglabelledas“atriskoffalling”oras“fallers.”Fallingisathreattotheidentityofapersonwhowouldprefertoberegardedasthetypeofpersonwhodoesnotfall(Dollardetal.,2012).Ithasbeennotedintheliteraturethatoneofthereasonsofferedforthepooruptakeoffallspreventionpro-grammesistheconceptthatindividualsrejecttheideaofbeing“atTABLE1SummaryofincludedstudiesReferencesMethodology and methodSampleAim/sBerlinHallrupetal.(2009)PhenomenologicallifeworldapproachthroughinterviewsPurposivesampletocreatevariation 13womenlivingontheirowninruralareasToexplorethelivedexperienceoffallriskfromalifeworldperspectiveinelderlywomenwithpreviousfragilityfracturesDollardetal.(2012)Groundedtheory.Semi-structuredinterviews,purposively sampledCommunitydwelling sixwomenandthreemenagedover6585 yearsTounderstandolderpeoplesperceptionoftheirandotherolderpeoplesfallsrisk.IncreaseunderstandingofwhyolderpeoplemightnotbelievefallsarerelevanttothemselvesHawley(2009)Groundedtheory.UnstructuredinterviewsNineolderpeopleover60yearsoldwhohadbeenfallsrehabilitation.Oneparticipantlivedinanursinghome,threelivedwithspouses,therestaloneToexplorewhatmightencourageolderpeopletoexerciseathomeafterfallsrehabilitationHorton(2007)Exploratorydesign,groundedtheoryanalysis.In-depthinterviewsConveniencesampleof40olderpeoplelivingintheSEEngland.20men,20womenaged5695yearsoldExploretheinfluenceofgenderonolderpeoplesperceptionsoftheirriskoffallingandtheiractionstopreventfuturefallsKongetal.(2002)Explorativequalitativeapproachwithsemi-structuredinterviews20informantswithrecentfallsexperienceeitherinthecommunityorhospitalsettingToexplorethepsychosocialconsequencesoffallingwithagroupofolderChinesewhohadrecentlyfallenMahleretal.(2012)Narrativeinterviewsinspiredbyinterpretativephenom-enologyusingthematicanalysisFivewomenaged8194years.Adhocsamplingaccordingtowillingnessandabilitytotalkin-depthwithastrangerToilluminatetheexperiencesandthemeaningoffearoffallinginadaily-lifecontextPorter(1999)OpenendedinterviewsusingdescriptivephenomenologyapproachSubsampleofninewomen,aged8396 yearsToexploreaneglectedrealmoffrailolderwomensexperienceoffallingtothefloorandtryingtogetupwhileathomealoneRoeetal.(2008)Semi-structuredinterviewsandfollow-upinterviewthematiccontentanalysisConveniencesampleof27olderpeopleagedbetween65and98yearsToexploretheexperiencesofolderpeoplewhosufferedarecentfallandidentifypossiblefactorsthatcouldcontributetoservicedevelopment.Roeetal.(2009)Anexploratory,qualitativedesigninvolvingtwotimepoints.Semi-structuredinterviewsAconveniencesampleof27olderpeoplewhohadarecentfallToexploretheexperiencesofolderpeoplewhohadarecentfallanditsimpactontheirhealth,well-being,qualityoflifeandrelatedfactors.ToexploreolderpeoplesexperiencesandviewsofformalservicesfollowingafallandtheroleofsocialnetworksandinformalcareWalkeretal.(2011)Semi-structuredinterviews Videoobservationandexaminationofparticipantreferral records13participants,11interviewedToexploretheexperiencesofolderpeoplewhohadarecentfallanditsimpactontheirhealth,w
