(3.10)--原文预医医学信息检索与利用.pdf

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1、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 Glogow

2、ska 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,UK3OxfordUniversityHospitalsNHS

3、FoundationTrust,Oxford,UK4StrokePreventionResearchUnit,NuffieldDepartmentofClinicalNeurosciences,JohnRadcliffeHospital,andtheUniversityofOxford,Oxford,UK5OxfordNIHRBiomedicalResearchCentre,JohnRadcliffeHospital,Oxford,UK6NuffieldDepartmentofMedicine,UniversityofOxford,Oxford,UK7DepartmentofNursing,O

4、xfordBrookesUniversity,Oxford,UK8FacultyofHealth,UniversityofTechnology(UTS),Sydney,AustraliaCorrespondenceSiobhanGardiner,OxfordInstituteofNursingandAlliedHealthResearch(OxINAHR),Oxford,UK.Email:Funding informationNationalInstituteforHealthResearchAim:Toexaminequalitativeresearchexploringolderpeopl

5、esexperiencesoffallingandtheperceivedriskoffallinginthecommunity.Thiswillcontributenewinsightsintohowfallingisperceivedbytheoldercommunity.Background:Fallsareamajorproblemforolderpeopleandhealthcareservicesacrosstheworld.Accidentalfallsinthecommunityareapersistentproblemthatisgenerallyrecognisedasan

6、intrinsicriskofageing.Thisreviewprovidesanewsynthesisofevi-dencethatconsidersolderpeoplesperceptionoffallsinthecommunityasnewin-sightsareneedediftheincreasingproblemsoffallsaretobeaddressed.Design:SynthesisofthequalitativeliteratureemployingNoblitandHaresmethodofreciprocaltranslation.CINAHL,Medline,

7、EMBASE,PsychINFOandBNIweresearched19992015.Methods:NoblitandHaresmethodofreciprocaltranslationswasusedtoconceivethismeta-ethnographicsynthesis.TheENTREQstatementwasemployedasatoolforre-portingthesynthesisofqualitativeresearch.ThePRISMAstatementwasusedforre-portingthedifferentphaseoftheliteraturesear

8、ch,andtheCriticalAppraisalSkillsProgrammequalitativeresearchchecklistwasusedasanappraisalframework.Results:Elevenpapersfittheinclusioncriteriaandrevealedaseriesofthemes.Thesewerefallsasathreattopersonalidentity,fallsasathreattoindependence,fallsasathreattosocialinteractionandcarefulnessasaprotective

9、strategy.Conclusion:Manyolderpeoplerejectthelabelof“atriskoffalling”becauseoftheper-ceivedimplicationofdependencyandincompetence.Tobeconsidered“atrisk”offallingisperceivedasthreateningtheidentityofindividualswhoarecomfortablemaintainingtheirownindependence.However,therearealsothosewhoaccepttheriskof

10、fallingandindoingsochoosecarefulnessasapersonalstrategytomanagetherisk.Forthemajorityofolderpeople,maintainingindependenceisthekeymotivatorinfluencingtheiractions.Independencetopursuesocialinteractionsafeguardsagainstlossofidentity,socialisolationandnegativefeelingsofdependency.Fallinginthecommunity

11、isaprob-lemthatpersists,despiteinterventionoflocalhealthteams.Thisarticlecontributestoabodyofevidenceonolderpeoplesexperienceoffallinginthecommunitywiththeaimofprovidingnewinsightsfornursesastheyapproachtheissueswithpatients.Implications for practice:Managementoffallsriskimprovesthroughconstructive,

12、proactivehealthbehaviour.Promotingapositiveattitudetowardslivingwellencour-agesolderpeopletoengageinhealthy,riskreducingbehaviours.Olderpeoplereject2|GARDINA Net Gal1|INTRODUCTIONFallsareamajorproblemforolderpeopleandforhealthandsocialservicesworldwide(Yoshida2007).IntheUnitedKingdom(UK),upto30%ofpe

13、opleagedover65yearsoldfalleachyear,althoughonlyoneinfivefallsrequiremedicalattentionandlessthanoneintenresultsinafracture(Gillespieetal.,2009).InaGlobalReportonFallsPreventionfortheWorldHealthOrganisation,Yoshida(2007)reportedthatthefrequencyoffallsincreaseswithageandfrailty;mostoccurduringtheday,wi

14、thonly20%occurringatnight.Menaremorelikelytofallwhilebeingactiveoutdoors,whilewomenaremorelikelytofallinthehome.Infact,womenare40%60%morelikelytofallthanmenandovertwiceaslikelytosufferfractures(Yoshida,2007).Recentdataonfallsincidencearelimited,althoughintheUK,fallscosttheNationalHealthServicemoreth

15、an2billionayear,andwiththenumberofpeopleagedover65yearsoldpredictedtoincreaseby2millionin2021,thereareconcernsthatthetrajectoryissettocontinueupwards(Tianetal.,2013).High-incomecountriesaccountfor25%ofthetotalnumberoffatalfallsworldwide,thehighestratesoccurringinEuropeancountries(Yoshida,2007).Asare

16、sult,theUKNationalHealthServicehasinitiatedfallspreventionprogrammestomanagetheanticipatedrisktopeopleagedover65yearsofage.However,thereissomeevidencetosuggestthateffortsbyhealth-careprofessionalstointervenetoreducetheriskoffallsarepoorlytakenupandoftenrejectedbythepopulationstheyareaimingtosupport(

17、Nyman&Ballinger,2007;Yardley,2005).Thegeographicalaspectmaycausedifficultiesinsomecommunitieswherethelocationofagroupinterventionmaycausedifficultiesforolderpeoplewillingtoattend.Alternatively,fallspreventionadviceisregardedasusefulinprinciple,butthecommon-senseadviceofferedmaynotbeperceivedasreleva

18、ntorappropriate(Yardley2005).While a large body of quantitative evidence exists including thecauses,numberandtreatmentoffalls,thereisratherlessliteratureontheexperiencesandperspectivesofolderpeoplethemselves.Inorderfornursestoinfluencehealthybehaviourstheyneedtounderstandtheper-ceptionofthepeoplethe

19、yarecaringfor.Thus,thefocusofthisreviewistogaininsightintotheexperienceofolderpeoplewhofallinthecommu-nityandindoingsoassistnursesdecision-makingfortheirpatients.Theevidenceexaminedincludestheperceptionoffallingortheriskoffallingbythoseconsideredatriskbythehealthcareprofession.Thisarticlehasgathered

20、informationtocreateasynthesistoassistnursesintheirunder-standingoftheissuesfacedbyolderpeople.Thisunderstandingwillaidthemintheireffortstoplacetheappropriateserviceswiththeirpatients.What does this research add to existing knowledge in gerontology?Thisreviewcontributestothebodyofevidencebyhigh-light

21、ingtheperceptionsofolderpeopleinthecommunityconsideredatriskoffalling.Fallsareaproblembeyondphysicalharm,threateningpersonalidentity,independ-enceandsocialinteraction.Fallsarenegativelyassociatedwithageingwiththeresultthatmanyolderpeopledenytheirfallsorriskoffalling.Theterminologyoffallspreventionis

22、viewednegativelybyolderpeopledenyingtheirfallsorriskoffalling.Asaresult,theydonotengageinfallspreventionmeasurestoreducetheriskoffalls.Despitemultiplepreviousreviewsonthetopic,theprob-lempersistsmeaningnewinterpretationsarerequired.What are the implications of this new knowledge for nurs-ing care wi

23、th older people?Management of falls risk could be portrayed more acceptablyifitisthroughconstructive,proactivehealthbehaviour.Bycreatingamorepositiveattitudetowardslivingwell,olderpeoplewillbemorelikelytoengageinhealthy,andthereforeriskreducingbehaviours.Manyolderpeoplerejectthelabelof“atriskoffalli

24、ng”becauseoftheperceivedimplicationofdependencyandincompetence.Asaresult,olderpeoplefailtoengagewith the interventions put in place to assist them in reducingtheirriskoffalling.How should the findings be used to influence practice or research?Understandingolderpeoplesreluctancetoengagewithfallspreve

25、ntionschemesshouldencouragenursestocon-sideralternativestrategiestoencouragethispopulation.Researchisneededtounderstandtheperceptionoffallsinolderpeoplewithdementialivinginthecommunity.Inthesameway,weneedtounderstandtheissuesfacedbyolderpeoplelivinginthecommunity,therewillbeissuesspecifictothosewith

26、dementia.Theseissueswillneedtobeunderstoodbynursessothattheappropriateservicesmaybeengaged.thedesignationof“atriskoffalling”duetoaperceivedassociationwithdependencyandincompetence.Thenegativeassociationisabarriertoengagingat-riskpopula-tionswithfallpreventioninterventions.K E Y W ORDScommunity,falls

27、,nursing,olderpeople,qualitativemethods,reciprocaltranslation|3GARDINA Net Gal2|METHODS AND METHODOLOGYThisarticleemploysthe“Enhancingtransparencyinreportingthesyn-thesisofqualitativeresearch(ENTREQ)Statement”(Tongetal.,2012)asaguideforreportingthesynthesisofqualitativehealthresearch.Allofthestudies

28、identifiedsharethemesandconceptsoffallingastheyareperceivedbyolderpeoplelivinginthecommunity;therefore,therearethemesthattranslateacrossstudies.Thesimilaritiesinthestudiesenabletheuseofreciprocaltranslationasamethodofsynthe-sis(NoblitandHare1988).This review employed a preplanned sensitive search st

29、rategythatcombinedthepopulationandcontextwasemployedtosearchforevidence,relatingtofalls,experienceandqualitativemethodol-ogy.Thesearchwasnotexhaustive.CINAHL,MedlineandEMBASEweresearchedusingtheexplodedtermsACCIDENTALFALLSORFALLINGANDFRAILELDERLY.PsychInfoandBNIweresearchedusingtheexplodedtermsFALLS

30、ORHEALTHIMPAIRMENTSAND“elder*”andBNIwithexplodedtermELDERLY:ACCIDENTSAND“fall*”AND“qualitative”.A comprehensive report of the differentphasesofthesearchstrategycanbeseeninthePRISMAflowchart(seeFigure1).Paperswere included if theywerewritten in English,published19992015andincludedolderpeoplesperspect

31、ivesoffallsorfallinginthecommunity.Theinitialsearchyielded628articles.Articlesexcludedwerethosenotofaqualitativeresearchdesignorthosethatwereirrel-evanttotheresearchobjectiveandwerediscardediftheyweredupli-catedacrossdatabases,inalanguageotherthanEnglish,opinionpiecesorsystematicliteraturereviews.St

32、udieswereexcludediftheytookplaceinhospitalsorothercaresettings,iftheywereinvestigatingtheimpactofaspecificinterventionorpreventionprogrammeoriftheywereevaluatingassessmenttools.Thesearchprocesswasconductedbythefirstauthorandauditedbyahealthlibrarian.Elevenpaperswereidentifiedasfittingtheinclusioncri

33、teria(seeFigure1),althoughtwowerereportsfromthesamedataset(Roeetal.2008,2009).Elevenpaperswereexaminedtoevaluaterigour,credibilityandrelevance,usingtheCriticalAppraisalProgramme(CriticalAppraisalSkillsProgramme2013)forqualitativeresearchandconductedinde-pendently by the author.Findings were tabulate

34、d into a table ofevidence(seeTable1).Eachpaperwasreviewedtodeterminetheperceptionsofolderpeopletowardsfalling,andthemescentraltotheperceptionsoffallingandriskasgivenbytheinformants.Allarticlessharetheinterestinthephenomenaofolderpeoplesperceptionoffallinginthecommunity.Thistypeofreciprocaltransla-ti

35、onsynthesis(NobiltandHare1988)requiressimilarstudiesthatcanbe“added”together.Itenablesamoreholisticunderstandingofhowfallsareperceivedbytheolderpopulationand,inturn,guidenursestowardsthemostappropriatemeasuresintheirapproachtofallspre-vention.Theauthorreadeachpaperseveraltimesfocusingoncon-ceptsandt

36、hemestheauthorsemployedtodescribetheirparticipantsexperience of falls in the community.The themes identified were“translated”acrossthestudies.(SeeTable2).Allinterpretationsweregroundedinthearticlessynthesised.Whentheconceptsandthemeswereidentifiedfromallpapers,asecondauthor(DJ)discussedthedescriptiv

37、ethemestofurtherdevelopthethemesfordiscussion.Thesynthesisedthemesandtheirapplicationtoolderpeoplesperceptionoffallingwillbereviewedinthesynthesisoffindings.2.1|Synthesis of findingsThisarticlepresentstheevidencethataccidentalfallsintheoldercommunityisrecognisedasaworldwideproblem;however,itisonetha

38、tpersists.Thisimpliesthathealthcareprofessionalsrequirenewwaysofunderstandingtheissuesrelevanttotheoldercommunitywherefallsmaybearisk.ExaminationoftheliteraturerevealedthatFIGURE1Literaturereviewflowchart4|GARDINA Net Galfallshavemultipleeffectsonthosefallingwellbeyondanyimmediatephysicalharms.Compl

39、exsequelaewererevealed.Thesewerefallsasathreattopersonalidentity,fallsasathreattoindependence,fallsasathreattosocialinteractionandcarefulnessasaprotectivestrategy.Thesethemesarediscussedindetailbelow.2.2|Falls as a threat to personal identityFallingaffectedconfidencesoseverelythatitrepresentedathrea

40、tto personal identity.Acceptance of being at risk undermined anindividualsstatusascompetentandindependentandassumedanacceptanceofbecomingoldandinfirm.Theimportanceofidentityisthefocusoftwoofthearticlesexaminedinthisreviewinresponsetotheevidencethatsomequalitativeresearchidentifiedolderpeo-pledistanc

41、ingthemselvesfrombeinglabelledas“atriskoffalling”oras“fallers.”Fallingisathreattotheidentityofapersonwhowouldprefertoberegardedasthetypeofpersonwhodoesnotfall(Dollardetal.,2012).Ithasbeennotedintheliteraturethatoneofthereasonsofferedforthepooruptakeoffallspreventionpro-grammesistheconceptthatindivid

42、ualsrejecttheideaofbeing“atTABLE1SummaryofincludedstudiesReferencesMethodology and methodSampleAim/sBerlinHallrupetal.(2009)PhenomenologicallifeworldapproachthroughinterviewsPurposivesampletocreatevariation 13womenlivingontheirowninruralareasToexplorethelivedexperienceoffallriskfromalifeworldperspec

43、tiveinelderlywomenwithpreviousfragilityfracturesDollardetal.(2012)Groundedtheory.Semi-structuredinterviews,purposively sampledCommunitydwelling sixwomenandthreemenagedover6585 yearsTounderstandolderpeoplesperceptionoftheirandotherolderpeoplesfallsrisk.Increaseunderstandingofwhyolderpeoplemightnotbel

44、ievefallsarerelevanttothemselvesHawley(2009)Groundedtheory.UnstructuredinterviewsNineolderpeopleover60yearsoldwhohadbeenfallsrehabilitation.Oneparticipantlivedinanursinghome,threelivedwithspouses,therestaloneToexplorewhatmightencourageolderpeopletoexerciseathomeafterfallsrehabilitationHorton(2007)Ex

45、ploratorydesign,groundedtheoryanalysis.In-depthinterviewsConveniencesampleof40olderpeoplelivingintheSEEngland.20men,20womenaged5695yearsoldExploretheinfluenceofgenderonolderpeoplesperceptionsoftheirriskoffallingandtheiractionstopreventfuturefallsKongetal.(2002)Explorativequalitativeapproachwithsemi-

46、structuredinterviews20informantswithrecentfallsexperienceeitherinthecommunityorhospitalsettingToexplorethepsychosocialconsequencesoffallingwithagroupofolderChinesewhohadrecentlyfallenMahleretal.(2012)Narrativeinterviewsinspiredbyinterpretativephenom-enologyusingthematicanalysisFivewomenaged8194years

47、.Adhocsamplingaccordingtowillingnessandabilitytotalkin-depthwithastrangerToilluminatetheexperiencesandthemeaningoffearoffallinginadaily-lifecontextPorter(1999)OpenendedinterviewsusingdescriptivephenomenologyapproachSubsampleofninewomen,aged8396 yearsToexploreaneglectedrealmoffrailolderwomensexperien

48、ceoffallingtothefloorandtryingtogetupwhileathomealoneRoeetal.(2008)Semi-structuredinterviewsandfollow-upinterviewthematiccontentanalysisConveniencesampleof27olderpeopleagedbetween65and98yearsToexploretheexperiencesofolderpeoplewhosufferedarecentfallandidentifypossiblefactorsthatcouldcontributetoserv

49、icedevelopment.Roeetal.(2009)Anexploratory,qualitativedesigninvolvingtwotimepoints.Semi-structuredinterviewsAconveniencesampleof27olderpeoplewhohadarecentfallToexploretheexperiencesofolderpeoplewhohadarecentfallanditsimpactontheirhealth,well-being,qualityoflifeandrelatedfactors.Toexploreolderpeoples

50、experiencesandviewsofformalservicesfollowingafallandtheroleofsocialnetworksandinformalcareWalkeretal.(2011)Semi-structuredinterviews Videoobservationandexaminationofparticipantreferral records13participants,11interviewedToexploretheexperiencesofolderpeoplewhohadarecentfallanditsimpactontheirhealth,w