P: older adults (60 years +)
I: The effect of physical exercise
C: Usual care by a geriatrician
O: Patient falls
T: Three months
Clinical Question: In older adults (60+ years), what is the effect of physical exercise compared to usual care by a geriatrician on patient falls over three months?
Two databases were used: PubMed (for EBP papers) and Google Scholar (to broaden the scope of the results). In this paper, I explain how I searched for articles on PubMed. The same procedure was repeated for Google Scholar. My search terms started with the intervention and outcome, which gave 1221 results on different patient demographics from older adults to osteoporosis and Parkinson’s disease. I refined the results by adding the population of interest, which gave me 903 results, and two high-quality papers by Liu-Ambrose et al. (2019) and Tricco et al. (2017).
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However, I wanted results that included my comparison. I added the OR Boolean operator to my search terms as follows: “older adults effect of physical exercise on patient falls OR effect of geriatric care on patient falls.” There were 1466 results. To increase the rigor and effectiveness of the database search, I filtered the works to papers published in the last five years, which cut down the results to 614. I also wanted fully available articles, meta-analysis, randomized controlled trials, and systematic reviews. The results were 212, of which Martínez-Velilla et al. (2019) stood out. However, I also wanted clinical trials only for patients above 65 years. There were 193 results. The next step would involve selecting the top ten results from different search criteria, reading the abstracts to narrow down the validity of the works by quality and relevance to the PICO(T) question. I ended up reading over sixty papers in groups of ten and sorting them by order of relevance to the subject matter.
References
Liu-Ambrose, T., Davis, J. C., Best, J. R., Dian, L., Madden, K., Cook, W., ... & Khan, K. M. (2019). Effect of a home-based exercise program on subsequent falls among community-dwelling high-risk older adults after a fall: a randomized clinical trial. Jama , 321 (21), 2092-2100.
Martínez-Velilla, N., Casas-Herrero, A., Zambom-Ferraresi, F., de Asteasu, M. L. S., Lucia, A., Galbete, A., ... & Iráizoz, I. A. (2019). Effect of exercise intervention on functional decline in very elderly patients during acute hospitalization: a randomized clinical trial. JAMA internal medicine , 179 (1), 28-36.
Tricco, A. C., Thomas, S. M., Veroniki, A. A., Hamid, J. S., Cogo, E., Strifler, L., ... & Riva, J. J. (2017). Comparisons of interventions for preventing falls in older adults: a systematic review and meta-analysis. Jama , 318 (17), 1687-1699.
