Ask an answerable question (PICO)：
Cognitive impairment is a common disease in the elderly, and its factors include unstable gait, decreased balance, loss of orientation, confusion, and anxiety, which can easily lead to falls. Conventional fall prevention interventions cannot effectively reduce the incidence of falls. Studies have found that exercise could improve gait speed and overall cognitive function in people with mild cognitive impairment; both are known risk factors associated with falls. In clinical, exercise is difficult to implement for patients with cognitive impairment. Only nursing homes or few patients have finished the exercise course, and the implementation and effectiveness were inconsistent. The patient said ‘’we do not want to fall again.’’ Thus, we ask a clinical question ‘’ Can the implementation of fall prevention reduce the incidence of falls in cognitive impairment patients?‘’ We hope to provide clinical treatment guidance under evidence-based review.
The Method and Analysis of Literature Review：
In this review, we followed the first three steps of the evidence-based nursing 5As process: asking, acquire, appraisal and propose a PICO question ‘’Will the exercise reduce the incidence of falls in cognitive impairment elderly?’’ We systematically searched Airity Library, PubMed/MEDLINE, Cochrane Library, Embase, CINAHL database under setting the MeSH term and synonyms related to ‘’cognitive impairment’’, ‘’exercise’’ and ‘’fall’’ in English and Chinese databases. We included 136 papers with search strategies of OR and AND by Boolean logic and restricted to non-comparative research design. After excluding papers with duplicate articles and without explored the effect of prevention intervention for falls, we included one mixed review and 2 randomized controlled trials for further evaluation.
Critical Appraisal：
In our review, we used the 2020 CASP systematic review and randomized controlled trial standard checklist as the tool for critical appraisal. All 3 studies examined the effectiveness of fall prevention interventions in reducing the incidence of falls. As the result of critical appraisal of the quality, 2 RCTs are high-risk of bias on non-blinding and no intention-to-treat analysis, and whether the value of interventions was better than other existing interventions are moderate risk, and other bias are low risk. The overall results, all 3 studies showed that the incidence of falls and the degree of injury among cognitive impairment patients in the hospital were much higher than health people, and routine exercise or multiple fall prevention interventions did not significantly reduce the incidence of falls. The three studies are level 1c and 2b evidence in JBI 2014 evidence level for evidence-based medicine (2014).
Results, Conclusions and Recommendations：
As the result of 3 studies, older hospital patients with cognitive impairment fell and injury are worse compared to older patients without cognitive impairment. Routine exercise does not significantly reduce the incidence of falls. One of studies showed that the process of exercise caused the elderly with cognitive impairment to fall. Exercise interventions require a high degree of compliance and inter-professional involvement to be effective. Thus, we don’t encourage routine use exercise prescriptions or multiple fall prevention measures to reduce the incidence of falls in clinical is not recommended. We suggest that establish a inter-professional team model and medical care to prevent falls in patients with cognitive impairment, in order to improve the quality of life of the elderly with mild cognitive impairment, reduce the burden on caregivers, and achieve the integrity of whole-person care.
