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The purpose of the study “Quantitative gait markers and incident fall risk in older adults” conducted by Verghese, Holtzer, Lipton, and Wang was to identify the gait markers that can be associated with the risks of falls in older persons (Verghese, Holtzer, Lipton, & Wang, 2009, p. 896). The authors state that the problem is in the fact that older adults’ falls often lead to negative outcomes, and there is no quantitative information regarding fall risk factors to develop screening procedures and interventions.
There is no literature review in the article, and there is limited information on previous studies in the field. The references are used only to describe the problem and support the necessity of the research. The cited articles are relevant, but the majority of articles are outdated because they were published in the 1980s-1990s. However, the lack of cited research that were conducted before 2009 supports the idea that the discussed study was urgent for the period of its development. The little discussion of the topic demonstrates the need for more quantitative studies to measure gait speed and associate it with falls.
The researchers do not provide any discussion of the theoretical background for the research while decreasing its value to the theory of nursing.
The research objectives formulated by the authors point to the necessity to determine the relationships between gait speed and other markers and the risk of falls in older adults. This objective should be discussed as relevant to address the problem and direct the quantitative study.
Verghese et al. develop their study to determine the relationship between the gait markers and risk of falls, where gait markers including gait speed, double support, swing, cadence, stride length variability, stride length, and swing time variability are independent variables and the risk of falls in older adults is a dependent variable (Verghese et al., 2009, p. 896). To make the dependent variable easy to measure, the researchers refer to the incident fall rate as the operational definition. The focus on these characteristics is important to reduce possible inaccuracies in results.
Thus, attributes and demographic variables important to be referred to in the study include the participants’ age, gender, level of education, the presence of chronic illnesses, the presence of disability, the use of medications, and cognitive status. These factors are important to be taken into consideration during the analysis of the study results.
The researchers chose the appropriate prospective cohort study to monitor participants for several years in order to receive the most accurate results. The study was divided into several phases to determine changes in the participants’ gait and rate of falls. No pilot-study was conducted.
The researchers referred to the Einstein Aging Study to identify participants and invited the members of Bronx County to participate in the study. Thus, it is possible to state that the authors used the convenience sampling method. The main criterion for inclusion was the age (aged 70 and older) and exclusion sample criteria were institutionalization, severe audiovisual conditions, and the fact of being bed bound (Verghese et al., 2009, p. 896). 827 persons were invited to participate in the study, but only 597 people could participate in the study because of being assessed in relation to all set factors. The written informed consents were received after the discussion of details via telephone. Then, the participants were invited to Yeshiva University at yearly intervals to be assessed. Focusing on the fact that the participants were selected with references to the Einstein Aging Study, the sampling strategy can be discussed as rather appropriate.
The quantitative gait studies were completed with the help of the GAITRite system that measured the speed of gait and other factors. The used scale was interval, and the instrument can be discussed as reliable because it is actively used in similar studies. The rate of falls was determined with the help of interviews. This method can be discussed as valid to determine the rate of falls in relation to the concrete person. The used scale was ratio. The clinical assessments were completed with the help of structured questionnaires and different types of scales. Thus, the interval level of measurement was applied. These approaches can be discussed as reliable to examine the patients’ health status.
The procedures for data collection can be discussed as effective because the interviews and studies appropriately long and carefully prepared.
The used statistical analyses can be discussed as relevant for the study because baseline characteristics typical for participants were compared with descriptive statistics, and the main focus was on using generalized estimating equations (GEEs). During the analysis stage, speed of gait and other factors were identified as markers depending on their role for influencing falls. This approach was effective to complete a range of assessments. Referring to the statistical procedure and the probability level, it is possible to state that the provided results are credible (Agresti & Finlay, 2009, p. 24).
The researchers noted that they referred to the assessments conducted primarily after 2004 and the main focus was on discussing the probability of determining the risks of falls with references to the aspects of the gait. It was found that the decrease in speed leads to the increase in falls in older patients. As a result, the findings can be applied to the nursing practice because the identified factors can be modified, and it is possible to focus on procedures improving the gait and preventing falls.
References
Agresti, A., & Finlay, B. (2009). Statistical methods for the social sciences (4th ed.). New Jersey: Prentice Hall, Inc.
Verghese, J., Holtzer, R., Lipton, R., & Wang, G. (2009). Quantitative gait markers and incident fall risk in older adults. Journal of Gerontology, 64A(8), 896–901.
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