J. Overcash on Older Adults With Cancer

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The article “Prediction of Falls in Older Adults with Cancer: A Preliminary Study” by Overcash, J. (2007), establishes the extent to which falls transpire in older adult patients with cancer. The article has been a useful study in recognizing how falls relate to depression, age, functional status, and cognition and this helps in developing a model for forecasting falls.

Statement of the problem

Loiselle, C., & McGrath, J. states that the problem statement “articulates the problem to be addressed.” (2006, p.112). In a reflective evaluation of the article, it becomes clear that Overcash (2007) was able to affirm the problem undertaken for research in the very introduction itself. The author is effective in making, in unambiguous language, the exact pronouncement of the problem that the article deals with. One identifies the problem statement unambiguously as an exploration of “the frequency of falls that occurred in community-dwelling older adults diagnosed with cancer and how those falls related to scores on a comprehensive geriatric assessment (CGA) consisting of depression, age, functional status, and cognition screening instruments.” ( Overcash, 2007)

The problem defined in the article has great significance for nursing as the result of the study can contribute heavily towards the service of the nurses. As a result, nurses do need to know or recognize multifactorial risks and causes of falls in older adults, and it is necessary that nurses have the skills that help them to prevent falls and promote older adult’s health there is also an important relationship between the research problem, the paradigm, and methods used.

The quantities approach seems to be most appropriate to the conclusion upon such a research problem and only a quantitative analysis of the samples and variables can establish the extent to which falls emerge in older adult patients with cancer. The analysis of a large number of samples incorporating 165 patients aged 70 years or older with any diagnosis of cancer, treatment type, and stage helps in the exact conclusions.

Literature review

An evaluation of the review of Literature would maintain that it is many sources are up-to-date, and few sources were dated back as far as 1970. It is based mainly on primary sources, though some more thorough review of the literature would authenticate the study.

The incorporation of the latest literature also validates the arguments and definition of the problem. These include Feder, Cryer, Donovan, & Carter, 2000; Overcash, Beckstead, Extermann, & Cobb, 2005; Overcash, Beckstead, Moody, Extermann, & Cobb, 2006; Pluijm et al., 2006; Stevens, Powell, Smith, Wingo, & Sattin, 1997; Wolf et al., 2003; Chu, Chiu, & Chi, 2006; Cesari et al., 2002; Sheeran, Brown, Nassisi, & Bruce, 2004; Turcu et al., 2004; Kose, Cuvalci, Ekici, Otman, & Karakaya, 2005; and O’Connell, Cockayne, Wellman, & Baker, 2005. The author has a strong background in geriatric cancer, as she conducted several research; therefore, she used some of her previous research studies in this study.

The review of literature has been effective in summarizing the information on the dependent and independent variables and the relationship, which are falls, functional status, depression, cognition, gender, and age. The report included research from medical journals, gerontologists, psychology, and epidemiology. The literature review used a meta-analysis concept because the author gathered information from different studies to try and understand one concept; falls in older adults with cancer. There is a solid basis for the new study provided by the literature review, though it could be further expanded and established.

Theoretical and conceptual framework

According Loiselle et al.(2006) ( p.162). One issue concerning the introduction to the report is that Overcash did not discuss the conceptual or theoretical underpinnings of her study in the discussion report. It would be useful for her to discuss the conceptual model specific to functional status and falls in the older adult with cancer. The article defines the key concepts including falls and fall assessment adequately and abstractly.

Although there are some theoretical bases in the definition of the concepts such as falls, it is manifest that the use of the sound theoretical and conceptual framework to amplify the ideas is deficient. However, one may clearly justify the lack of the appropriate theoretical framework as the author very well establishes the insufficiency of the studies and researches in the area of falls and older adults with cancer. Thus the validity of the study undertaken is further established.

Hypothesis or Research Question

There is no hypothesis in the study because it is not an experimental study. A hypothesis could have strengthened the report because if the researchers incorporated one the end results could have been enhanced. A hypothesis restates a research question to help determine the overall conclusion. However, there are four research questions presented in the study. In analyzing the research questions that the study undertakes, it is imperative to establish that the research questions are explicitly stated, appropriately worded, and they are consistent with the literature review.

The research questions included ‘What is the frequency of falls in a population of older patients with cancer?’ ‘What is the relationship of falls to scores on screening instruments often administered as part of a CGA (depression, age, functional status, and cognition)?’ and ‘Are the scores on the Instrumental Activities of Daily Living (IADL) Scale (Lawton & Brody, 1969) predictive of falls in a population of older patients with cancer?’ (Overcash, 2007). If at all one finds some absence of clarity and appropriateness in the research questions, it amounts, as the literature review establishes, from the insufficiency of the research materials on the topic and therefore it is justified.

Research design

The research design used was a cross-sectional design, as the data were collected during the one-time interview. It lacks randomization. The researcher sampled by convenience sample. Convenience sampling consists of individuals that are readily available for a study (Loiselle (2006). Convenience sampling was used therefore the selection threat in internal and external validity was affected.

The external validity depends on the intrinsic as well as the extrinsic factors respectively. The intrinsic and the extrinsic factors are clearly established. The former includes issues that are likely to arise as a result of cancer treatment such as anemia, fatigue, and pain, gait, and balance problems, and medications whereas the latter includes environmental concerns such as uneven walking areas, rugs, and slippery surfaces.

Internal Validity

The internal validity of the design is sound, but not without threats that need to be addressed. On the positive side, mortality, instrument, regression, and maturation are not threats in this study. However, the author identified the issues that are likely to arise as a result of cancer treatment such as anemia, pain, cognition, gait and balance problems, and medications. Subject characteristics could be a threat since the test groups are all older adults diagnosed with cancer and receiving care from the Senior Adult Oncology and not very representative of the population as a whole in learning.

The subjects were only provided one-time interviews based on 30 minutes of observation; therefore, if the location where the test was given had any distractions or the patient is unfamiliar then the results could be suspect. Also, if the location where a group of subjects took the test differed from other groups, there is the potential for inequalities that might affect one’s results. Another threat to the internal validity of the study is the possibility of data collection bias as it is not stated how long it took geriatric nurse practitioners and RNs to collected the data from 165 samples and 30 minutes for each sample. It could affect the internal validity.

External validity

According to Loiselle (2006) external validity is “the degree to which study results can be generalized to settings or samples other than the one studied” (p.500). There are three major threats to external validity people, place, and time. Thus, analyzing the first threat, the people, it is clear that the sample representative cannot be generalized to the population because first, the author used a convenience sample, which lacks randomization. As a result, there are several external threats to this study. The first result is the “Hawthorn effect”, where the subjects perform differently as they realize that they are being studied.

Second, most people of the study consisted of “well-educated, Caucasian, middle-class older adults with generally intact social support systems” (Overcash, 2006). It is difficult to transfer this data to the general population, which includes people with low income, not well educated, and/or people who are non-Caucasian. If the author chose to conduct the study in a variety of places, with different people randomly selected, and at different times, it would enhance the validity of the result and control the bias.

Population and sample

Yet another strength point of the article is that it clearly identifies and describes the population and sample. Loiselle (2006) “population is the entire aggregation of cases that meet specific criteria” (p.252). The study identifies the prospective convenience sample of patients who are aged 70 years or older at the Senior Adult Oncology Program at the H. Lee Moffitt Cancer Center and Research Institute and it provided enough quantity of sample for the study. According to Loiselle et al. (2007) “convenience sampling is the weakest (but most widely used) form of sampling… The problem with this type of sampling is that the subjects might be atypical of the population; therefore, the price of convenience is the risk of bias” (p. 255).

The selection of the samples was efficiently managed sampling design helped in enhancing the sample’s representativeness of the various types of treatment such as hormone therapy, chemotherapy, or radiation therapy, or observations. There is no report in the study indicates that power analysis was used to estimate sample size needs. However, it is not a great problem to use a small size as it is a preliminary study (Loiselle, 2006). It also helped in the best sampling design.

Data collection and measurement

The data collection and measurement procedure contributed to the advantage of the study and the conceptual definitions are evaluated as operational and harmonious. The instruments used for the data collection and measurement established efficiency and the usefulness of the instruments are clearly ascertained in the article. Thus, the ADL scale which measures basic functional status addressed the areas such as bathing, dressing, toileting, incontinence, transferring, and feeding. The IADL scale addressed more refined activities that are important to independence as well as the mode of transportation.

The deployment of GDS which is a valid and reliable screening instrument for depression and is used commonly in geriatric health care also establishes the merit of the instruments used. Similarly, the employment of the MMSE which is commonly used to evaluate cognition problems also helped in the data collection and measurement procedure. Thus, the specific instruments are adequately described and they have been good choices. This also helped the report in providing evidence to the fact that the data collection methods and the yielded data were high on reliability and validity.

Procedures

The procedures adopted had some significant usefulness and the intervention which is adequately described in the article contributed to the study. Thus, the article states that the participants were screened once using a CGA, and the assessment instruments were scored according to their individual cut points and published scoring guidelines. This procedure also ensured effective intervention. According to the report, “Screening required approximately 30 minutes, and the instruments were administered by a geriatrics nurse practitioner or a geriatrics RN. Information concerning treatment type, age, and the diagnosis was collected.” (Overcash, 2007) Thus, the data were collected in a manner that minimized bias and the members of the data collection group were appropriately trained. There were also appropriate procedures used to maintain the rights of study participants as the procedure adopted published scoring guidelines.

Results

Data Analysis

Various factors determined the results of the study and the data analysis contributed highly towards this. The analyses were undertaken to address each research question and the data analysis included “descriptive techniques which used frequencies and cross-tabulation commands to explain the relationship between falls and gender” (Overcash, 2006). Cross-tabulation is about taking two variables and tabulating the results of one variable against the other variable (Loiselle (2006).

The Pearson product-moment correlation coefficient was used to test the relationship among age, IADL, ADL, MMSE, and GDS scores and this ensured appropriate statistical methods. A point biserial correlation was used to explore the relationship among falls and IADL, ADL, MMSE, and GDS scores, and “multiple regression analysis was used to construct a model to predict falls. Bivariate regression was used to understand the relationships between the individual instruments’ total scores and falls” (Overcash, 2007). Therefore, according to the level of measurement of the variables, a number of groups being compared, and so on, the most fitting statistical methods were used.

Discussion

The discussion of the research which incorporates the interpretation of the findings contributes to the effectiveness of the article. It is imperative to establish that all the major findings are interpreted and discussed within the context of prior research and/ or the study’s conceptual framework. It is also noticeable that the interpretations are very much consistent with the results and with the study’s limitations. Also, the report addresses the issue of the ability to generalize the findings.

The study declares that assessing for functional status limitations using the IADL scale can present an extrapolative value for falls. As the discussion in the article maintains, “The finding is addressed in the geriatric medicine and nursing literature in that chronologic age should not be a limiting factor for cancer treatment… Little research has been conducted concerning falls and older adults with cancer; therefore, comparing the data used in the present study to established norms is difficult… A limitation of the study is the high functional status of the sample. Future studies of falls should be conducted in older adults with cancer with functional status scores that are more normally distributed.” (“Overcash,2007) All these establish the effect of the discussion in the article.

Implications and Recommendation

The article has been able to maintain, though in a distinct heading, some of the implications and recommendations which will help in future studies in the area. The researchers, therefore, clearly discuss the implications of the study for clinical practice and further research. In the strengths and limitations section, the report does fairly describe some limitations to the study addressing the possibility of a different design These implications are reasonable and complete as it is a novice study in the area.

The paper clearly states that “Future studies of falls should be conducted in older adults with cancer with functional status scores that are more normally distributed… This was a preliminary study simply designed to determine whether and to what extent falls were occurring in patients in the outpatient older adult oncology program.” (Overcash, 2007)

Summary

The summary and assessment established through the conclusions of the article maintain the validity of the study as well as contribute to future developments in the area. It is of paramount consideration that the study findings, in spite of some identified limitations, appear to be valid and useful. The true value of the results may be realized as indisputable. The study donates heavily to the meaningful evidence that can be used in nursing practice. This feature of the study makes it more significant and promising. Establishing this point, Overcash maintains that the “Nurses must be attuned to the prevalence and risk of falls occurring in older adults with cancer.

They must play a vital role in conducting fall screening and risk assessments. Identifying older adults at risk for falls will direct nurses’ education efforts to patients with cancer in need of fall precaution teaching.” (Overcash, 2007) In conclusion, this critique of the article “Prediction of Falls in Older Adults with Cancer: A Preliminary Study” by Overcash establishes that it has been a valid study in the area as well as it contributes to the practice of the nurses and future studies in the area.

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