Boethius and falls in elderly populations: injury outcomes and nursing home placement

¶ … patient falls in U.S. healthcare institutions is staggering. They increase insurance costs, staff pressure, and even more accidental injuries other than falls. Research has shown that there are a number of ways patient falls may be mitigated: more nursing rounds, patient exercise, and body awareness conditioning. Tai Chi is a Chinese martial art that is practices for both defense training and health benefits, as well as longevity. The overall theory is to allow the individual to become more flexible, increase strength in certain muscle groups that are not always used in modern life, and to become more aware and attuned to the individual's own body. A 2012 study looked at the effectiveness of tai chi and low-level exercise in reducing falls in older adults, but concluded that there was no difference between the control group and the experimental group over a 1.5-year period. In fact, the study shows that the adjusted incident rate ratio was not different between the Tai Chi and the Low Level Exercise groups, but there was a statistically significant reduction between fall rates for all groups as opposed to those who did not exercise at all. This suggests that strength and balance improve in older adults simply through movement and body awareness. It is likely, based on this study (n=684), that movement, whether Tai-Chi or other exercise, improves muscle function and body awareness and reduces falls, but that Tai-Chi vs. other low-impact exercise is not statistically a valid assumption (Taylor, et al., 2011).

Part 2- The therapeutic value of music has been recognized as vital and powerful since Ancient Times; archaeological evidence shows flutes carved from bone in pictures of physicians healing patients, Greek physicians used music and vibration to heal, aid in digestion and induce sleep; the Early Egyptians used musical incantations to help with the healing process; and certainly, numerous native tribes use singing and chanting as part of their healing rituals. Music does many things, but may aid in healing through dissociative means, or placing patients in a semi-hypnotic or relaxing state. However, many issues like this are also anecdotal in interpretation, and Evidence-Based Practice asks the healthcare professional to combine scientific inquiry with past knowledge to find ways of treating patients in a more effective manner with better patient outcomes. In the case of a 2008 study, the emotional responses to music were studies finding that there were quantitative effects from music (salivary cortisol levels, mental fatigue, etc.) based on certain musical tones (major scales as opposed to minor). The research suggests that stress is reduced through the upper temporal cortex, and that happiness is accentuated by tonality and calm, regular musical applications. The suggestion for practice is that use of music may diminish anxiety and pain in most clinical situations (Suda, et al., 2008).

Part 3 -- A chi-square test is a statistical test in which the sampling distribution of the test is measured to uncover whether there is a normal distribution in the population under study. In other words, Chi square tests compare observed data with data we might expect to obtain according to a specific hypothesis. If one were studying plants, for instance, we might expect 10 of 20 offspring to be male, but the actual number was 8. We would then want to know if the observed and expected fit, or if the deviation was artificial. Chi-Square, in fact, tests the null hypothesis, which says that there is no expected difference between what we expect and what we observe. In the observed research study, the question focused on which variables were predictive of an increase in developing a nosocomial bloodstream infection. While the authors did establish certain variables that increased the odds of infection, the study might have been more robust had the authors used additional predictive population variables (type of population, current diagnosis, and disease process for hospitalization). Of course, a population that has a compromised immune system, or which is otherwise vulnerable should show more propensity for infection than a standard, bell curve population (ARTICLE).