Research Article Critique Tonya L. Smith, RN Liberty University NUR 225 Research Article Critique The title of the research article I chose to critique is from the Journal of the American Geriatrics Society. “Hypertension, orthostatic-hypotension, and the risk of falls in a community-dwelling elderly population: The maintenance of balance, independent living, intellect, and zest in the elderly Boston study”; this title fits well with the content presented in the research article. The independent variables are clearly defined as well as the dependent variables for the research being conducted.
The content of the abstract is a very good overview of the content and it is consistent with the content. The abstract summarizes the objective, design, setting, participants, measurements, and results. Problem/Purpose The problem being investigated is the risk of falls in the elderly population related to the effects of controlled and uncontrolled hypertension and orthostatic hypotension. The authors do identify the significance of the problem as falls for being the leading cause of disability for the elder generations.
Adequate background information is not provided to support the problem because the subject at hand “has not been investigated previously” (Gangavati, et al. , 2011, p. 383). Explanation of the purpose of this study being conducted is provided by the authors. Literature Review The previous research articles and their outcomes are briefly described with different amounts of time from 1-3 minutes after individual is standing before a decrease in blood pressure of 10-20mmHg would occur and be related to a fall.
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The purpose “was to assess the association between hypertension, OH using multiple definitions, and their combination and the risk of recurrent falls in a community-dwelling elderly population” (Gangavati, et al. , 2011, p. 384). The list of twenty eight references is used is this article. There are eight references dated up to ten years old, four references dated five years old or less, and sixteen references that are more than ten years old with one of them being twenty-three years old. The authors do very briefly summarize their review of the literature as to what is known and not known to the study.
They do explain a need for further study from previous research with a lack of knowledge in definitions of orthostatic hypertension presented. Framework/Theoretical Perspective The study is based upon a specific situation theory regarding the relationship between falls and changes in blood pressure of the elderly population older than seventy. The authors connect their theory to the study by demonstrating a connection between a change in systolic orthostatic hypotension and standing for one minute.
This change in systolic orthostatic hypotension would prove to be increasing falls for the elder population with uncontrolled hypertension. Research Question(s) OR Hypotheses The hypothesis was that the risk of falls would be highest in people with uncontrolled hypertension and in those with orthostatic hypotension. The questions at hand of the research were to assess the association between hypertension, orthostatic hypotension using different definitions, and to assess their combination and the risk of falls in a community-dwelling elderly population. Variables
The independent variables were the total number of individuals that were seventy years old or older living within a 5-mile radius of the study. These individuals would present with no hypertension, controlled hypertension, uncontrolled hypertension, and systolic orthostatic hypotension. The dependent variables are the blood pressure measurements, number of falls reported, and the amount of time standing from one to three minutes. The blood pressure measurements were taken at two different times at two minutes apart after five minutes of rest and an average of the two would be used in the analysis.
The measurements of blood pressure were obtained using a manual blood pressure cuff that was accurate for size. The number of falls was reported over a year of time and at the end of each month on a monthly falls calendar and only counted if they had experienced two falls. Demographics of Sample A few examples of the demographics used in the sample was 22% non-white, 64% female,70% receiving antihypertensive medications, 38% history of falls and 25% with a history of stroke. Research Design The research design used was prospective population-based study.
Prospective designs are a type of longitudinal design that can be experimental or non-experimental and they are “studies that begin in the present and end in the future” (Schmidt & Brown, 2012, p. 158). This study was a non-experimental prospective study completed on a population of the elderly followed over a course of a year. This design was appropriate to obtain the necessary data. Subjects were not necessarily assigned to the group but they were chosen depending on if they lived within five miles of the study, seventy years old or older, and the ability to meet certain criteria.
There was no indication of a pilot study having been conducted. Sample/Setting The sampling criteria that had to be met were the individual had to be living in the five mile radius of the study and they had to remain in the area for three years. This research study used simple random sampling for the sampling method; with equal chances of being selected, less risk of bias, and ample representation of the population. People were chosen based on “ability to understand and communicate in English, ability to walk 20 feet without personal assistance, sufficient vision, and able to live in the area for at least 3 years” (Gangavati, et al. 2011, p. 384). Individuals were assessed with a baseline assessment that included medical history, fall history, cognition, medication, and in-clinic evaluations of balance, and muscle strength. Informed consent was obtained from all participants by written informed consent. The setting of the study was the community; this setting fit well with the study’s objectives. Measurement, Methods & Instruments Kaplan-Meier curves and Multivariate Cox proportional hazard modeling were used to assess the risk of falls in participants with orthostatic ypotension. Fisher exact test was used for categorical variables. Wilcoxon rank sum was used for continuous variables. A manual sphygmomanometer was used to obtain blood pressure readings. The type of measurement used was physiological measure at the ordinal level of measurement. The authors did discuss the reliability of measurements being obtained with individuals who had been trained in appropriate blood pressure techniques and for potential sources of error. Data Collection The data was collected for the number of falls by mail.
The one month calendar was mailed back at the end of each month charting number of falls. Measurements for blood pressure were taken at 1 minute after standing and 3 minutes after standing, 2 blood pressures were taken while laying supine, and then again after resting 5 minutes. Data was collected by longitudinal design. The data was collected at home by the participant or the caregiver. Data Analysis The data analysis procedures were clearly described using description of follow-up time of truncation.
The analysis listed characteristics of the groups and how they were compared. The data analysis procedures were appropriate for the type of data being collected because it was a systematic review of the data that was collected for the research study. Statistical Analyses The analysis included an alpha level of 0. 05 to determine statistical importance. This alpha level indicated that the researchers felt 95% confident in that the risk of falls in the population being tested would be related to uncontrolled hypertension and orthostatic hypotension. Limitations
The limitations that were identified by this research study was a bias for number of falls through the use of a falls calendar and standing blood pressure was not measured beyond 3 minutes. The findings were also limited because of the population was a majority of Caucasians, and limited to community-dwelling adults. There was also limitation on knowledge of any medication changes during this time. Other limitations I can think of is we do not know if individuals were accurately checking the blood pressure each day or was it just in the preset of the study. Implication of Findings
The implications for nursing were not clearly described in this study. Some implications for nursing that were not described are to become more aware of orthostatic hypotension upon standing of the elderly and to oversee compliance of hypertensive medications. Further study was suggested in order to confirm findings in a clinical trial setting. Generalization of Findings The authors did generalize the findings in this research study. They did not apply their findings beyond this study. It is not indicated in the study that they applied any findings to the population in general.
Format I did not see any spelling, punctuation, or grammatical errors. The sentence structure was good. This research was difficult to interpret at first but after reading it a couple of times and breaking down the information being provided it was more logical. Overall Evaluation The steps of the research process were logically linked together. The hypothesis of this study did make sense based on review of the literature. The method used in this research prospective population-based study and the qualitative data collected did fit well with the intent of the study.
The impression this research gave was that individuals over the age of seventy are going undiagnosed with orthostatic hypotension and those with uncontrolled hypertension are at a high risk for falls. Recognition of fall risk is an important subject for me; I can relate to the findings because I work with the geriatric population in a long term care facility. Awareness needs to be raised not only to geriatric nurses but all caregivers about the importance in acknowledging the high risk of falls related to hypertension or hypotension. References Gangavati, A. , Hajjar, I. , Quach, L. Jones, R. , Kiely, D. , Gagnon, P. , & Lipsitz, L. (2011). Hypertension, orthostatic hypotension, and the risk of falls in a community-dwelling elderly population: the maintenance of balance, independent living, intellect, and zest in the elderly of Boston study. Journal Of The American Geriatrics Society, 59 (3), 383-389. doi:http://dx. doi. org. ezproxy. liberty. edu:2048/10. 1111/j. 1532-5415. 2011. 03317. x Schmidt, N. , & Brown, J. (2012). Evidence-Based Practice for Nurses: Appraisal and application of research (2 ed. ). Valparaiso, IN: Jones & Bartlett Learning.
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