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The Well-Built, Patient-Oriented Clinical Question
Case: 75 year old widow female lives alone with home assistance, she recently fell in bathroom
and broke her right dominant hand. Her daughter lives 5 miles away. The elderly woman goes
to nearby ER for care. Daughter tells Nurse she has recently been slightly confused and is
losing weight. PMH: Obesity, Diabetic type 2, HTN. The daughter asked is it safe for her to be
living alone? What can be done to keep her independent and safe? Meds: Hydrochloride 25mg
daily Diet: regular Wears glasses Ambulates without cane. Think about safety when writing up
your PICOT Question. Should she live along? Move to Assisted Nursing Home? What are the
risks of falls for Elderly? Home Safety? How do we keep senior independent safely at home?
Question Components Your Question
P – Patient or Population
Describe the most important characteristics of the
patient.(e.g., age, disease/condition, gender)
I – Intervention; Prognostic Factor; Exposure
Describe the main intervention.(e.g., drug or other treatment, diagnostic/screening test)
C – Comparison (if appropriate)
Describe the main alternative being considered.(e.g., placebo, standard therapy, no treatment, the gold standard)
O – Outcome
Describe what you’re trying to accomplish, measure,
improve, affect.(e.g., reduced mortality or morbidity, improved memory, accurate and
timely diagnosis)
The well-built clinical question:
Search Strategy Development come up with search terms to help access your
research data (ie: P: Elderly , Senior, Aged)
Primary search term Synonym 1 Synonym 2
P
I
C
O
Dartmouth Biomedical Libraries

PICOT Development

Student’s Name

Institutional Affiliations

PICOT Development

Aging does not only increase the physical needs of the elderly, but it also increases their medical needs. Geriatric nurses must be able to identify the needs of older adults and be able to develop interventions that will promote their physical, spiritual, psychological, medical, and cultural health and wellbeing (Wang & Liu, 2021). The initial stage in identifying an evidence-based intervention to address patient care issues is to develop a well-built patient-oriented question in the population (P), intervention (I), comparison (C), outcome (O), and time (T) (PICOT) format. The purpose of this assignment is to develop a patient-oriented PICOT question aimed at enhancing the safety of a 75-year-old female widow who lives alone with home assistance.

PICOT Components

P – Patient or Population

The patient population that will be the focus of the research comprises older adults aged 75 years and above. They should be females who are managing multiple chronic conditions, are at risk of falling, need assistance with activities of daily living (ADLs), and who are living alone at home. The primary concerns affecting this patient population are related to safety and disease management.
I – Intervention; Prognostic Factor; Exposure

The intervention that is being proposed for the chosen patient population is ‘movement to an assisted nursing home.’ According to SeniorLiving.org (2022), an important factor to consider when making a decision to either place older adults on home care or move them to a nursing home is the amount and nature of daily help that they need. The patient described in the case study needs assistance with ADLs and close medical assistance from a team of healthcare professionals which can best be obtained from an assisted nursing home.
C – Comparison
The main alternative that is being considered is allowing the elderly to live independently at home. A majority of older adults usually prefer to age in place under home-based care to being moved to an assisted nursing home (National Institute on Aging, 2017). While this might lead to psychological comfort for the patient, it is important to consider the fact that independent living at home might not be the best option for the patient described in the case study considering her advanced age and health status. The family might have to hire several professionals to assist with daily living activities and to provide medical assistance in varied areas of medical specialties.

O – Outcome
The key outcome that the nurse intends to accomplish by implementing the proposed intervention is reduced incidents of falls and improved quality of life. As reported by Vipperman et al. (2021), assisted living facilities have remained the best residential care organizations for the elderly who need supportive care. The specific measures related to the named outcomes are rates of falls and incidences of health complications.

The Well-Built Clinical Question:

“For older female adults aged 75 years and above, who are managing multiple chronic conditions, who are at risk of falling, who need assistance with activities of daily living (ADLs), and who are living alone at home (P), does moving them to an assisted nursing home (I), compared with allowing them to live independently at home (C) reduce incidents of falls and improve their quality of life (O)?”

Search Strategy Development

References

National Institute on Aging (NIA). (2017). Aging in place: Growing older at home.  https://www.nia.nih.gov/health/aging-place-growing-older-home

SeniorLiving.org. (2022). Nursing homes vs home care. https://www.seniorliving.org/compare/nursing-home-vs-home-care/

Vipperman, A., Zimmerman, S., & Sloane, P. D. (2021). COVID-19 recommendations for assisted living: implications for the future. Journal of the American Medical Directors Association, 22(5), 933–938.e5. https://doi.org/10.1016/j.jamda.2021.02.021

Wang, Z., & Liu, Z. (2021). Older adults’ demand for integrated care and its influencing factors: A scoping review. International Journal of Integrated Care, 21(4), 28. https://doi.org/10.5334/ijic.5946