A randomized trial of a consultation service to reduce falls in nursing homes.
BACKGROUND
Falls are a major health problem in nursing homes, but no interventions have been shown to prevent falls in nursing home residents.


OBJECTIVE
To evaluate an intervention program designed to prevent falls and associated injuries in high-risk nursing home residents.


METHODS
Randomized controlled trial.


METHODS
Seven pairs of middle Tennessee nursing homes with 1 facility in each pair randomly assigned to the intervention. Facilities had 482 (261 control, 221 intervention) residents who qualified for the study because they had high risk of falls and a potential safety problem that could be addressed by the intervention.


METHODS
Comprehensive structured individual assessment with specific safety recommendations that targeted suboptimal practices for environmental and personal safety, wheelchair use, psychotropic drug use, and transferring and ambulation. Facility staff were encouraged to implement the individual recommendations and to improve overall facility safety.


METHODS
The mean proportion of recurrent fallers and incidence rate of injurious falls in the facility in the year following the intervention.


RESULTS
The mean proportion of recurrent fallers in intervention facilities (43.8%) was 19.1% (95% confidence interval, 2.4%-35.8%) lower than that in control facilities (54.1%, P=.03). Intervention facilities had a nonsignificant trend toward a lower mean rate of injurious falls (13.7 vs 19.9 per 100 person-years, reduction of 31.2%, P=.22). Subgroup analyses suggested greatest benefits for residents for whom the recommended interventions were carried out or who had 3 or more falls in the preceding year.


CONCLUSIONS
The high rate of falls and related injuries in nursing homes should not be viewed as inevitable, but as outcomes that can be substantially improved through structured safety programs.
Ray
W A
WA
Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
Taylor
J A
JA
Meador
K G
KG
Thapa
P B
PB
Brown
A K
AK
Kajihara
H K
HK
Davis
C
C
Gideon
P
P
Griffin
M R
MR
D000056:Accident Prevention; D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D014150:Antipsychotic Agents; D005260:Female; D006707:Homes for the Aged / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008124:Locomotion; D008297:Male; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000592:standards / Q000706:statistics & numerical data*; D016012:Poisson Distribution; D016016:Proportional Hazards Models; D012017:Referral and Consultation; D014481:United States / Q000453:epidemiology; D014910:Wheelchairs
D014150:Antipsychotic Agents