title: Fall and injury prevention in older people living in residential care facilities. A cluster randomized trial.
abstract: BACKGROUND
  Falls and resulting injuries are particularly common in older people living in residential care facilities, but knowledge about the prevention of falls is limited.
  
  
  OBJECTIVE
  To investigate whether a multifactorial intervention program would reduce falls and fall-related injuries.
  
  
  METHODS
  A cluster randomized, controlled, nonblinded trial.
  
  
  METHODS
  9 residential care facilities located in a northern Swedish city.
  
  
  METHODS
  439 residents 65 years of age or older.
  
  
  METHODS
  An 11-week multidisciplinary program that included both general and resident-specific, tailored strategies. The strategies comprised educating staff, modifying the environment, implementing exercise programs, supplying and repairing aids, reviewing drug regimens, providing free hip protectors, having post-fall problem-solving conferences, and guiding staff.
  
  
  METHODS
  The primary outcomes were the number of residents sustaining a fall, the number of falls, and the time to occurrence of the first fall. A secondary outcome was the number of injuries resulting from falls.
  
  
  RESULTS
  During the 34-week follow-up period, 82 residents (44%) in the intervention program sustained a fall compared with 109 residents (56%) in the control group (risk ratio, 0.78 [95% CI, 0.64 to 0.96]). The adjusted odds ratio was 0.49 (CI, 0.37 to 0.65), and the adjusted incidence rate ratio of falls was 0.60 (CI, 0.50 to 0.73). Each of 3 residents in the intervention group and 12 in the control group had 1 femoral fracture (adjusted odds ratio, 0.23 [CI, 0.06 to 0.94]). Clustering was considered in all regression models.
  
  
  CONCLUSIONS
  An interdisciplinary and multifactorial prevention program targeting residents, staff, and the environment may reduce falls and femoral fractures.
authors.affiliation: Department of Community Medicine and Rehabilitation, Geriatric Medicine and Physiotherapy, Umeå University, SE-901 85, Umeå, Sweden. , jane.jensen@germed.umu.se
authors.forename: Jane
authors.initials: J
authors.lastname: Jensen
authors.forename: Lillemor
authors.initials: L
authors.lastname: Lundin-Olsson
authors.forename: Lars
authors.initials: L
authors.lastname: Nyberg
authors.forename: Yngve
authors.initials: Y
authors.lastname: Gustafson
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D000488:Allied Health Personnel / Q000193:education; D064420:Drug-Related Side Effects and Adverse Reactions; D015444:Exercise; D016330:Frail Elderly; D006707:Homes for the Aged / Q000592:standards*; D006801:Humans; D009735:Nursing Homes / Q000592:standards*; D017063:Outcome Assessment, Health Care; D011482:Protective Devices; D012656:Self-Help Devices / Q000600:supply & distribution; D013548:Sweden