Fall and injury prevention in older people living in residential care facilities. A cluster randomized trial.
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.
Jensen
Jane
J
Department of Community Medicine and Rehabilitation, Geriatric Medicine and Physiotherapy, Umeå University, SE-901 85, Umeå, Sweden. , jane.jensen@germed.umu.se
Lundin-Olsson
Lillemor
L
Nyberg
Lars
L
Gustafson
Yngve
Y
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