Prevention of fall-related injuries in long-term care: a randomized controlled trial of staff education.
BACKGROUND
Fall-related injuries, a major public health problem in long-term care, may be reduced by interventions that improve safety practices. Previous studies have shown that safety practice interventions can reduce falls; however, in long-term care these have relied heavily on external funding and staff. The aim of this study was to test whether a training program in safety practices for staff could reduce fall-related injuries in long-term care facilities.


METHODS
A cluster randomization clinical trial with 112 qualifying facilities and 10,558 study residents 65 years or older and not bedridden. The intervention was an intensive 2-day safety training program with 12-month follow-up. The training program targeted living space and personal safety; wheelchairs, canes, and walkers; psychotropic medication use; and transferring and ambulation. The main outcome measure was serious fall-related injuries during the follow-up period.


RESULTS
There was no difference in injury occurrence between the intervention and control facilities (adjusted rate ratio, 0.98; 95% confidence interval, 0.83-1.16). For residents with a prior fall in facilities with the best program compliance, there was a nonsignificant trend toward fewer injuries in the intervention group (adjusted rate ratio, 0.79; 95% confidence interval, 0.57-1.10).


CONCLUSIONS
More intensive interventions are required to prevent fall-related injuries in long-term care facilities.
Ray
Wayne A
WA
Division of Pharmacoepidemiology and Center for Education and Research on Therapeutics, Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA. Cindy.naron@vanderbilt.edu
Taylor
Jo A
JA
Brown
Anne K
AK
Gideon
Patricia
P
Hall
Kathi
K
Arbogast
Patrick
P
Meredith
Sarah
S
D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D040381:Education, Public Health Professional / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008134:Long-Term Care; D008297:Male; D008503:Medical Staff / Q000193:education*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000517:prevention & control*