title: Effectiveness of individualized fall prevention program in geriatric rehabilitation hospital setting: a cluster randomized trial.
abstract: OBJECTIVE
  There is no conclusive evidence that hospital fall prevention programs can reduce the number of falls. We aimed to investigate the effect of a targeted individualized falls prevention program in a geriatric rehabilitation hospital.
  
  
  METHODS
  This was a two-stage cluster-controlled trial carried out in five geriatric rehabilitation wards. Participants were 752 patients with mean age 83.2 years. The intervention was a two-phase targeted intervention falls prevention program. The intervention included an assessment of patient's risk by a risk assessment tool and an individual management that includes medical, behavioral, cognitive and environmental modifications. Patients with moderate risk received additionally orientation guidance, and mobility restriction. Patients determined as high risk were additionally placed under permanent personal supervision. Outcome measures were falls during hospital stay.
  
  
  RESULTS
  In both stages of the trial, intervention and control wards were almost similar at baseline for individual patient characteristics. Overall, 37 falls occurred during the study. No significant difference was found in fall rates during follow-up between intervention and control wards: 1.306 falls per 1000 bed days in the intervention groups and 1.763-1.826 falls per 1000 bed days in the control groups. The adjusted hazard ratio for falls in the intervention groups was 1.36 (95 % confidence interval 0.89-1.77) (P = 0.08) in the first stage and 1.27 (95 % confidence interval 0.92-1.67) (P = 0.12) in the second stage.
  
  
  CONCLUSIONS
  These results suggest that in a geriatric rehabilitation hospital a targeted individualized intervention falls prevention program is not effective in reducing falls.
authors.affiliation: Bruce Rappaport Faculty of Medicine, Technion-Institute of Technology, Fliman Geriatric Rehabilitation Hospital, Zalman Shneur St., P. O. Box 2263, 31021, Haifa, Israel. eaizen_il@yahoo.com.
authors.forename: Efraim
authors.initials: E
authors.lastname: Aizen
authors.affiliation: Fliman Geriatric Rehabilitation Hospital, Haifa, Israel.
authors.forename: Galina
authors.initials: G
authors.lastname: Lutsyk
authors.affiliation: Fliman Geriatric Rehabilitation Hospital, Haifa, Israel.
authors.forename: Lea
authors.initials: L
authors.lastname: Wainer
authors.affiliation: Fliman Geriatric Rehabilitation Hospital, Haifa, Israel.
authors.forename: Sarit
authors.initials: S
authors.lastname: Carmeli
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D061345:Early Medical Intervention / Q000379:methods*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006299:Health Services for the Aged; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D018570:Risk Assessment / Q000379:methods; D016896:Treatment Outcome
keywords: Elderly; Falls; Hospital; Prevention; Rehabilitation