A cluster randomised controlled trial to prevent injury due to falls in a residential aged care population

Abstract

Objective: To test the effectiveness of using a full‐time project nurse to assist residential aged care facilities in using evidence‐based approaches to falls injury prevention. Design, setting and participants: Cluster randomised controlled trial involving 5391 residents in 88 aged care facilities in the Hunter and Lower Mid North Coast areas of New South Wales. Residents were followed for 545 days or until death or discharge. Data were collected from July 2005 to June 2007. Intervention: Employment of a project nurse to encourage best‐practice falls injury prevention strategies during the 17‐month intervention period. Main outcome measures: Monthly data about falls, falls injury and falls injury prevention programs; audit of hospitalisation for fractured neck of femur. Results: Despite significant increases in the provision of hip protectors and use of vitamin D supplementation in both intervention and control facilities, there was no difference in the number of falls or falls injuries between the intervention and control groups, nor a reduction in falls overall. There was also no difference between the 7‐month pre‐intervention period and the intervention period in the number of falls or falls injuries. Factors related to residents having an increased risk of falls with fractured neck of femur included being ambulant, having dementia, increasing age, and having a high falls risk assessment score. Conclusion: It is difficult to change falls risk among high‐risk populations, including people with dementia. The use of important strategies such as hip protectors and vitamin D and calcium supplementation increased during the study, probably with contamination of control facilities. Longer follow‐up may be required to measure the impact on falls outcomes of the strategy of using a facilitating nurse. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12605000540617.

Characteristics and Effectiveness of Fall Prevention Programs in Nursing Homes: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

“…An a priori secondary subgroup analysis of one study showed that the effect was only significant in cognitively impaired residents (relative risk (RR) = 0.49, 95% confidence interval (CI) = 0.35–0.69) and not in cognitively intact residents (hazard rate (HR) = 0.91, 95% CI = 0.68–1.22). Pooled data from 10 studies showed no effect on number of falls (RR = 0.93, 95% CI = 0.76–1.13; I ² = 89.8%, P < .001) …”

“…The number of falls was reported in 12 studies (Table ) . In nine studies, the intervention and control groups did not differ significantly in number of falls . Two multifactorial studies showed a significant decrease in falls of 36% and 45%, respectively, over a 12‐month period for the intervention groups.…”

“…19,20 Fourteen articles, describing 13 studies, met the inclusion criteria. [27][28][29][30][31][32][33][34][35][36][37][38][39][40] Two studies 34,35 were combined as one study in the metaanalysis because they reported data on the same cohort of individuals.…”

Interventions for preventing falls in older people in care facilities and hospitals

“…Of note is that four trials that had been excluded in Cameron 2012 because they included participants with post-stroke hemiplegia, have now either been retracted (Sato 2000; Sato 2005a; Sato 2005b; see Retraction Watch) or, for Sato 2011, likely to be retracted in future because of serious concerns about research misconduct as revealed in Bolland 2016.…”

Reduction of Femoral Fractures in Long-Term Care Facilities: The Bavarian Fracture Prevention Study

“…Some studies have included exercise and other non-pharmaceutical interventions [6] to reduce falls and fall related injuries. There is evidence that fall prevention interventions reduce falls [6] but there is little evidence to support a reduction in fractures [7]; [8].…”