Effectiveness of a Multifaceted Intervention on Falls in Nursing Home Residents

• Published in: Journal of the American Geriatrics Society (JAGS) 2003-03, Vol.51 (3), p.306-313
• Main Authors: Becker, Clemens, Kron, Martina, Lindemann, Ulrich, Sturm, Elisabeth, Eichner, Barbara, Walter-Jung, Barbara, Nikolaus, Thorsten
• Format: Article
• Language: English
• Subjects: accidental falls; Accidental Falls - prevention & control; Accidental Falls - statistics & numerical data; Accidents; Aged; Aged, 80 and over; Biological and medical sciences; Effectiveness; Elderly people; exercise; Falls; Female; Follow-Up Studies; Frail Elderly; hip protector; Homes for the Aged; Humans; Intervention; Male; Medical sciences; Miscellaneous; Nursing Homes; older people; Prevention; Prevention and actions; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Resistance training; Specific populations (family, woman, child, elderly...); Traumas. Diseases due to physical agents
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1046/j.1532-5415.2003.51103.x

OBJECTIVES:   To evaluate the effectiveness of a multifaceted, nonpharmaceutical intervention on incidence of falls and fallers. DESIGN:   Prospective, cluster‐randomized, controlled 12‐month trial. SETTING:   Six community nursing homes in Germany. PARTICIPANTS:   Long‐stay residents (n = 981) aged 60 and older; mean age 85; 79% female. INTERVENTIONS:   Staff and resident education on fall prevention, advice on environmental adaptations, progressive balance and resistance training, and hip protectors. MEASUREMENTS:   Falls, fallers, and fractures. RESULTS:   The incidence density rate of falls per 1,000 resident years (RY) was 2,558 for the control group (CG) and 1,399 for the intervention group (IG) (relative risk (RR) = 0.55, 95% confidence interval (CI) = 0.41–0.73). Two hundred forty‐seven (52.3%) fallers were detected in the CG and 188 (36.9%) in the IG (RR = 0.75, 95% CI = 0.57–0.98). The incidence density rate of frequent fallers (>2/year) was 115 (24.4%) for the CG and 66 (13.0%) for the IG (RR = 0.56, 95% CI = 0.35–0.89). The incidence density rate of hip fractures per 1,000 RY was 39 for the CG and 43 for the IG (RR = 1.11, 95% CI = 0.49–2.51). Other fractures were diagnosed with an incidence density rate of 52 per 1,000 RY for CG and 41 per 1,000 RY for IG (RR = 0.78, 95% CI = 0.57–1.07). CONCLUSION:   The incidence density rate of falls and fallers differed considerably between the control and intervention groups. The study was underpowered to demonstrate a significant difference of hip or nonhip fractures. Because of a low fracture rate in both groups, the investigation of fracture rates would have required a larger sample size to detect an effect of the intervention.