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Effectiveness of a multifaceted intervention on falls in nursing home residents
Clemens Becker1, Martina Kron, Ulrich Lindemann
1Bethesda Geriatric Clinic, Academic Center at the University of Ulm, Zollernring 26-28, D-89073 Ulm, Germany. clemens.becker@medizin.uni-ulm.de
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.