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ARTICLE

Fall and Injury Prevention in Older People Living in Residential Care Facilities: A Cluster Randomized Trial

Jane Jensen, MSc, RPT; Lillemor Lundin-Olsson, PhD, RPT; Lars Nyberg, PhD, RPT; and Yngve Gustafson, PhD, MD

21 May 2002 | Volume 136 Issue 10 | Pages 733-741

Background: Falls and resulting injuries are particularly common in older people living in residential care facilities, but knowledge about the prevention of falls is limited.

Objective: To investigate whether a multifactorial intervention program would reduce falls and fall-related injuries.

Design: A cluster randomized, controlled, nonblinded trial.

Setting: 9 residential care facilities located in a northern Swedish city.

Patients: 439 residents 65 years of age or older.

Intervention: An 11-week multidisciplinary program that included both general and resident-specific, tailored strategies. The strategies comprised educating staff, modifying the environment, implementing exercise programs, supplying and repairing aids, reviewing drug regimens, providing free hip protectors, having post-fall problem-solving conferences, and guiding staff.

Measurements: The primary outcomes were the number of residents sustaining a fall, the number of falls, and the time to occurrence of the first fall. A secondary outcome was the number of injuries resulting from falls.

Results: During the 34-week follow-up period, 82 residents (44%) in the intervention program sustained a fall compared with 109 residents (56%) in the control group (risk ratio, 0.78 [95% CI, 0.64 to 0.96]). The adjusted odds ratio was 0.49 (CI, 0.37 to 0.65), and the adjusted incidence rate ratio of falls was 0.60 (CI, 0.50 to 0.73). Each of 3 residents in the intervention group and 12 in the control group had 1 femoral fracture (adjusted odds ratio, 0.23 [CI, 0.06 to 0.94]). Clustering was considered in all regression models.

Conclusion: An interdisciplinary and multifactorial prevention program targeting residents, staff, and the environment may reduce falls and femoral fractures.

Editors' Notes Context In frail older people living in residential care facilities, hip protectors reduce fall-related femoral and pelvic injuries. In older people living in the community, prevention programs that target exercise and fall-related risk factors reduce falls and injuries. In older people living in residential care facilities, fall prevention programs, other than the use of hip protectors, have had mixed results. Contribution This randomized trial shows that a multidisciplinary fall prevention program reduces falls and femoral fractures in older people living in residential care facilities. The program included general as well as resident-specific, tailored strategies. Editors' Note The Cochrane Library (Issue 3, 2001) has two systematic reviews that summarize randomized trial evidence about interventions to prevent falls. –The Editors

 

Author and Article Information

From Umeå University, Umeå, Sweden.

Acknowledgments: The authors thank the Social Authorities of the municipality of Umeå for fruitful cooperation; the participants; the physicians (Gösta Bucht, MD, PhD, Inger Bylén, MD, Agnetha Byström, MD, Eva Gagerman, MD, PhD, Börje Hermansson, MD, Mai Mattsson, MD, Olov Sandberg, MD, PhD, and Per-Olov Österlind, MD, PhD); the physiotherapists (Staffan Eriksson, RPT, Ellinor Nordin, RPT, Erik Rosendahl, RPT, and Monica Östensson, RPT); and Hans Stenlund, PhD, for outstanding statistical advice.

Grant Support: By the Federation of County Councils in Sweden, the Vårdal Foundation, the Borgerskapet of Umeå Research Foundation, and the Gun and Bertil Stohne Foundation.

Requests for Single Reprints: Jane Jensen, MSc, RPT, Geriatric Medicine, Umeå University, SE-901 85 Umeå, Sweden; e-mail, jane.jensen{at}germed.umu.se.

Current Author Addresses: Drs. Jensen, Lundin-Olsson, Nyberg, and Gustafson: Department of Community Medicine and Rehabilitation, Geriatric Medicine and Physiotherapy, Umeå University, SE-901 85, Umeå, Sweden.

Author Contributions: Conception and design: J. Jensen, L. Lundin-Olsson,

L. Nyberg, Y. Gustafson.

Analysis and interpretation of the data: J. Jensen, L. Lundin-Olsson,

L. Nyberg, Y. Gustsafon.

Drafting of the article: J. Jensen.

Critical revision of the article for important intellectual content: J. Jensen, L. Lundin-Olsson, L. Nyberg, Y. Gustafson.

Final approval of the article: J. Jensen, L. Lundin-Olsson, L. Nyberg, Y. Gustafson.

Provision of study materials or patients: Y. Gustafson.

Statistical expertise: J. Jensen, L. Lundin-Olsson, Y. Gustafson.

Obtaining of funding: J. Jensen, L. Lundin-Olsson, L. Nyberg, Y. Gustafson.

Administrative, technical, or logistic support: Y. Gustafson.

Collection and assembly of data: J. Jensen, L. Lundin-Olsson, L. Nyberg, Y. Gustafson.

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