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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
Abstract
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.
Article and Author Information
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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.
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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.
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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.
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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.
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Author Contributions: Conception and design: J. Jensen, L. Lundin-Olsson,
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L. Nyberg, Y. Gustafson.
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Analysis and interpretation of the data: J. Jensen, L. Lundin-Olsson,
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L. Nyberg, Y. Gustsafon.
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Drafting of the article: J. Jensen.
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Critical revision of the article for important intellectual content: J. Jensen, L. Lundin-Olsson, L. Nyberg, Y. Gustafson.
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Final approval of the article: J. Jensen, L. Lundin-Olsson, L. Nyberg, Y. Gustafson.
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Provision of study materials or patients: Y. Gustafson.
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Statistical expertise: J. Jensen, L. Lundin-Olsson, Y. Gustafson.
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Obtaining of funding: J. Jensen, L. Lundin-Olsson, L. Nyberg, Y. Gustafson.
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Administrative, technical, or logistic support: Y. Gustafson.
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Collection and assembly of data: J. Jensen, L. Lundin-Olsson, L. Nyberg, Y. Gustafson.
- Copyright ©2004 by the American College of Physicians
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