Abstract
Objectives
To determine the efficacy of fall intervention programs in nursing homes (NHs) and
the generalizability of these interventions to people living with cognitive impairment
and dementia.
Design
Systematic review and meta-analysis.
Setting and Participants
NH residents (n = 30,057) living in NHs defined as residential facilities that provide
24-hours-a-day surveillance, personal care, and some clinical care for persons who
are typically aged ≥65 years with multiple complex chronic health conditions.
Methods
Meta-analysis of falls prevention interventions on number of falls, fallers, and recurrent
fallers.
Results
Thirty-six studies met inclusion criteria for the systematic review. Overall, fall
prevention interventions reduced the number of falls [risk ratio (RR) = 0.73, 95%
confidence interval (CI) = 0.60-0.88], fallers (RR = 0.80, 95% CI = 0.72-0.89), and
recurrent fallers (RR = 0.70, 95% CI = 0.60-0.81). Subanalyses revealed that single
interventions have a significant effect on reducing fallers (RR = 0.78, 95% CI = 0.69-0.89)
and recurrent fallers (RR = 0.60, 95% CI = 0.52-0.70), whereas multiple interventions
reduce fallers (RR = 0.69, 95% CI = 0.39-0.97) and multifactorial interventions reduce
number of falls (RR = 0.65, 95% CI = 0.45-0.94).
Conclusions and Implications
Exercise as a single intervention reduced the number of fallers and recurrent fallers
by 36% and 41%, respectively, in people living in NHs. Other effective interventions
included staff education and multiple and multifactorial interventions. However, more
research on exercise including people with cognitive impairment and dementia is needed
to improve the generalizability of these interventions to the typical NH resident.
Keywords
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References
- Epidemiology of falls in residential aged care: Analysis of more than 70,000 falls from residents of bavarian nursing homes.J Am Med Dir Assoc. 2012; 13: 187.e1-187.e6
- Indicator library: Falls in the Last 30 Days in Long-Term Care 2018. Canadian Institute for Health Information.(Available at:)https://yourhealthsystem.cihi.ca/hsp/indepth?lang=en#/indicator/051/2/C5001/Date accessed: July 2, 2019
- Percentage of long-stay residents experiencing one or more falls with major injury. Nursing Home Compare 2018.(Available at:)https://data.medicare.gov/Nursing-Home-Compare/Quality-Measures-Long-Stay/iqd3-nsf3Date accessed: July 2, 2019
- Defining safety in the nursing home setting: Implications for future research.J Am Med Dir Assoc. 2016; 17: 473-481
- Prevalence of psychiatric disorders among older adults in long-term care homes: A systematic review.Int Psychogeriatr. 2010; 22: 1025-1039
- Dementia and neuropsychiatric symptoms in nursing-home patients in Nord-Trøndelag County.Tidsskr Nor Laegeforen. 2012; 132: 1956-1959
- Prevalence and severity of cognitive impairment with and without dementia in an elderly population.Lancet. 1997; 349: 1793-1796
- Incidence and prediction of falls in dementia: A prospective study in older people.PLoS One. 2009; 4: e5521
- Dementia as a risk factor for falls and fall injuries among nursing home residents.J Am Geriatr Soc. 2003; 51: 1213-1218
- Falls prevention in the elderly: Translating evidence into practice.Hong Kong Med J. 2015; 21: 165-181
- Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons and Recommendations 2011. American Geriatrics Society/British Geriatrics Society.(Available at:)www.geriatricscareonline.org/FullText/CL014/CL014_BOOK003Date accessed: March 26, 2019
- A palliative approach to falls in advanced dementia.Am J Geriatr Psychiatry. 2018; 26: 407-415
- The effectiveness of physical restraints in reducing falls among adults in acute care hospitals and nursing homes: A systematic review.JBI Libr Syst Rev. 2012; 10: 307-351
- The slippery slope: Reducing fall risk in older adults.Prim Care. 2005; 32: 683-697
- Tying the knot between resident care and quality of life.Balance. 1997; 1 (16, 18)
- Physical restraints in nursing homes: A review of the literature since the Nursing Home Reform Act of 1987.Med Care Res Rev. 1998; 55 (discussion 171–176): 139-170
- Falls in the nursing home.Ann Intern Med. 1994; 121: 442-451
- Interventions for preventing falls in older people in nursing care facilities and hospitals.Cochrane Database Syst Rev. 2010; : CD005465
- Interventions for preventing falls in older people in care facilities and hospitals.Cochrane Database Syst Rev. 2018; 12 (review): CD005465
- Characteristics and effectiveness of fall prevention programs in nursing homes: A systematic review and meta-analysis of randomized controlled trials.J Am Geriatr Soc. 2015; 63: 211-221
- Review of Systematic Reviews on Prevention of Falls in Institutions [Internet]. Oslo, Norway: Knowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH), 2015.(Available at:)http://www.ncbi.nlm.nih.gov/books/NBK390564/Date accessed: October 1, 2019
- Effectiveness of intervention programs in preventing falls: A systematic review of recent 10 years and meta-analysis.J Am Med Dir Assoc. 2012; 13: 188.e13-188.e21
- A taxonomy and economic consequences of nursing home falls.Drugs Aging. 2006; 23: 251-262
- Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0.(The Cochrane Collaboration, 2011. Available at:)www.handbook.cochrane.org(Accessed January 13, 2020)Date: 2011
- Prevention of Fall Network Europe.(Available at:)www.profane.eu.org/documents/Falls_Taxonomy.pdfDate accessed: March 21, 2019
- Introduction to Meta-Analysis.John Wiley & Sons, Ltd, West Sussex, UK2009
- Introduction, comparison, and validation of meta-essentials: A free and simple tool for meta-analysis.Res Synth Methods. 2017; 8: 537-553
- Modern Epidemiology.3rd ed. Lippincott Williams & Wilkins, Philadelphia, PA2008
- Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: Systematic review and meta-analyses.BMJ. 2007; 334: 82
- Effectiveness of a multifaceted intervention on falls in nursing home residents.J Am Geriatr Soc. 2003; 51: 306-313
- Caring for Aged Dementia Care Resident Study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: A cluster-randomised trial.Lancet Neurol. 2009; 8: 317-325
- Effect of promoting high-quality staff interactions on fall prevention in nursing homes: A cluster-randomized trial.JAMA Intern Med. 2017; 177: 1634-1641
- Educating nursing home staff on fracture prevention: A cluster randomised trial.Age Ageing. 2008; 37: 167-172
- Falls prevention in residential care homes: A randomised controlled trial.Age Ageing. 2004; 33: 596-602
- Effectiveness of exergaming training in reducing risk and incidence of falls in frail older adults with a history of falls.Arch Phys Med Rehabil. 2015; 96: 2096-2102
- Optimizing function and physical activity among nursing home residents with dementia: Testing the impact of function-focused care.Gerontologist. 2014; 54: 930-943
- An educational intervention on drug use in nursing homes improves health outcomes resource utilization and reduces inappropriate drug prescription.J Am Med Dir Assoc. 2014; 15: 885-891
- Progressive resistance and balance training for falls prevention in long-term residential aged care: A cluster randomized trial of the sunbeam program.J Am Med Dir Assoc. 2018; 19: 361-369
- Low-frequency exercise and vitamin D supplementation reduce falls among institutionalized frail elderly.Int J Gerontol. 2016; 10: 202-206
- Nurse education to reduce harmful medication use in assisted living facilities: Effects of a randomized controlled trial on falls and cognition.Drugs Aging. 2015; 32: 947-955
- Does a functional activity programme improve function, quality of life, and falls for residents in long term care? Cluster randomised controlled trial.BMJ. 2008; 337: a1445
- Effects of a multimodal exercise program on balance, functional mobility and fall risk in older adults with cognitive impairment: A randomized controlled single-blind study.Eur J Phys Rehabil Med. 2013; 49: 639-648
- Effect of a pharmacist-led multicomponent intervention focusing on the medication monitoring phase to prevent potential adverse drug events in nursing homes.J Am Geriatr Soc. 2011; 59: 1238-1245
- Vitamin D supplementation and the prevention of fractures and falls: Results of a randomised trial in elderly people in residential accommodation.Age Ageing. 2006; 35: 482-486
- A randomized controlled trial of fall prevention strategies in old peoples’ homes.Gerontology. 2000; 46: 83-87
- Comparison of a fall risk assessment tool with nurse’s judgement alone: A cluster-randomised controlled trial.Age Ageing. 2009; 38: 417-423
- A multifactorial intervention for the prevention of falls in psychogeriatric nursing home patients, a randomised controlled trial (RCT).Age Ageing. 2009; 38: 194-199
- An evaluation of an adapted U.S. model of pharmaceutical care to improve psychoactive prescribing for nursing home residents in Northern Ireland (Fleetwood Northern Ireland Study).J Am Geriatr Soc. 2010; 58: 44-53
- Deprescribing in frail older people: A randomised controlled trial.PLoS One. 2016; 11: e0149984
- Prevention of falls in nursing homes: Subgroup analyses of a randomized fall prevention trial.J Am Geriatr Soc. 2008; 56: 1092-1097
- A randomized trial of a consultation service to reduce falls in nursing home.JAMA. 1997; 278: 557-562
- Fall prevention using olfactory stimulation with lavender odor in elderly nursing home residents: A randomized controlled trial.J Am Geriatr Soc. 2012; 60: 1005-1011
- The influence of tai chi and yoga on balance and falls in a residential care setting: A randomised controlled trial.Contemp Nurse. 2014; 48: 76-87
- Does an exercise and incontinence intervention save healthcare costs in a nursing home population?.J Am Geriatr Soc. 2003; 51: 161-168
- A fall prevention program for elderly individuals. Exercise in long-term care settings.J Gerontol Nurs. 2000; 26: 43-51
- Effects of a whole body vibration (WBV) exercise intervention for institutionalized older people: A randomized, multicentre, parallel, clinical trial.J Am Med Dir Assoc. 2015; 16: 125-131
- Resident-to-resident mistreatment: Evaluation of a staff training program in the reduction of falls and injuries.J Gerontol Nurs. 2018; 44: 15-23
- Postural stability and quality of life after guided and self-training among older adults residing in an institutional setting.Clin Interv Aging. 2013; 8: 1237-1246
- Fewer adverse events as a result of the SAFE or SORRY? Programme in hospitals and nursing homes. Part I: Primary outcome of a cluster randomised trial.Int J Nurs Stud. 2011; 48: 1040-1048
- Self-paced cycling improves cognition on institutionalized older adults without known cognitive impairment: A 15-month randomized controlled trial.J Aging Phys Act. 2018; 26: 614-623
- The Falls in Care Home Study: A feasibility randomized controlled trial of the use of a risk assessment and decision support tool to prevent falls in care homes.Clin Rehabil. 2016; 30: 972-983
- A cluster randomised controlled trial to prevent injury due to falls in a residential aged care population.Med J Aust. 2010; 192: 319-322
- Feasibility and efficacy of a multi-factorial intervention to prevent falls in older adults with cognitive impairment living in residential care (ProF-Cog). A feasibility and pilot cluster randomised controlled trial.BMC Geriatr. 2017; 17: 115
- Podiatry intervention versus usual care to prevent falls in care homes: Pilot randomised controlled trial (the PIRFECT study).BMC Geriatr. 2017; 17: 143
- Short stick exercises for fall prevention among older adults: A cluster randomized trial.Disabil Rehabil. 2015; 37: 1268-1276
- Factors associated with the risk of falls of nursing home residents aged 80 or older.Rehabil Nurs. 2016; 41: 16-25
- Outcome measures correlated with falls in nursing home residents—A pilot study.Physiother Theory Pract. 2017; 33: 725-732
- Functional mobility limitations and falls in assisted living residents with dementia: Physical performance assessment and quantitative gait analysis.J Geriatr Phys Ther. 2013; 36: 78-86
- Exercise interventions for preventing falls among older people in care facilities: A meta-analysis.Worldviews Evid Based Nurs. 2017; 14: 74-80
- Exercise to prevent falls in older adults: An updated systematic review and meta-analysis.Br J Sports Med. 2017; 51: 1750-1758
- Exercise for preventing falls in older people living in the community.Cochrane Database Syst Rev. 2019; : CD012424
- Psychotropic drugs and risk of recurrent falls in ambulatory nursing home residents.Am J Epidemiol. 1995; 142: 202-211
- A feasibility study of a multifaceted walking intervention to maintain the functional mobility, activities of daily living, and quality of life of nursing home residents with dementia.Rehabil Nurs. 2020; 45: 204-217
- Scheduled medications and falls in dementia patients utilizing a wander garden.Am J Alzheimers Dis Other Demen. 2009; 24: 322-332
- Effectiveness of environment-based interventions that address behavior, perception, and falls in people with Alzheimer’s disease and related major neurocognitive disorders: A systematic review.Am J Occup Ther. 2017; 71 (7105180030p1–7105180030p10)
- The effect of enhanced supervision on fall rates in residential aged care.Am J Phys Med Rehabil. 2009; 88: 823-828
- Hourly rounding and patient falls: What factors boost success?.Nursing. 2015; 45: 25-30
- Older people's recruitment, sustained participation, and adherence to falls prevention interventions in institutional settings: A supplement to the Cochrane systematic review.Age Ageing. 2011; 40: 430-436
- Facilitators of and barriers to hip protector acceptance and adherence in long-term care facilities: A systematic review.J Am Med Dir Assoc. 2015; 16: 185-193
- Effectiveness and implementation aspects of interventions for preventing falls in elderly people in long-term care facilities: A systematic review of RCTs.J Am Med Dir Assoc. 2011; 12: 410-425
- Use of physical restraints in nursing homes: A multicentre cross-sectional study.BMC Geriatr. 2015; 15: 129
- The use of physical restraints in long-term care in Spain: A multi-center cross-sectional study.BMC Geriatr. 2017; 17: 29
- Factors associated with the trend of physical and chemical restraint use among long-term care facility residents in Hong Kong: Data from an 11-year observational study.J Am Med Dir Assoc. 2017; 18: 1043-1048
- Development of a common outcome data set for fall injury prevention trials: The prevention of falls network Europe consensus.J Am Geriatr Soc. 2005; 53: 1618-1622
Article info
Publication history
Published online: January 23, 2020
Footnotes
This work was supported by funding from the Walter and Maria Schroeder Institute for Brain Innovation and Recovery.
The authors declare no conflicts of interest.
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© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
