Fall and injury prevention in older people living in residential care facilities. A cluster randomized trial.

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.