Prevention of falls in nursing homes: subgroup analyses of a randomized fall prevention trial.

OBJECTIVES

To evaluate the effectiveness of a multifactorial fall prevention program in prespecified subgroups of nursing home residents.

DESIGN

Secondary analysis of a cluster-randomized, controlled trial.

SETTING

Six nursing homes in Germany.

PARTICIPANTS

Seven hundred twenty-five long-stay residents; median age 86; 80% female.

INTERVENTION

Staff and resident education on fall prevention, advice on environmental adaptations, recommendation to wear hip protectors, and progressive balance and resistance training.

MEASUREMENTS

Time to first fall and the number of falls. Falls were assessed during the 12-month intervention period. Univariate regression analyses were performed, including a confirmatory test of interaction.

RESULTS

The intervention was more effective in people with cognitive impairment (hazard ratio (HR)=0.49, 95% confidence interval (CI)=0.35-0.69) than in those who were cognitively intact (HR=0.91, 95% CI=0.68-1.22), in people with a prior history of falls (HR=0.47, 95% CI=0.33-0.67) than in those with no prior fall history (HR=0.77, 95% CI=0.58-1.01), in people with urinary incontinence (HR=0.59, 95% CI=0.45-0.77) than in those with no urinary incontinence (HR=0.98, 95% CI=0.68-1.42), and in people with no mood problems (incidence rate ratio (IRR)=0.41, 95% CI=0.27-0.61) than in those with mood problems (IRR=0.74, 95% CI=0.51-1.09).

CONCLUSION

The effectiveness of a multifactorial fall prevention program differed between subgroups of nursing home residents. Cognitive impairment, a history of falls, urinary incontinence, and depressed mood were important in determining response.