Interventions for preventing falls in older people in nursing care facilities and hospitals

Cochrane Review: Authors – Ian D Cameron,´Geoff R Murray,Lesley D Gillespie, M Clare Robertson, Keith D Hill, Robert G Cumming, Ngaire Kerse

 

Abstract

Background

Falls in nursing care facilities and hospitals are common events that cause considerable morbidity and mortality for older people.

Objectives

To assess the effectiveness of interventions designed to reduce falls by older people in nursing care facilities and hospitals.

Search methods

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (January 2009); the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 2); MEDLINE, EMBASE, and CINAHL (all to November 2008); trial registers and reference lists of articles.

Selection criteria

Randomised controlled trials of interventions to reduce falls in older people in nursing care facilities or hospitals. Primary outcomes were rate of falls and risk of falling.

Data collection and analysis

Two review authors independently assessed trial quality and extracted data. Data were pooled where appropriate.

Main results

We included 41 trials (25,422 participants).

In nursing care facilities, the results from seven trials testing supervised exercise interventions were inconsistent. This was the case too for multifactorial interventions, which overall did not significantly reduce the rate of falls (rate ratio (RaR) 0.82, 95% CI 0.62 to 1.08; 7 trials, 2997 participants) or risk of falling (risk ratio (RR) 0.93, 95% CI 0.86 to 1.01; 8 trials, 3271 participants). A post hoc subgroup analysis, however, indicated that where provided by a multidisciplinary team, multifactorial interventions reduced the rate of falls (RaR 0.60, 95% CI 0.51 to 0.72; 4 trials, 1651 participants) and risk of falling (RR 0.85, 95% CI 0.77 to 0.95; 5 trials, 1925 participants). Vitamin D supplementation reduced the rate of falls (RaR 0.72, 95% CI 0.55 to 0.95; 4 trials, 4512 participants), but not risk of falling (RR 0.98, 95% CI 0.89 to 1.09; 5 trials, 5095 participants).

In hospitals, multifactorial interventions reduced the rate of falls (RaR 0.69, 95% CI 0.49 to 0.96; 4 trials, 6478 participants) and risk of falling (RR 0.73, 95% CI 0.56 to 0.96; 3 trials, 4824 participants). Supervised exercise interventions showed a significant reduction in risk of falling (RR 0.44, 95% CI 0.20 to 0.97; 3 trials, 131 participants).

Authors‘ conclusions

There is evidence that multifactorial interventions reduce falls and risk of falling in hospitals and may do so in nursing care facilities. Vitamin D supplementation is effective in reducing the rate of falls in nursing care facilities. Exercise in subacute hospital settings appears effective but its effectiveness in nursing care facilities remains uncertain.

Plain language summary

Interventions for preventing falls in older people in nursing care facilities and hospitals

Falls by older people in nursing care facilities and hospitals are common events that may cause loss of independence, injuries, and sometimes death as a result of injury. Effective interventions are important as they will have significant health benefits.

This review includes 41 trials involving 25,422 participants, with about three quarters being women and having an average age of 83 years. Many of the participants had cognitive problems.

In nursing care facilities, interventions targeting multiple risk factors were not clearly effective in preventing falls but may be so when these interventions are provided by a co-ordinated team of health workers. The prescription of vitamin D reduces falls, as may a review of medication by a pharmacist. There is no evidence that other interventions targeting single risk factors reduce falls and this includes exercise interventions.

For patients who are in hospital for more than a few weeks, interventions targeting multiple risk factors, and supervised exercise, are effective.

Limitations of the review included the small number of hospital studies, difficulty isolating effects of individual components of treatments that involved multiple components, and the variability of interventions.

Quelle / Abstract:    http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005465.pub2/abstract

 

Full Text / pdf / Reprint – online im internet – Zugriff vom 30.09.12 – Interventions for preventing falls in older people in nursing care facilities and hospitals  :

http://www.globalaging.org/health/us/2010/FallIntervention.pdf

 

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Interventions for preventing falls in elderly people

  1. Lesley D Gillespie,
  2. William J Gillespie,
  3. M Clare Robertson,
  4. Sarah E Lamb,
  5. Robert G Cumming,
  6. Brian H Rowe

The Cochrane Database of systematic review

Abstract

Background

Approximately 30 per cent of people over 65 years of age and living in the community fall each year; the number is higher in institutions. Although less than one fall in 10 results in a fracture, a fifth of fall incidents require medical attention.

Objectives

To assess the effects of interventions designed to reduce the incidence of falls in elderly people (living in the community, or in institutional or hospital care).

Search strategy

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (January 2003), Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to February 2003), EMBASE (1988 to 2003 Week 19), CINAHL (1982 to April 2003), The National Research Register, Issue 2, 2003, Current Controlled Trials (www.controlled-trials.com accessed 11 July 2003) and reference lists of articles. No language restrictions were applied. Further trials were identified by contact with researchers in the field.

Selection criteria

Randomised trials of interventions designed to minimise the effect of, or exposure to, risk factors for falling in elderly people. Main outcomes of interest were the number of fallers, or falls. Trials reporting only intermediate outcomes were excluded.

Data collection and analysis

Two reviewers independently assessed trial quality and extracted data. Data were pooled using the fixed effect model where appropriate.

Main results

Sixty two trials involving 21,668 people were included.

Interventions likely to be beneficial:

Multidisciplinary, multifactorial, health/environmental risk factor screening/intervention programmes in the community both for an unselected population of older people (4 trials, 1651 participants, pooled RR 0.73, 95%CI 0.63 to 0.85), and for older people with a history of falling or selected because of known risk factors (5 trials, 1176 participants, pooled RR 0.86, 95%CI 0.76 to 0.98), and in residential care facilities (1 trial, 439 participants, cluster-adjusted incidence rate ratio 0.60, 95%CI 0.50 to 0.73)
A programme of muscle strengthening and balance retraining, individually prescribed at home by a trained health professional (3 trials, 566 participants, pooled relative risk (RR) 0.80, 95% confidence interval (95%CI) 0.66 to 0.98)
Home hazard assessment and modification that is professionally prescribed for older people with a history of falling (3 trials, 374 participants, RR 0.66, 95% CI 0.54 to 0.81)
Withdrawal of psychotropic medication (1 trial, 93 participants, relative hazard 0.34, 95%CI 0.16 to 0.74)
Cardiac pacing for fallers with cardioinhibitory carotid sinus hypersensitivity (1 trial, 175 participants, WMD -5.20, 95%CI -9.40 to -1.00)
A 15 week Tai Chi group exercise intervention (1 trial, 200 participants, risk ratio 0.51, 95%CI 0.36 to 0.73).

Interventions of unknown effectiveness:

Group-delivered exercise interventions (9 trials, 1387 participants)
Individual lower limb strength training (1 trial, 222 participants)
Nutritional supplementation (1 trial, 46 participants)
Vitamin D supplementation, with or without calcium (3 trials, 461 participants)
Home hazard modification in association with advice on optimising medication (1 trial, 658 participants), or in association with an education package on exercise and reducing fall risk (1 trial, 3182 participants)
Pharmacological therapy (raubasine-dihydroergocristine, 1 trial, 95 participants)
Interventions using a cognitive/behavioural approach alone (2 trials, 145 participants)
Home hazard modification for older people without a history of falling (1 trial, 530 participants)
Hormone replacement therapy (1 trial, 116 participants)
Correction of visual deficiency (1 trial, 276 participants).

Interventions unlikely to be beneficial:

Brisk walking in women with an upper limb fracture in the previous two years (1 trial, 165 participants).

Authors‘ conclusions

Interventions to prevent falls that are likely to be effective are now available; less is known about their effectiveness in preventing fall-related injuries. Costs per fall prevented have been established for four of the interventions and careful economic modelling in the context of the local healthcare system is important. Some potential interventions are of unknown effectiveness and further research is indicated.

Plain language summary

Interventions for preventing falls in elderly people

Approximately 30 per cent of people over 65 years and living in the community fall each year; the number is higher in institutions. A fifth of incidents require medical attention. Multidisciplinary interventions targeting multiple risk factors are effective in reducing the incidence of falls, as is muscle strengthening combined with balance retraining, individually prescribed at home by a trained health professional. Tai Chi may also be effective. Home hazard assessment and modification by a health professional may reduce falls, especially in those with a history of falling. Cardiac pacing for fallers with cardioinhibitory carotid sinus hypersensitivity is likely to be beneficial, as is withdrawal of psychotropic medication. Individually tailored interventions delivered by a health professional are more effective than standard or group delivered programmes.

Full Text / pdf:

The Cochrane Database of systematic review – Intervnetions for preventing falls in elderly people – Review / 2003 / 2004 von Gillespie et al. – online im internet – Zugriff vom 30.09.2012 :

http://www.rima.org/web/medline_pdf/CD000340.PDF

 

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The Relationship between Quadriceps Strength and Balance to Fall of Elderly Admitted to a Nursing Home

Tome Ikezoe1), Yasuyoshi Asakawa2), Akimitsu Tsutou3)

1) Department of Physical Therapy, College of Medical Technology, Kyoto University 2) Department of Physical Therapy, Faculty of Medicine, Gunma University 3) Faculty of Health Sciences, Kobe University School of Medicine

Released 2004/01/16

Keywords: Fall, Elderly, Quadriceps strength, Balance

ABSTRACT

This study was undertaken to determine the relationship between quadriceps strength and balance to falls of institutionalized elderly people.

The subjects comprised 25 elderly women aged 75.3 ± 3.4 years. The values of the postural sway in two standing positions, functional reach test, and quadriceps strength were compared between two groups of elderly adults, those with or without a history of fall.

Quadriceps strength was measured using isometric contraction of the knee extension. There were no significant differences between the two groups in the postural sway in the two standing positions and the functional reach test.

Quadriceps strength in the non-fall group was, however, significantly higher than that in the fall group (1.48 Nm/kg vs. 1.08 Nm/kg, p<0.01). The discriminating criterion for muscle strength between the two groups was 1.28 Nm/kg, with an apparent error rate of 24.8%.

These findings suggest that (1) the degree of quadriceps strength may be a useful indicator for the prospect of fall in institutionalized elderly people, and (2) quadriceps strength should be maintained at least more than 1.28 Nm/kg to prevent fall.

Quelle:  https://www.jstage.jst.go.jp/article/jpts/15/2/15_2_75/_article

Full Text / pdf:

https://www.jstage.jst.go.jp/article/jpts/15/2/15_2_75/_pdf

 

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Relationship between Falls and Knee Extension Strength in the Elderly

Yasuyoshi Asakawa1), Tome Ikezoe1), Kan Hazaki1), Ichiro Kawano2), Seigo Irie2), Hideto Kanzaki2), Nobuo Aoki3)

1) Division of Physical Therapy, College of Medical Technology, Kyoto University, 53 Shougoin Kawahara-cho, Sakyo-ku, Kyoto-city 606-01, Japan. 2) Department of Physical Therapy, Kyoto University Hospital 3) Kenkoen Geriatric Clinic

Released 2001/12/27

Keywords: Fall, Knee extension strength, Elderly

ABSTRACT

This study examined the relationship between falls and knee extension strength in the eldely. Twenty-seven elderly persons who resided at the same home for aged were asked about their individual histories of falling during the previous year, including the location where the fall had occured, such as near the bed, in the toilet, or in the corridor.

The isometric maximal knee extension strength of the subjects was determined, measured by a hand-held dynamometer in the knee flexed at 90 degrees, as a percentage of their weight. Calculations were obtained on the dominant side and non-dominant side, and the sum of both sides was also noted.

The subjects were then divided into two groups: no-fall group (n=18), and fall group (n=9). The fall group was further divided into the fall outside the home group (n=2) and the fall in the home group (n=7). The knee extension strength was compared by two-sample t-test between the no-fall and the fall outside the home group, and between the no-fall and the fall in the home group.

In addition, the range of knee extension strength in the fall in the home group was examined by scattergraph, in which the knee extension strength of all subjects were plotted. The two-sample t-test revealed significant differences in knee extension strength between the no-fall group and the fall in the home group (p<0.05). The scattergraph indicated that the knee extension strength of the subjects who had a fall in the home was at a range less than approximately 35% of their weight.

These results suggested that poor knee extension strength was closely related to falls in the home, and it is thus desirable that elderly maintain their knee extension strength above approximately 35% of their weight in each side to prevent falls in the home.

Quelle:  https://www.jstage.jst.go.jp/article/jpts/8/2/8_2_45/_article

 

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