Fall-prevention programs that specifically target at-risk nursing home residents may prove most effective in reducing the prevalence of falls

Vlaeyen E, Coussement J, Leysens G, et al.  Characteristics and effectiveness of fall prevention programs in nursing homes: A systematic review and meta-analysis of randomized controlled trials Journal of the American Geriatrics Society. 2015 Feb;63(2):211-21

Review question

Which fall-prevention programs are most effective in reducing the prevalence of falls among elderly patients living in nursing homes?

Background

Nursing home residents are highly prone to falling, and almost half of all residents experience more than one fall per year. Falls result in physical injuries, most notably hip fractures, and create psychological burden that can reduce quality of life.

Different fall-prevention programs employed at nursing homes include supervised exercise, staff training and tailored intervention programs to specific at-risk patients, but it is unclear which intervention is most effective.

Current reviews of fall-prevention programs have offered little evidence of best practices due to methodological shortcomings, vague definitions of care settings and the lack of differentiation between between those who have fallen once, and those who have experienced recurrent falls. 

How the review was done

A detailed search of a number of electronic databases for studies published up until 2013 was conducted. Studies that were conducted exclusively in nursing homes and used fall-prevention programs in an attempt to examine their effectiveness over six months in reducing the number of falls were included in the review.

A total of 1,424 studies were identified in searches and 13 were included in the review after assessment for eligibility.

This review was funded by the Flemish Ministry of Welfare, Public Health and Family along with the Universitiet Derde Leeftijd Leuven.

What the researchers found

There was no clear reduction in the number of falls shown in studies using single interventions or multiple interventions.

However, using approaches that target each resident’s unique risk factors reduced the total number of falls and the number of people who had recurring falls by a modest amount.

Nursing homes with a higher prevalence of residents with dementia were more likely to benefit from fall-prevention programs, but not all studies clearly reported the number of residents with dementia.

Conclusion

Prevention programs that target a resident’s unique risk factors were most effective in reducing the number of falls and number of people who had recurrent falls in nursing homes. Reducing the prevalence of falls has public health and clinical benefit because every fall carries a risk of injury among the elderly. Robust conclusions cannot be drawn, however, due to poor methodological quality among the limited number of included studies in this review.