There is a high incidence of falls in older people in care facilities (nursing homes) and hospitals. They can cause loss of independence, injuries and sometimes death. Many intrinsic and extrinsic risk factors have been recognized as responsible for falls.
Interventions to prevent falls like exercise, medication interventions (i.e. vitamin D supplementation), environment changes or assistive technologies (i.e. bed or chair alarms), social environment interventions and knowledge interventions have been studied and are currently in use. The multifactorial intervention, where a combination of strategies is selected and applied together based on the individual assessment of a person’s risk factors for falling seems to be ideal to prevent the fall incidence in this setting.
This is an update of a previous review summarizing the existing evidence of the impact of targeted interventions designed to prevent falls, in addition to the unknown impact of routine care in nursing homes and hospitals. Ninety-five randomised controlled trials were included and multifactorial interventions were tested in 13 trials.
In nursing homes, despite the large number of studies, the effect of exercise and general medication on falls prevention are still uncertain. Evidence shows that vitamin D supplementation probably reduces the rate of falls but not risk of falling while the effect of multifactorial interventions on the rate of falls is uncertain and they may make little or no difference to the risk of falling.
Also, in hospitals, the effects of additional physiotherapy on the rate of falls or the risk of falling are uncertain. In particular, multifactorial interventions may reduce the incidence especially in a subacute setting while the effect of these interventions on the risk of falling is still uncertain.
Interventions to prevent falls like exercise, medication interventions (i.e. vitamin D supplementation), environment changes or assistive technologies (i.e. bed or chair alarms), social environment interventions and knowledge interventions have been studied and are currently in use. The multifactorial intervention, where a combination of strategies is selected and applied together based on the individual assessment of a person’s risk factors for falling seems to be ideal to prevent the fall incidence in this setting.
This is an update of a previous review summarizing the existing evidence of the impact of targeted interventions designed to prevent falls, in addition to the unknown impact of routine care in nursing homes and hospitals. Ninety-five randomised controlled trials were included and multifactorial interventions were tested in 13 trials.
In nursing homes, despite the large number of studies, the effect of exercise and general medication on falls prevention are still uncertain. Evidence shows that vitamin D supplementation probably reduces the rate of falls but not risk of falling while the effect of multifactorial interventions on the rate of falls is uncertain and they may make little or no difference to the risk of falling.
Also, in hospitals, the effects of additional physiotherapy on the rate of falls or the risk of falling are uncertain. In particular, multifactorial interventions may reduce the incidence especially in a subacute setting while the effect of these interventions on the risk of falling is still uncertain.
Comment by Francesco Agostini