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27 - Fall Prevention in Residential Aged Care Facilities

from Part II - Strategies for Prevention

Published online by Cambridge University Press:  04 November 2021

Stephen R. Lord
Affiliation:
Neuroscience Research Australia, Sydney
Catherine Sherrington
Affiliation:
Sydney Medical School
Vasi Naganathan
Affiliation:
Concord Hospital
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Summary

The chapter synthesizes the current knowledge about falls, fall-related injuries, and fall prevention among residents of nursing homes, residential care, and assisted living. These groups are from here on referred to as residents of long-term care (LTC) facilities. Evidence on the efficacy and effectiveness of fall prevention measures is cross-linked to the findings of systematic reviews, meta-analyses, and the most recent Cochrane review published in 2018 [1]. Evidence based on controlled studies is not available for all relevant questions. Therefore, scientific evidence is augmented by recommendations based on observational data and the authors’ two decades of experience with large-scale implementation projects on fall prevention in German LTC facilities. The type of institutional care, and the qualification and cooperation of the staff differ significantly between countries and different care systems. In addition, resident case mix and care culture can differ considerably across countries. This should always be kept in mind. In order to update the knowledge, we performed a narrative literature search including study registries and databases. For the update, 46 either registered or published studies from 2010 onwards were considered.

Type
Chapter
Information
Falls in Older People
Risk Factors, Strategies for Prevention and Implications for Practice
, pp. 410 - 424
Publisher: Cambridge University Press
Print publication year: 2021

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References

Cameron, ID, Dyer, SM, Panagoda, CE et al. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev. 2018;2018:CD005465.Google Scholar
Rubenstein, LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing. 2006;35(2):ii3741.CrossRefGoogle ScholarPubMed
Rapp, K, Becker, C, Cameron, ID et al. Epidemiology of falls in residential aged care: analysis of more than 70,000 falls from residents of Bavarian nursing homes. J Am Med Dir Assoc. 2012;13:187.e16.CrossRefGoogle Scholar
Yang, Y, Mackey, DC, Liu-Ambrose, T et al. Clinical risk factors for head impact during falls in older adults: a prospective cohort study in long-term care. J Head Trauma Rehabil. 2017;32:168–77.Google Scholar
Zimmerman, SI, Girman, CJ, Buie, VC et al. The prevalence of osteoporosis in nursing home residents. Osteoporos Int. 1999;9:151–7.Google ScholarPubMed
Rapp, K, Becker, C, Cameron, ID et al. Femoral fracture rates in people with and without disability. Age Ageing. 2012;41:653–8.Google Scholar
Icks, A, Haastert, B, Wildner, M et al. Trend of hip fracture incidence in Germany 1995–2004: a population-based study. Osteoporos Int. 2008;19:1139–45.Google Scholar
Simon Fraser University. Technology for Injury Prevention in Seniors. 2019. www.sfu.ca/tips/ResearchProjects/videofalls.html (accessed April 2021).Google Scholar
Rubenstein, LZ, Josephson, KR, Robbins, AS. Falls in the nursing home. Ann Intern Med. 1994;121:442–51.Google Scholar
Deandrea, S, Bravi, F, Turati, F et al. Risk factors for falls in older people in nursing homes and hospitals. A systematic review and meta-analysis. Arch Gerontol Geriatr. 2013;56:407–15.Google Scholar
Chiarelli, PE, Mackenzie, LA, Osmotherly, PG. Urinary incontinence is associated with an increase in falls: a systematic review. Aust J Physiother. 2009;55:8995.Google Scholar
Luukinen, H, Koski, K, Laippala, P et al. Risk factors for recurrent falls in the elderly in long-term institutional care. Public Health. 1995;109:5765.CrossRefGoogle ScholarPubMed
van Doorn, C, Gruber-Baldini, AL, Zimmerman, S et al. Dementia as a risk factor for falls and fall injuries among nursing home residents. J Am Geriatr Soc. 2003;51:1213–18.Google Scholar
Thapa, PB, Gideon, P, Cost, TW et al. Antidepressants and the risk of falls among nursing home residents. N Engl J Med. 1998;339:875–82.Google Scholar
Kron, M, Loy, S, Sturm, E et al. Risk indicators for falls in institutionalized frail elderly. Am J Epidemiol. 2003;158:645–53.CrossRefGoogle ScholarPubMed
Leipzig, RM, Cumming, RG, Tinetti, ME. Drugs and falls in older people: a systematic review and meta-analysis. I. Psychotropic drugs. J Am Geriatr Soc. 1999;47:30–9.Google ScholarPubMed
Leipzig, RM, Cumming, RG, Tinetti, ME. Drugs and falls in older people: a systematic review and meta-analysis. II. Cardiac and analgesic drugs. J Am Geriatr Soc. 1999;47:4050.CrossRefGoogle ScholarPubMed
Hartikainen, S, Lonnroos, E, Louhivuori, K. Medication as a risk factor for falls: critical systematic review. J Gerontol A Biol Sci Med Sci. 2007;62:1172–81.CrossRefGoogle ScholarPubMed
Lord, SR, March, LM, Cameron, ID et al. Differing risk factors for falls in nursing home and intermediate-care residents who can and cannot stand unaided. J Am Geriatr Soc. 2003;51:1645–50.Google Scholar
Khatib, R, Santesso, N, Pickard, L et al. Fracture risk in long term care: a systematic review and meta-analysis of prospective observational studies. BMC Geriatr. 2014;14:130.CrossRefGoogle ScholarPubMed
Rapp, K, Lamb, SE, Klenk, J et al. Fractures after nursing home admission: incidence and potential consequences. Osteoporos Int. 2009;20:1775–83.Google Scholar
Marquardt, G, Bueter, K, Motzek, T. Impact of the design of the built environment on people with dementia: an evidence-based review. HERD. 2014;8:127–57.Google Scholar
Perell, KL, Nelson, A, Goldman, RL et al. Fall risk assessment measures: an analytic review. J Gerontol A Biol Sci Med Sci. 2001;56:M761–6.Google Scholar
Scott, V, Votova, K, Scanlan, A et al. Multifactorial and functional mobility assessment tools for fall risk among older adults in community, home-support, long-term and acute care settings. Age Ageing. 2007;36:130–9.Google Scholar
Lundin-Olsson, L, Jensen, J, Nyberg, L et al. Predicting falls in residential care by a risk assessment tool, staff judgement, and history of falls. Aging Clin Exp Res. 2003;15:51–9.CrossRefGoogle ScholarPubMed
Castle, NG, Engberg, J. Staff turnover and quality of care in nursing homes. Med Care. 2005;43:616–6.Google Scholar
Roigk, P, Becker, C, Schulz, C et al. Long-term evaluation of the implementation of a large fall and fracture prevention program in long-term care facilities. BMC Geriatr. 2018;18:233.Google Scholar
Wagner, LM, Capezuti, E, Taylor, JA et al. Impact of a falls menu-driven incident-reporting system on documentation and quality improvement in nursing homes. Gerontologist. 2005;45:835–42.Google Scholar
Woo, K, Milworm, G, Dowding, D. Characteristics of quality improvement champions in nursing homes: a systematic review with implications for evidence-based practice. Worldviews Evid Based Nurs. 2017;14:440–6.CrossRefGoogle ScholarPubMed
Kerse, N, Butler, M, Robinson, E et al. Fall prevention in residential care: a cluster, randomized, controlled trial. J Am Geriatr Soc. 2004;52:524–31.Google Scholar
Rask, K, Parmelee, PA, Taylor, JA et al. Implementation and evaluation of a nursing home fall management program. J Am Geriatr Soc. 2007;55:342–9.Google Scholar
Becker, C, Cameron, ID, Klenk, J et al. Reduction of femoral fractures in long-term care facilities: the Bavarian fracture prevention study. PLoS One. 2011;6:e24311.CrossRefGoogle ScholarPubMed
Schulz, C, Lindlbauer, I, Rapp, K et al. Long-term effectiveness of a multifactorial fall and fracture prevention program in Bavarian nursing homes: an analysis based on health insurance claims data. J Am Med Dir Assoc. 2017;18:552.e717.CrossRefGoogle ScholarPubMed
Jensen, J, Lundin-Olsson, L, Nyberg, L et al. Fall and injury prevention in older people living in residential care facilities: a cluster randomized trial. Ann Intern Med. 2002;136:733–41.CrossRefGoogle ScholarPubMed
Becker, C, Kron, M, Lindemann, U et al. Effectiveness of a multifaceted intervention on falls in nursing home residents. J Am Geriatr Soc. 2003;51:306–13.Google Scholar
Rapp, K, Lamb, SE, Erhardt-Beer, L et al. Effect of a statewide fall prevention program on incidence of femoral fractures in residents of long-term care facilities. J Am Geriatr Soc. 2010;58:70–5.Google Scholar
Vlaeyen, E, Stas, J, Leysens, G et al. Implementation of fall prevention in residential care facilities: a systematic review of barriers and facilitators. Int J Nurs Stud. 2017;70:110–21.Google Scholar
Ray, WA, Taylor, JA, Meador, KG et al. A randomized trial of a consultation service to reduce falls in nursing homes. J Am Med Assoc. 1997;278:557–62.Google Scholar
Rojas-Fernandez, CH, Seymour, N, Brown, SG. Helping pharmacists to reduce fall risk in long-term care: a clinical tool to facilitate the medication review process. Can Pharm J. 2014;147:171–8.Google Scholar
Bentzen, H, Forsen, L, Becker, C, et al. Uptake and adherence with soft- and hard-shelled hip protectors in Norwegian nursing homes: a cluster randomised trial. Osteoporos Int. 2008;19:101–11.CrossRefGoogle ScholarPubMed
Santesso, N, Carrasco-Labra, A, Brignardello-Petersen, R. Hip protectors for preventing hip fractures in older people. Cochrane Database Syst Rev. 2014:CD001255.Google Scholar
Minns, RJ, Marsh, AM, Chuck, A et al. Are hip protectors correctly positioned in use? Age Ageing. 2007;36:140–4.Google Scholar
Laing, AC, Feldman, F, Jalili, M et al. The effects of pad geometry and material properties on the biomechanical effectiveness of 26 commercially available hip protectors. J Biomech. 2011;44:2627–35.Google Scholar
Mackey, DC, Lachance, CC, Wang, PT et al. The Flooring for Injury Prevention (FLIP) Study of compliant flooring for the prevention of fall-related injuries in long-term care: a randomized trial. PLoS Med. 2019;16:e1002843.Google Scholar
Lindemann, U, Reicherz, A, Nicolai, S et al. Evaluation of an ergonomically modified bed to enhance mobilization in geriatric rehabilitation: a pilot study. Z Gerontol Geriatr. 2010;43:235–8.Google Scholar
Salminen, AL, Brandt, A, Samuelsson, K et al. Mobility devices to promote activity and participation: a systematic review. J Rehabil Med. 2009;41:697706.Google Scholar
McMurdo, ME, Millar, AM, Daly, F. A randomized controlled trial of fall prevention strategies in old peoples’ homes. Gerontology. 2000;46:83–7.Google Scholar
Mulrow, CD, Gerety, MB, Kanten, D et al. A randomized trial of physical rehabilitation for very frail nursing home residents. J Am Med Assoc. 1994;271:519–24.Google Scholar
Hewitt, J, Goodall, S, Clemson, L et al. Progressive resistance and balance training for falls prevention in long-term residential aged care: a cluster randomized trial of the sunbeam program. J Am Med Dir Assoc. 2018;19:361–9.Google Scholar
Toots, A, Littbrand, H, Lindelöf, N et al. Effects of a high-intensity functional exercise program on dependence in activities of daily living and balance in older adults with dementia. J Am Geriatr Soc. 2016;64:5564.CrossRefGoogle ScholarPubMed
Gardner, MM, Buchner, DM, Robertson, MC, et al. Implementation of an exercise-based falls prevention programme. Age Ageing. 2001;30:7783.Google Scholar
Sherrington, C, Michaleff, ZA, Fairhall, N et al. Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. Br J Sports Med. 2017;51:1750–8.Google Scholar
Oliver, D, Connelly, JB, Victor, CR et al. Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses. Br Med J. 2007;334:82.Google Scholar
Rapp, K, Lamb, SE, Buchele, G et al. Prevention of falls in nursing homes: subgroup analyses of a randomized fall prevention trial. J Am Geriatr Soc. 2008;56:1092–7.Google Scholar
Kovacs, E., Sztruhar Jonasne, I., Karoczi, CK, et al. Effects of a multimodal exercise program on balance, functional mobility and fall risk in older adults with cognitive impairment: a randomized controlled single-blind study. Eur J Phys Rehabil Med. 2013;49:639–48.Google ScholarPubMed
Jansen, CP, Diegelmann, M, Schilling, OK et al. Pushing the boundaries: a physical activity intervention extends sensor-assessed life-space in nursing home residents. Gerontologist. 2018;58:979–88.Google Scholar
Roigk, P, Rupp, K, Becker, C et al. Long-term evaluation of the fidelity of a strength and balance training in long-term care facilities: the Bavarian Fall and Fracture Prevention Programme (BF2P2). Physioscience. 2018;14:512.Google Scholar
Schnelle, JF, Alessi, CA, Simmons, SF et al. Translating clinical research into practice: a randomized controlled trial of exercise and incontinence care with nursing home residents. J Am Geriatr Soc. 2002;50:1476–83.Google Scholar
Brown, JS, Vittinghoff, E, Wyman, JF et al. Urinary incontinence: does it increase risk for falls and fractures? Study of Osteoporotic Fractures Research Group. J Am Geriatr Soc. 2000;48:721–5.Google Scholar
Klay, M, Marfyak, K. Use of a continence nurse specialist in an extended care facility. Urol Nurs. 2005;25:101–2, 107–8.Google Scholar
Leung, FW, Schnelle, JF. Urinary and fecal incontinence in nursing home residents. Gastroenterol Clin North Am. 2008;37:697707.Google Scholar
Kua, CH, Yeo, CYY, Char, CWT et al. Nursing home team-care deprescribing study: a stepped-wedge randomised controlled trial protocol. BMJ Open. 2017;7:e015293.Google Scholar
Wouters, H, Quick, EH, Boersma, F et al. Discontinuing inappropriate medication in nursing home residents (DIM-NHR Study): protocol of a cluster randomised controlled trial. BMJ Open. 2014;4:e006082.Google Scholar
Ailabouni, N, Mangin, D, Nishtala, PS. Deprescribing anticholinergic and sedative medicines: protocol for a Feasibility Trial (DEFEAT-polypharmacy) in residential aged care facilities. BMJ Open. 2017;7:e013800.Google Scholar
Seppala, L, Wermelink, A, De Vries, M et al. Falls-risk-increasing drugs: a systematic review and meta-analysis: II. Psychotrophics. J Am Med Dir Assoc. 2018;19:371.e1117.CrossRefGoogle Scholar
Shaw, FE, Bond, J, Richardson, DA et al. Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: randomised controlled trial. Br Med J. 2003;326:73.CrossRefGoogle Scholar
Zermansky, AG, Alldred, DP, Petty, DR et al. Clinical medication review by a pharmacist of elderly people living in care homes: randomised controlled trial. Age Ageing. 2006;35:586–91.CrossRefGoogle ScholarPubMed
Chapuy, MC, Arlot, ME, Duboeuf, F et al. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med. 1992;327:1637–42.Google Scholar
Beaudart, C, Buckinx, F, Rabenda, V et al. The effects of vitamin D on skeletal muscle strength, muscle mass, and muscle power: a systematic review and meta-analysis of randomized controlled trials. J Clin Endocrinol Metab. 2014;99:4336–45.Google Scholar
Jensen, J, Nyberg, L, Gustafson, Y et al. Fall and injury prevention in residential care – effects in residents with higher and lower levels of cognition. J Am Geriatr Soc. 2003;51:627–35.Google Scholar
Hofmann, H, Hahn, S. Characteristics of nursing home residents and physical restraint: a systematic literature review. J Clin Nurs. 2014;23:3012–24.Google Scholar
Sze, TW, Leng, CY, Lin, SK. The effectiveness of physical restraints in reducing falls among adults in acute care hospitals and nursing homes: a systematic review. JBI Libr Syst Rev. 2012;10:307–51.Google Scholar
Castle, NG, Engberg, J. The health consequences of using physical restraints in nursing homes. Med Care. 2009;47:1164–73.Google Scholar
Rapp, K, Becker, C, Lamb, SE et al. Hip fractures in institutionalized elderly people: incidence rates and excess mortality. J Bone Miner Res. 2008;23:1825–31.Google Scholar

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