Report Of Fall Prevention Among Older People In Hospital Settings – Summary Table And Critical Appraisal

Sl.no.

Author/s, year, Country

Aims

Sample/setting

Design/methods

Main findings

Strengths and limitations of the study

Article 1

Cameron et al., 2012,

Australia

To evaluate the effectiveness of interventions designed for reducing falls by older people in care facilities and hospitals.

The Cochrane database 2012;MEDLINE, EMBASE, and CINAHL (all to March 2012); ongoing trial registers (to August 2012), and reference lists of articles were searched. 43 trials (30,373 participants) in care facilities and 17 (29,972 participants) in hospitals were studied.

Review of randomized controlled trials of interventions to reduce falls in older people in residential or nursing care facilities or hospitals.

For exercise interventions the results were inconsistent. Vitamin D supplementation decreased the rate of falls but not the risk of falling. Multifactorial interventions in care facilities and hospitals suggested a decrease in the rate of falls and risk of falling. Additional physiotherapy did not significantly reduce rate of falls but achieved a significant reduction in risk of falling. Carpet flooring significantly increased the rate of falls compared with vinyl flooring and potentially increased the risk of falling. Training and education of nurses and patients significantly decreased the risk of falling.

Strengths: Two review authors independently assessed the risk of bias and extracted data. A rate ratio was used to compare the rate of falls   between intervention and control groups. Risk ratio (RR) was used to assess the risk of falling in each group. Results were pooled where appropriate.

Limitations: No conclusive results obtained. More trials are needed to confirm the effectiveness of multifactorial interventions in acute and subacute hospital settings.

Article 2

Haines TP et al. 2011

Australia

To identify single intervention strategies that prevent falls across a mixture of hospital wards

Participants were older adults admitted to acute and sub-acute wards of the Princess Alexandra Hospital, Brisbane, Australia, and the acute and sub-acute wards of Swan Districts Hospital, Perth, Australia.

3-group randomized control trial. There were two intervention groups and one control group. One intervention group was given complete patient education by providing written, video-based materials and 1- to-1 follow-up with a health professional trained to provide this program at the patient’s bedside. The second intervention group was provided with materials only.

The rate of falls was significantly lower among participants with intact cognitive function and allocated to the complete program group compared with the rate among similar participants allocated to the control and materials-only groups, and the proportion of these patients who became fallers was lower in the complete program group than in the control group.

Strengths: Appropriate randomization and blinding.

Limitations: Patients who were too ill to provide informed consent or those who had previously participated in the trial were excluded.

Article 3

Dykes PC et al. 2010

US

To investigate whether a fall prevention tool kit (FPTK) using health information technology (HIT) decreases patient falls in hospitals

4 urban US hospitals in units that received usual care (4 units and 5104 patients) or the intervention (4 units and 5160 patients)

Cluster randomized study conducted January 1, 2009, through June 30, 2009, comparing patient fall rates

The number of patients with falls differed between control (n = 87) and intervention (n = 67) units. Site-adjusted fall rates were significantly higher in control units than in intervention units. The FPTK was found to be particularly effective with patients aged 65 years or older. No significant effect was noted in fall-related injuries.

Strengths: This is the first fall prevention clinical trial that provides evidence for using a specific HIT intervention to reduce falls in short-stay hospitals

Limitations: It was conducted in 4 hospitals within a single health care system. The intervention was not blinded and the reporting of falls was biased. The FPTK was not effective with younger patients. The sample size was small.

Article 4

Gates et al.

2008

England

To evaluate the effectiveness of multifactorial

assessment and intervention programs to prevent falls

and injuries among older adults recruited to trials in primary care, community, or emergency care settings.

Six electronic databases (Medline, Embase,

CENTRAL, CINAHL, PsycINFO, Social Science Citation

Index) to 22 March 2007, reference lists of included studies, and previous reviews.

Systematic review of randomised and quasi randomised controlled trials, and meta-analysis. Eligible studies were randomised or

quasi-randomised trials (n=19) that evaluated interventions to

prevent falls that were based in emergency departments,

primary care, or the community that assessed multiple risk

factors for falling and provided or arranged for treatments to address these risk factors.

No clear overall effect was found on the number of

fallers during follow-up in 18 studies. Only one study gave accurate data on the number of falls per person year

of follow-up. Evidence that multifactorial fall prevention

programmes in primary care, community, or emergency

care settings are effective in reducing the number of fallers or fall related injuries is limited.

Strengths: NA

Limitations: No studies

reported quantitative data on health related quality of life or physical activity. Data was insufficient to

assess fall and injury rates. The overall quality of the evidence was not high. Most

of the trials were small and many had methodological

drawbacks leaving them open to bias due to either insecure

allocation concealment, lack of blinding of outcome

assessment, high losses to follow-up, and poor reporting.

Article 5

Cumming et al. 2008

Australia

To determine the efficacy of a targeted

multifactorial falls prevention programme in elderly care wards with relatively short lengths of stay.

24 elderly care wards in 12 hospitals in Sydney,

Australia. 3999 patients, mean age 79 years, with a median hospital stay of seven days.

Cluster randomised trial. A nurse and physiotherapist each worked

for 25 hours a week for three months in all intervention

wards. They provided a targeted multifactorial

intervention that included a risk assessment of falls, staff

and patient education, drug review, modification of

bedside and ward environments, an exercise programme,

and alarms for selected patients.

Intervention and control wards were similar at

baseline for previous rates of falls and individual patient characteristics. In all, 381 falls occurred during the

study. No difference was found in fall rates during follow up between intervention and control wards. A targeted multifactorial falls prevention

programme was not effective among older people in

hospital wards with relatively short lengths of stay.

Strengths: Large sample size,

which resulted in fairly narrow confidence intervals.

Limitations: Relatively short average length of stay (7 days). data were not

collected blind to intervention status. Some falls prevention

activities were already occurring in control (and

intervention) wards before the start of the study.