Featured Review: Interventions for preventing falls in older people in care facilities and hospitals

How effective are interventions designed to reduce falls in older people in care facilities and hospitals?

Falls by older people in care facilities, such as nursing homes, and hospitals are common events that may cause further loss of independence, injuries, and sometimes death as a result of injury. Effective interventions to prevent falls are therefore important.

Many types of interventions are in use. These include:

  • exercise
  • medication interventions that include vitamin D supplementation
  • medication review of the drugs that people are taking
  • environment or assistive technologies including bed or chair alarms or the use of special (low/low) beds
  • social environment interventions that target staff members and changes in the organisational system, and knowledge interventions

A special type of intervention is the multifactorial intervention, where the selection of single interventions such as exercise and vitamin D supplementation is based on an assessment of a person's risk factors for falling.

A recent Cochrane Review looked at the outcomes of rate of falls (number of falls over time), risk of falling (number of fallers), number of people with fall-related fractures, and adverse events.

This review included 95 randomised controlled trials involving 138,164 participants. Seventy-one trials (40,374 participants) were in care facilities, and 24 (97,790 participants) in hospitals. On average, participants were 84 years old in care facilities and 78 years old in hospitals. In care facilities, 75% were women and in hospitals, 52% were women.

For both hospitals and care facilities, the review is structured by the main categories of interventions evaluated in at least one setting in the review: exercise, medication (medication review; vitamin D supplementation); psychological interventions, environment/assistive technology, social environment, interventions to increase knowledge, other interventions, multiple interventions and multifactorial interventions. There was a lack of evidence on surgery, management of urinary incontinence, or fluid or nutrition therapy in both settings.

Lead author, Ian Cameron, said:

We found evidence of effectiveness for some fall-prevention interventions in care facilities and hospitals, although in several cases the quality of the evidence was considered low or very low. For all interventions, we are uncertain of their effects on fractures and on adverse events as the quality of the evidence for both outcomes was assessed as very low.”

“A key clinical implication of the findings of the Review is that the use of vitamin D supplements in nursing homes and other care facilities should increase. There are already a number of guidelines recommending this and the findings highlight the evidence to practice gap.”

In care facilities: the review authors were uncertain of the effect of exercise on rate of falls and concluded that it may make little or no difference to the risk of falling. General medication review may make little or no difference to the rate of falls or risk of falling. Vitamin D supplementation probably reduces the rate of falls but not risk of falling. The review team is uncertain of the effect of multifactorial interventions on the rate of falls; they may make little or no difference to the risk of falling.

In hospitals: the review authors are uncertain of the effect of additional physiotherapy on the rate of falls or whether it reduces the risk of falling. The review team is uncertain of the effect of providing bed sensor alarms on the rate of falls or risk of falling. Multifactorial interventions may reduce rate of falls, although subgroup analysis suggests this may apply mostly to a subacute setting; the authors are uncertain of the effect of these interventions on risk of falling.