Fall and Injury Prevention in Older People Living in Residential Care Facilities: A Cluster Randomized Trial

The study was a cluster randomized, controlled, nonblinded trial that divided nine facilities into two groups and randomly assigned the groups by lots to an intervention or a control group. Group A included four facilities with 224 residents; the facilities had 29 to 74 residents each, and the median age by facility ranged from 82 to 85 years. Group B included five facilities with a total of 215 residents; there were 31 to 66 residents per facility, and the median age by facility ranged from 79 to 85 years.

The control group received usual care. The other group received an intervention program that included strategies targeting general and resident-specific risk factors for falling. The interventions included:
 

• Staff education: All staff were invited to a 4-hour educational session, and more than half attended. Led by a physician and a physiotherapist, the sessions covered risk factors for falls and intervention strategies.
• Environmental modification: The intervention facilities reduced environmental hazards in common areas by rearranging furniture that posed a risk for falling, quickly wiping wet areas on the floor, and clearing snow from the entrance to the facility. Staff and study physiotherapists made adjustments in the residents’ accommodations such as removing loose carpets and repairing doorsteps (n = 18); adding grip bars, new beds, and firm mattresses in the bedroom and bathroom (n =15); furniture changes (n = 6); and better lighting (n = 3).
• Exercise: Residents received training to improve strength, balance, gait, and safe transfer.
• Supply or repair of aids: The intervention facilities gave 29 residents various types of aids or repaired their aids.
• Change in medication: During the 11-week intervention period, staff adjusted the medications for 21 residents because their side effects were believed to increase the risk for falling. In addition, pharmacologic treatment was initiated or adjusted in 26 residents because of medical conditions believed to pose a particular risk for falling such as anemia, heart disease, infection, pain, and depression.
• Hip protectors: Of the 47 residents who were considered particularly vulnerable to fall-related hip fracture and offered free hip protectors, 34 agreed to use them.
• Postfall problem-solving conferences: A registered nurse followed up on falls on the same day, and the physiotherapist followed up within 3 days. A team that included a physician, nurse, physiotherapist, and sometimes other staff members met weekly to discuss fall reports.
• Staff guidance: Staff and study researchers regularly discussed safety issues pertaining to 90 fall-prone residents. The most significant measure adopted was enhancing safe mobility by providing individualized supervision, improving the transfer technique, and supplying bed alarms.