Effectiveness of a Multifaceted Intervention on Falls in Nursing Home Residents


Address correspondence to Clemens Becker, MD, Bethesda Geriatrische Klinik, Academic Center at the University of Ulm, Zollernring 26–28, D-89073 Ulm, Germany. E-mail: clemens.becker@medizin.uni-ulm.de


OBJECTIVES:   To evaluate the effectiveness of a multifaceted, nonpharmaceutical intervention on incidence of falls and fallers.

DESIGN:   Prospective, cluster-randomized, controlled 12-month trial.

SETTING:   Six community nursing homes in Germany.

PARTICIPANTS:   Long-stay residents (n = 981) aged 60 and older; mean age 85; 79% female.

INTERVENTIONS:   Staff and resident education on fall prevention, advice on environmental adaptations, progressive balance and resistance training, and hip protectors.

MEASUREMENTS:   Falls, fallers, and fractures.

RESULTS:   The incidence density rate of falls per 1,000 resident years (RY) was 2,558 for the control group (CG) and 1,399 for the intervention group (IG) (relative risk (RR) = 0.55, 95% confidence interval (CI) = 0.41–0.73). Two hundred forty-seven (52.3%) fallers were detected in the CG and 188 (36.9%) in the IG (RR = 0.75, 95% CI = 0.57–0.98). The incidence density rate of frequent fallers (>2/year) was 115 (24.4%) for the CG and 66 (13.0%) for the IG (RR = 0.56, 95% CI = 0.35–0.89). The incidence density rate of hip fractures per 1,000 RY was 39 for the CG and 43 for the IG (RR = 1.11, 95% CI = 0.49–2.51). Other fractures were diagnosed with an incidence density rate of 52 per 1,000 RY for CG and 41 per 1,000 RY for IG (RR = 0.78, 95% CI = 0.57–1.07).

CONCLUSION:   The incidence density rate of falls and fallers differed considerably between the control and intervention groups. The study was underpowered to demonstrate a significant difference of hip or nonhip fractures. Because of a low fracture rate in both groups, the investigation of fracture rates would have required a larger sample size to detect an effect of the intervention.