Prevention of Falls in Nursing Homes: Subgroup Analyses of a Randomized Fall Prevention Trial

Authors

  • Kilian Rapp MD, MPH,

    1. From the *Department of Clinical Gerontology, Robert-Bosch Hospital, Stuttgart, GermanyInstitute of Epidemiology, Ulm University, Ulm, GermanyWarwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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  • Sarah E. Lamb PhD,

    1. From the *Department of Clinical Gerontology, Robert-Bosch Hospital, Stuttgart, GermanyInstitute of Epidemiology, Ulm University, Ulm, GermanyWarwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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  • Gisela Büchele MPH,

    1. From the *Department of Clinical Gerontology, Robert-Bosch Hospital, Stuttgart, GermanyInstitute of Epidemiology, Ulm University, Ulm, GermanyWarwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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  • Ranjit Lall PhD,

    1. From the *Department of Clinical Gerontology, Robert-Bosch Hospital, Stuttgart, GermanyInstitute of Epidemiology, Ulm University, Ulm, GermanyWarwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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  • Ulrich Lindemann MSc,

    1. From the *Department of Clinical Gerontology, Robert-Bosch Hospital, Stuttgart, GermanyInstitute of Epidemiology, Ulm University, Ulm, GermanyWarwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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  • Clemens Becker MD

    1. From the *Department of Clinical Gerontology, Robert-Bosch Hospital, Stuttgart, GermanyInstitute of Epidemiology, Ulm University, Ulm, GermanyWarwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Address correspondence to Kilian Rapp, MD, Department of Clinical Gerontology, Robert-Bosch Hospital, Auerbachstrasse 110, 70376 Stuttgart, Germany. E-mail: kilian.rapp@rbk.de

Abstract

OBJECTIVES: To evaluate the effectiveness of a multifactorial fall prevention program in prespecified subgroups of nursing home residents.

DESIGN: Secondary analysis of a cluster-randomized, controlled trial.

SETTING: Six nursing homes in Germany.

PARTICIPANTS: Seven hundred twenty-five long-stay residents; median age 86; 80% female.

INTERVENTION: Staff and resident education on fall prevention, advice on environmental adaptations, recommendation to wear hip protectors, and progressive balance and resistance training.

MEASUREMENTS: Time to first fall and the number of falls. Falls were assessed during the 12-month intervention period. Univariate regression analyses were performed, including a confirmatory test of interaction.

RESULTS: The intervention was more effective in people with cognitive impairment (hazard ratio (HR)=0.49, 95% confidence interval (CI)=0.35–0.69) than in those who were cognitively intact (HR=0.91, 95% CI=0.68–1.22), in people with a prior history of falls (HR=0.47, 95% CI=0.33–0.67) than in those with no prior fall history (HR=0.77, 95% CI=0.58–1.01), in people with urinary incontinence (HR=0.59, 95% CI=0.45–0.77) than in those with no urinary incontinence (HR=0.98, 95% CI=0.68–1.42), and in people with no mood problems (incidence rate ratio (IRR)=0.41, 95% CI=0.27–0.61) than in those with mood problems (IRR=0.74, 95% CI=0.51–1.09).

CONCLUSION: The effectiveness of a multifactorial fall prevention program differed between subgroups of nursing home residents. Cognitive impairment, a history of falls, urinary incontinence, and depressed mood were important in determining response.

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