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Effect of a Statewide Fall Prevention Program on Incidence of Femoral Fractures in Residents of Long-Term Care Facilities

Authors

  • Kilian Rapp MD,

    1. From the *Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Institute of Epidemiology, Ulm University, Ulm, Germany; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom; §Kadoorie Critical Care Research Centre, University of Oxford, Oxford, United Kingdom; and Allgemeine Ortskrankenkasse, Baden-Württemberg, Germany.
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  • Sarah E. Lamb PhD,

    1. From the *Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Institute of Epidemiology, Ulm University, Ulm, Germany; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom; §Kadoorie Critical Care Research Centre, University of Oxford, Oxford, United Kingdom; and Allgemeine Ortskrankenkasse, Baden-Württemberg, Germany.
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  • Luzia Erhardt-Beer,

    1. From the *Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Institute of Epidemiology, Ulm University, Ulm, Germany; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom; §Kadoorie Critical Care Research Centre, University of Oxford, Oxford, United Kingdom; and Allgemeine Ortskrankenkasse, Baden-Württemberg, Germany.
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  • Ulrich Lindemann MSc,

    1. From the *Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Institute of Epidemiology, Ulm University, Ulm, Germany; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom; §Kadoorie Critical Care Research Centre, University of Oxford, Oxford, United Kingdom; and Allgemeine Ortskrankenkasse, Baden-Württemberg, Germany.
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  • Ulrich Rissmann,

    1. From the *Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Institute of Epidemiology, Ulm University, Ulm, Germany; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom; §Kadoorie Critical Care Research Centre, University of Oxford, Oxford, United Kingdom; and Allgemeine Ortskrankenkasse, Baden-Württemberg, Germany.
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  • Jochen Klenk,

    1. From the *Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Institute of Epidemiology, Ulm University, Ulm, Germany; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom; §Kadoorie Critical Care Research Centre, University of Oxford, Oxford, United Kingdom; and Allgemeine Ortskrankenkasse, Baden-Württemberg, Germany.
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  • Clemens Becker MD

    1. From the *Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Institute of Epidemiology, Ulm University, Ulm, Germany; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom; §Kadoorie Critical Care Research Centre, University of Oxford, Oxford, United Kingdom; and Allgemeine Ortskrankenkasse, Baden-Württemberg, Germany.
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Address correspondence to Kilian Rapp, Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376 Stuttgart, Germany. E-mail: kilian.rapp@rbk.de

Abstract

OBJECTIVES: To evaluate the effect of a statewide dissemination of a modified evidence-based fall prevention program on incidence of femoral fractures in nursing homes.

DESIGN: Observational study of a staged implementation of a successful fall prevention program.

SETTING: One thousand three hundred fifty-nine nursing homes in two federal states in the south of Germany.

PARTICIPANTS: Nine thousand seventy-seven residents in the intervention homes and 43,583 residents in control homes from the same and a different federal state.

INTERVENTION: Staff education on fall prevention, advice on environmental adaptations, and progressive strength and balance training over at least 1 year.

MEASUREMENTS: Incident femoral fractures.

RESULTS: One thousand five hundred eighteen femoral fractures occurred in the total study population during the intervention period. The crude incidence rate of femoral fractures was 39.5/1,000 person-years in residents from the intervention homes and 40.9 and 39.7/1,000 person-years in residents from two sets of control homes. In a multivariate model, there was no evidence of an effect of the fall prevention program on incidence of femoral fracture when compared with control homes from the same federal state (adjusted hazard ratio (AHR)=0.96, 95% confidence interval (CI)=0.83–1.11) or from a different federal state (AHR=1.00, 95% CI=0.86–1.16).

CONCLUSION: The statewide dissemination of a multifactorial fall prevention program did not appear to reduce the burden of femoral fractures in residents of nursing homes.

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