Fall and injury prevention in older people living in residential care facilities - A cluster randomized trial

Background: Falls and resulting injuries are particularly common in older people living in residential care facilities, but knowledge about the prevention of falls is limited. Objective: To investigate whether a multifactorial intervention program would reduce falls and fall-related injuries. Design: A cluster randomized, controlled, nonblincled trial. Setting: 9 residential care facilities located in a northern Swedish city. Patients: 439 residents 65 years of age or older. Intervention: An 11-week multidisciplinary program that included both general and resident-specific, tailored strategies. The strategies comprised educating staff, modifying the environment, implementing exercise programs, supplying and repairing aids, reviewing drug regimens, providing free hip protectors, having post-fall problem-solving conferences, and guiding staff. Measurements: The primary outcomes were the number of residents sustaining a fall, the number of falls, and the time to occurrence of the first fall. A secondary outcome was the number of injuries resulting from falls. Results: During the 34-week follow-up period, 82 residents (44%) in the intervention program sustained a fall compared with 109 residents (56%) in the control group (risk ratio, 0.78 [95% Cl, 0.64 to 0.96]). The adjusted odds ratio was 0.49 (Cl, 0.37 to 0.65), and the adjusted incidence rate ratio of falls was 0.60 (Cl, 0.50 to 0.73). Each of 3 residents in the intervention group and 12 in the control group had 1 femoral fracture (adjusted odds ratio, 0.23 [Cl, 0.06 to 0.94]). Clustering was considered in all regression models. Conclusion: An interdisciplinary and multifactorial prevention program targeting residents, staff, and the environment may reduce falls and femoral fractures.