Using targeted risk factor reduction to prevent falls in older in-patients: a randomised controlled trial

Background: falls and related injuries are known to be a significant problem for older people. There is evidence that identifying and addressing individual risk factors can reduce the incidence of falls in the community but no evidence of the effectiveness of targeted risk factor reduction methods applied to hospital in-patients. Objective: to test the efficacy of a targeted risk factor reduction core care plan in reducing risk of falling while in hospital. Design: a group (ward) randomised trial. Setting: elderly care wards and associated community units of a district general hospital in the North of England. Subjects: all elderly patients who received care in eight wards and community units during a 12-month study period. Methods: matched pairs of wards were randomly allocated to intervention or control groups. In the intervention wards, staff used a pre-printed care plan for patients identified as at risk of falling and introduced appropriate remedial measures. Numbers of falls in each group were then compared. Results: after introduction of the care plan there was a significant reduction in the relative risk of recorded falls on intervention wards (relative risk 0.79, 95% CI 0.65-0.95) but not on control wards (RR 1.12, 95% CI 0.96-1.31). The difference in change between the intervention wards and control wards was highly significant (RR 0.71, 95% CI 0.55-0.90, P = 0.006). There was no significant reduction in the incidence of falls-related injuries. Conclusion: the use of a core care plan targeting risk factor reduction in older hospital in-patients was associated with a reduction in the relative risk of recorded falls.