The Effect of Enhanced Supervision on Fall Rates in Residential Aged Care

Research Team for Promoting Independence of the Elderly, Tokyo Metropolitan Institute of Gerontology, Itabashiku, Tokyo, Japan.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists (Impact Factor: 2.2). 10/2009; 88(10):823-8. DOI: 10.1097/PHM.0b013e3181b71ec2
Source: PubMed


To test the effect of a targeted falls prevention intervention involving risk factor reduction and enhanced supervision carried out by a falls prevention aide, on fall rates in older residents of a long-term aged-care facility.
The participants were residents 60 yrs or older (mean age, 86.6 yrs) of a residential care facility in Japan. The intervention was carried out by two falls prevention aides and involved supervision through recreational activities or conversation and environmental modifications to reduce the risk of falls. The intervention was carried out for 25 wks, two times per week, 8 hrs per day. Fall rates and number of fallers in 50 intervention days and 50 nonintervention days were compared. Scores on the Fall-Related Behavior scale, the Gottfries, Brane & Steen scale, and the Troublesome Behavior scale were compared before the commencement of the intervention and after its completion. Baseline scores were compared between the participants who experienced a fall/falls only on nonintervention days (n = 10) and those who experienced a fall/falls on intervention days as well (n = 7).
Introduction of a falls prevention aide significantly reduced the total number of falls (P = 0.046) and the total number of fallers (P = 0.012). Scores on the Fall-Related Behavior scale and the Troublesome Behavior scale also decreased significantly (P = 0.02 and P = 0.002, respectively) after intervention; however, there was no change in the overall Gottfries, Brane & Steen scale score. Emotional impairment (P = 0.041) and symptoms that are common in dementia (P = 0.035) in the Gottfries, Brane & Steen subscale before the intervention commencing were higher in the residents who experienced a fall/falls on intervention days than the residents who experienced a fall/falls only on nonintervention days.
A falls prevention aide can reduce the risk of falling in institutionalized older people through enhanced supervision that targets falls-risk factors.

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    • "Home, America Shimada et al 2009 [45] Uncontrolled before/after study (25 week FU) Does a falls prevention aide using systematic supervision reduce falls? I = Aide delivered intervention, targeting residents considered to be at high risk of falls "
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    ABSTRACT: Falls are a leading cause of mortality and morbidity in older people and the risk of falling is exacerbated by mental health conditions. Existing reviews have focused on people with dementia and cognitive impairment, but not those with other mental health conditions or in mental health settings. The objective of this review is to evaluate the effectiveness of fall prevention interventions for older people with mental health problems being cared for across all settings. A systematic review of fall prevention interventions for older people with mental health conditions. We undertook electronic database and lateral searches to identify studies reporting data on falls or fall related injuries. Searches were initially conducted in February 2011 and updated in November 2012 and October 2013; no date restrictions were applied. Studies were assessed for risk of bias. Due to heterogeneity results were not pooled but are reported narratively. Seventeen RCTs and four uncontrolled studies met the inclusion criteria; 11 involved single interventions and ten multifactorial. Evidence relating to fall reduction was inconsistent. Eight of 14 studies found a reduction in fallers (statistically significant in five), and nine of 14 reported a significant reduction in rate or number of falls. Four studies found a non-significant increase in falls. Multifactorial, multi-disciplinary interventions and those involving exercise, medication review and increasing staff awareness appear to reduce the risk of falls but evidence is mixed and study quality varied. Changes to the environment such as increased supervision or sensory stimulation to reduce agitation may be promising for people with dementia but further evaluation is needed. Most of the studies were undertaken in nursing and residential homes, and none in mental health hospital settings. There is a dearth of falls research in mental health settings or which focus on patients with mental health problems despite the high number of falls experienced by this population group. This review highlights the lack of robust evidence to support practitioners to implement practices that prevent people with mental health problems from falling.
    BMC Nursing 02/2014; 13(1):4. DOI:10.1186/1472-6955-13-4
    • "This may be in part due to the relatively simplistic unidimensional approach taken to date. Interventions to address behaviors associated with cognitive impairment including maximizing safe wandering, addressing agitation and providing more supervision seem promising (Chenoweth et al., 2009; Detweiler, Murphy, Kim, Myers, & Ashai, 2009; Shimada, Tiedemann, Lord, & Suzuki, 2009). "
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    ABSTRACT: To develop a simple screen based on easily collectable measures to identify older people living in residential care facilities at high risk of falls. This prospective study was conducted in seven residential care facilities in the U.K. Residents aged>60 years who were not bedbound or terminally ill participated. Demographics, medical history, medication use, cognition (mini mental state examination (MMSE)), function (Barthel, balance and sit-to-stand ability) and behavior (neuro-psychiatric inventory (NPI) and impulsivity) were recorded at baseline. Falls and injuries were prospectively recorded over 6 months. Data were analyzed for differences between fallers and non-fallers and significant variables entered into logistic regression analysis. Two hundred and forty residents completed the study. In the follow-up period, 50% fell ≥1 times. Fallers had worse function, cognition, behavior and balance and took more medications. Falling in the past year, walking frame and hypnotic/anxiolytic and anti-depressant medication use were also associated with increased likelihood of falling. Logistic regression identified MMSE<17, impulsivity score≥2, standing balance score<6, requiring a walking frame, falling in the previous year and use of antidepressants and hypnotics/anxiolytics as independent and significant predictors of falls. The area under the receiver operating curve (ROC) for this model was 0.79 (95% CI 0.73-0.84). This tool comprising multi-factorial measures provides a simple way of quantifying the probability with which a care home resident will fall over a 6-month period. The tool may also assist in guiding the development and targeting of interventions to prevent falls in this group.
    Archives of gerontology and geriatrics 07/2012; 55(3):690-5. DOI:10.1016/j.archger.2012.05.010 · 1.85 Impact Factor
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    • "The combined information is important for identifying risks of falls and preventing falls in frail elderly people, because correct risk-assessments by care staff may lead to successful assessment and interventions for preventing falls [29,30]. We reported previously that an intervention study using supervision technique based on the assessment of fall-risk behaviors can reduce the risk of falling in institutionalized elderly people [31]. Thus, we considered that the assessment and intervention used in the SRRST may be useful for preventing falls in frail elderly people. "
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    ABSTRACT: Objective measurements can be used to identify people with risks of falls, but many frail elderly adults cannot complete physical performance tests. The study examined the relationship between a subjective risk rating of specific tasks (SRRST) to screen for fall risks and falls and fall-related fractures in frail elderly people. The SRRST was investigated in 5,062 individuals aged 65 years or older who were utilized day-care services. The SRRST comprised 7 dichotomous questions to screen for fall risks during movements and behaviours such as walking, transferring, and wandering. The history of falls and fall-related fractures during the previous year was reported by participants or determined from an interview with the participant's family and care staff. All SRRST items showed significant differences between the participants with and without falls and fall-related fractures. In multiple logistic regression analysis adjusted for age, sex, diseases, and behavioural variables, the SRRST score was independently associated with history of falls and fractures. Odds ratios for those in the high-risk SRRST group (≥ 5 points) compared with the no risk SRRST group (0 point) were 6.15 (p < 0.01) for a single fall, 15.04 (p < 0.01) for recurrent falls, and 5.05 (p < 0.01) for fall-related fractures. The results remained essentially unchanged in subgroup analysis accounting for locomotion status. These results suggest that subjective ratings by care staff can be utilized to determine the risks of falls and fall-related fractures in the frail elderly, however, these preliminary results require confirmation in further prospective research.
    BMC Geriatrics 08/2011; 11:40. DOI:10.1186/1471-2318-11-40 · 1.68 Impact Factor
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