Oliver, D. et al. Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses. BMJ 334, 82

University of Reading Institute of Health Sciences, Reading RG1 5AG.
BMJ (online) (Impact Factor: 17.45). 02/2007; 334(7584):82. DOI: 10.1136/bmj.39049.706493.55
Source: PubMed


To evaluate the evidence for strategies to prevent falls or fractures in residents in care homes and hospital inpatients and to investigate the effect of dementia and cognitive impairment.
Systematic review and meta-analyses of studies grouped by intervention and setting (hospital or care home). Meta-regression to investigate the effects of dementia and of study quality and design.
Medline, CINAHL, Embase, PsychInfo, Cochrane Database, Clinical Trials Register, and hand searching of references from reviews and guidelines to January 2005.
1207 references were identified, including 115 systematic reviews, expert reviews, or guidelines. Of the 92 full papers inspected, 43 were included. Meta-analysis for multifaceted interventions in hospital (13 studies) showed a rate ratio of 0.82 (95% confidence interval 0.68 to 0.997) for falls but no significant effect on the number of fallers or fractures. For hip protectors in care homes (11 studies) the rate ratio for hip fractures was 0.67 (0.46 to 0.98), but there was no significant effect on falls and not enough studies on fallers. For all other interventions (multifaceted interventions in care homes; removal of physical restraints in either setting; fall alarm devices in either setting; exercise in care homes; calcium/vitamin D in care homes; changes in the physical environment in either setting; medication review in hospital) meta-analysis was either unsuitable because of insufficient studies or showed no significant effect on falls, fallers, or fractures, despite strongly positive results in some individual studies. Meta-regression showed no significant association between effect size and prevalence of dementia or cognitive impairment.
There is some evidence that multifaceted interventions in hospital reduce the number of falls and that use of hip protectors in care homes prevents hip fractures. There is insufficient evidence, however, for the effectiveness of other single interventions in hospitals or care homes or multifaceted interventions in care homes.

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    • "Falls are a substantial concern across the residential and long-term aged-care sector with half its population falling annually (Haralambous et al. 2010, Nyman & Victor 2011, Burland et al. 2013). Between 25-30% of falls among older people in residential aged care result in physical injury (Oliver et al. 2007, Burland et al. 2013) and are associated with an increased risk of mortality functional decline, depression and anxiety (Rubenstein 2006, Morley 2007, Oliver et al. 2007). Frail, older people who require nursing home care are at high risk of falls as they present with combinations of; multiple co-morbidities, age-related systems decline and cognitive impairment (Rubenstein 2006, Onder et al. 2012). "
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    ABSTRACT: The aim of this study was to facilitate the implementation and operation of a falls prevention Community of Practice in a residential aged-care organization and evaluate its effect on falls outcomes. Falls are a substantial concern across the residential aged-care sector with half its older population falling annually. Preventing falls requires tailoring of current evidence for reducing falls and adoption into daily activity, which is challenging for diversely skilled staff caring for a frailer population. Forming a community of practice could provide staff with the opportunity to share and develop their expertise in falls prevention and innovate change. A mixed methods design based on a realist approach conducted across 13 residential care facilities (N = 779 beds). Staff will be invited to become a member of the community of practice with all sites represented. The community of practice will be supported to audit falls prevention activity and identify gaps in practice for intervention. The impact of the community of practice will be evaluated at three levels: individual member level, facility level and organizational level. A pre-post design using a range of standardized measures supported by audits, surveys, focus groups and interviews will determine its effect on falls prevention practice. Falls outcomes will be compared at five time intervals using negative binomial regression and logistic regression. The study is funded 2013-2017. Findings from this research will assist residential aged-care providers to understand how to effectively translate evidence about falls prevention into clinical practice. © 2015 John Wiley & Sons Ltd.
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    • "This approach resulted in a multitude of clinical assessment tools to identify high-risk patients as a " physiologically anticipated " group (Morse, Tylko, & Dixon, 1987). However, the value of assessment tools has been questioned (Schwendimann, Buhler, Geest, & Milisen, 2008; Oliver et al., 2007), and recently, a review of research evidence in the United Kingdom recommended that as STF assessment tools had little predictive value, all people admitted to hospital older than 65 years should automatically be considered to be at high risk of STFs (National Institute for Health and Care Excellence [NICE], 2013). So, despite numerous best-practice interventions, STFs remain one of the major patient safety events and preventable harm issues. "
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    ABSTRACT: The aim of this study was to use a theoretical model (bench) for human factors and ergonomics (HFE) and a comparison with occupational slips, trips, and falls (STFs) risk management to discuss patient STF interventions (bedside). Risk factors for patient STFs have been identified and reported since the 1950s and are mostly unchanged in the 2010s. The prevailing clinical view has been that STF events indicate underlying frailty or illness, and so many of the interventions over the past 60 years have focused on assessing and treating physiological factors (dizziness, illness, vision/hearing, medicines) rather than designing interventions to reduce risk factors at the time of the STF. Three case studies are used to discuss how HFE has been, or could be, applied to STF risk management as (a) a design-based (building) approach to embed safety into the built environment, (b) a staff- (and organization-) based approach, and (c) a patient behavior-based approach to explore and understand patient perspectives of STF events. The results from the case studies suggest taking a similar HFE integration approach to other industries, that is, a sustainable design intervention for the person who experiences the STF event-the patient. This paper offers a proactive problem-solving approach to reduce STFs by patients in acute hospitals. Authors of the three case studies use HFE principles (bench/book) to understand the complex systems for facility and equipment design and include the perspective of all stakeholders (bedside). © 2015, Human Factors and Ergonomics Society.
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    • "An incident reporting system is commonly used to identify patient safety incidents or adverse events in a hospital (Aspden et al., 2004). However, non-reporting is an inevitable problem in this method because the method relies on voluntary willingness of medical staff (Cullen et al., 1995; Oliver et al., 2007). In addition, a significant lag time between incidents and submission of incident reports impairs quick detection of incidents (Hirose et al., 2007). "
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    ABSTRACT: An incident reporting system is the most commonly used method to identify patient safety incidents in a hospital. However, non-reporting of incidents for various reasons is a serious problem. We studied the rate of inpatient falls that were not reported in an incident reporting system but were recorded in medical charts and we evaluated characteristics of those falls by comparing with the falls reported in incident reports in a Japanese acute care hospital setting. Falls recorded in medical charts were detected by using a text mining method followed by a manual chart review. About 25% of the recorded falls were not reported in incident reports. Male patients, first fall, long lag time until recording, no witness at the time of the fall and physician profession were shown to be significant factors associated with non-reporting. Our results show that the rate of non-reporting of inpatient falls in a Japanese acute care hospital is compable to that shown in previous studies in other conutries and that the same barriers to incident reporting as those found in previous studies exist in the medical staff.
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