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Prevention of Falls in Nursing Homes: Subgroup Analyses of a Randomized Fall Prevention Trial
Author(s) -
Rapp Kilian,
Lamb Sarah E.,
Büchele Gisela,
Lall Ranjit,
Lindemann Ulrich,
Becker Clemens
Publication year - 2008
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2008.01739.x
Subject(s) - medicine , hazard ratio , fall prevention , randomized controlled trial , urinary incontinence , confidence interval , mood , physical therapy , rate ratio , incidence (geometry) , poison control , gerontology , injury prevention , emergency medicine , psychiatry , surgery , physics , optics
OBJECTIVES: To evaluate the effectiveness of a multifactorial fall prevention program in prespecified subgroups of nursing home residents. DESIGN: Secondary analysis of a cluster‐randomized, controlled trial. SETTING: Six nursing homes in Germany. PARTICIPANTS: Seven hundred twenty‐five long‐stay residents; median age 86; 80% female. INTERVENTION: Staff and resident education on fall prevention, advice on environmental adaptations, recommendation to wear hip protectors, and progressive balance and resistance training. MEASUREMENTS: Time to first fall and the number of falls. Falls were assessed during the 12‐month intervention period. Univariate regression analyses were performed, including a confirmatory test of interaction. RESULTS: The intervention was more effective in people with cognitive impairment (hazard ratio (HR)=0.49, 95% confidence interval (CI)=0.35–0.69) than in those who were cognitively intact (HR=0.91, 95% CI=0.68–1.22), in people with a prior history of falls (HR=0.47, 95% CI=0.33–0.67) than in those with no prior fall history (HR=0.77, 95% CI=0.58–1.01), in people with urinary incontinence (HR=0.59, 95% CI=0.45–0.77) than in those with no urinary incontinence (HR=0.98, 95% CI=0.68–1.42), and in people with no mood problems (incidence rate ratio (IRR)=0.41, 95% CI=0.27–0.61) than in those with mood problems (IRR=0.74, 95% CI=0.51–1.09). CONCLUSION: The effectiveness of a multifactorial fall prevention program differed between subgroups of nursing home residents. Cognitive impairment, a history of falls, urinary incontinence, and depressed mood were important in determining response.