A multifactorial intervention did not prevent falls or fractures in elderly patients during short hospital stays
R G Cumming
Dr R G Cumming, Concord Hospital, Concord, New South Wales, Australia;
Does a tailored, multifactorial intervention prevent falls in elderly patients during short hospital stays?
cluster randomised controlled trial.
unclear allocation concealment.
during stay in study ward.
24 elderly care wards in 12 hospitals in Sydney, New South Wales, Australia.
3999 patients (mean age 79 y; 59% women; mean lengths of stay, acute wards 8.2 to 8.5 d, rehabilitation wards 16.5 to 16.8 d).
2047 patients in 12 wards received a multifactorial intervention delivered by a nurse and a physiotherapist. The intervention included a falls risk assessment, usually within 24 hours of admission; patient, family, and staff education from the nurse and physiotherapist; appropriate patient support (walking aids, eyewear, bedside modifications, and increased supervision); staff liaison for management of confusion, drug changes, and foot problems; and physiotherapist support for referred patients, including exercises for balance and functional abilities, and practice of safe mobility. Selected patients who required support for walking wore a pressure alarm on one foot. 1952 patients in 12 wards received usual care.
number of falls in study wards (a fall was defined as unintentionally coming to rest on the ground or other lower level, except as a result of major internal or external events).
The intervention and usual care groups did not differ for number of patients who fell or had injurious falls or fractures (table). Mean fall rate was 9.3 v 9.2 per 1000 bed days (p = 0.96).
A tailored, multifactorial intervention did not prevent falls or fractures in elderly patients during short hospital stays.
Cumming RG, Sherrington C, Lord SR, et al. Cluster randomised trial of a targeted multifactorial intervention to prevent falls among older people in hospital. BMJ 2008;336:758–60.
Clinical impact ratings: Elderly care 7/7; General/internal medicine 5/7
Source of funding: National Health and Medical Research Council of Australia Health Research Partnership Scheme.
The study by Cumming et al addresses an essential global issue for healthcare professionals involved in care of elderly patients in hospital. There are discrepancies between their findings and those of other studies, which have found multifactorial interventions to be effective for fall prevention.1 2The findings of Cumming et al draw our attention to factors that may contribute to the effectiveness of intervention programmes and should not lead us to conclude that multifaceted interventions to prevent falls do not work.
The intervention was delivered during shorter inpatient stays than in previous studies, and it included exercise, which is unlikely to be effective over a short period. The intervention was delivered for only 3 months in each ward, and the authors point out that this would have provided limited opportunity for fall prevention strategies to become embedded in the culture of the ward. The extent to which fall prevention activities were undertaken as routine care in both intervention and usual care wards before and during the intervention period is unclear, and so it is difficult to know how the intervention differed from usual care. The amount of time allocated to, and content of, individual components of the intervention (eg, education) are also unclear, although available resources were identified as 50 person-hours per week.
Further research is needed to test the efficacy of multifactorial interventions for preventing falls in elderly inpatients. Until further data are available, use of existing evidence-based guidelines for preventing falls in this population, such as those developed by the Royal College of Nursing,3 is recommended.