Interventions to reduce the incidence of falls in older adult patients in acute care hospitals: a systematic review.

Abstract

Falls can have a considerable impact on a patients' well being, they can result in serious physical and emotional injury, poor quality of life and increased length of hospital stay. Most of the current literature recommends a comprehensive approach to fall prevention that addresses a wide variety of risk factors and involves the use of risk assessment. The objective of this review was to present the best available evidence for the effectiveness of interventions designed to reduce the incidence of falls in older adult patients in acute care hospitals. Only randomised controlled trials (RCTs) assessing the effectiveness of risk assessment or other interventions that aimed to minimise the number of falls were included.Participants were older adult inpatients (defined as aged 65 years or over) in acute care hospitals.This review focused on interventions designed to assess the risk of falling or those used to minimise the risk of falling in older adult hospital patients. These interventions were compared to either standard practice, which included any method or technique already in place at the facility, or no intervention.The primary outcome was the number of patient falls during hospitalisation. A search for published and unpublished literature from 1998 to 2008 published in the English language was conducted using all major electronic databases. A three-step search strategy was developed using MeSH terminology and keywords to ensure that all material relevant to the review was captured. The methodological quality of included studies was assessed by two reviewers, who appraised each study independently, using standardised Joanna Briggs Institute (JBI) critical appraisal tools DATA COLLECTION AND ANALYSIS: Data was extracted from the studies that were identified as meeting the criteria for methodological quality using the standard JBI data extraction tools. Due to the heterogeneity of populations and interventions, meta-analyses were not possible and results are presented in narrative form. Seven studies were included in the review. The evidence on interventions for reducing the number of falls in older adults during their stay in an acute health care facility is sparse. There is some evidence to suggest that certain multifactorial interventions are more effective than others and that increasing patient education or targeting fall risk factors may be of benefit. Further high quality research is needed in order to ascertain effective fall prevention strategies in acute care facilities.There are some evidence to suggest that implementing the following interventions in acute hospitals may be effective in reducing the amount of falls of older adult inpatients:˙ a multidisciplinary multifactorial intervention program consisting of a falls risk alert card, an exercise program, an education program and the use of hip protectors after approximately 45 days˙ a one-on-one patient education package entailing information on risk factors and preventative strategies for falls as well as goal setting˙ a targeted falls risk factor reduction intervention that includes a falls risk factor screen, recommended interventions encompassing local advice and a summary of the evidenceThere is some evidence to suggest that implementing a multidisciplinary multifactorial intervention that consists of systematic assessment and treatment of fall risk factors, as well as active management of postoperative complications can reduce the amount of falls in patients with femoral neck fracture following surgery. Better designed RCTs that distinguish subgroups of populations (for example people with or without cognitive impairment) and that targets interventions at specific groups is required. Further research that focuses on individual intervention components that are part of larger multifactorial interventions are also warranted.