Abstract
BackgroundFalls and fractures are extremely frequent in long-term care facilities (LTCFs). Therefore, a fall and fracture prevention program was started in nearly 1000 LTCFs in Bavaria/Germany between 2007 and 2010. The components of the program were exercise classes, the documentation of falls, environmental adaptations, medication reviews, the recommendation to use hip protectors and education of staff. The present study aimed to provide a comprehensive evaluation of the implementation process of the program regarding results of the implementation phase and the follow-up of 3–9 years after start of implementation.MethodsData from numerous sources were used, including data from published studies, statistical data, health insurance claims data and unpublished data from an online questionnaire. To incorporate different aspects, time periods and results, the RE-AIM framework was applied.ResultsThe program was adopted by 942 of the 1150 eligible LTCFs and reached about 62,000 residents. During the implementation phase exercise classes and recommendation about environmental adaptations were offered in nearly all LTCFs. 13.5% of the residents participated in exercise classes. Hip protectors were available for 9.2% of all residents. In the first implementation wave, femoral fracture rate was significantly reduced by 18% in the first year. At follow-up nearly 90% of all LTCFs still offered exercise classes, which were attended by about 11% of residents. However, only 10% of the exercise classes completely fulfilled the requirements of an effective strength and balance training. Individual advice about environmental adaptations was provided in 74.3% of the LTCFs and nearly all LTCFs claimed to offer hip protectors to their residents. A long-term effect of the program on femoral fractures could not be detected.ConclusionsThe program did not affect the femoral fracture rate in the long run. Possible reasons could be a high turn-over of the staff, a reduced fidelity of training components or a shift in daily priorities among the staff.
Highlights
Falls and fractures are extremely frequent in long-term care facilities (LTCFs)
In total nearly 1000 LTCFs started with the Bavarian fall and fracture prevention program (BF2P2) after having signed a contract to participate in the program for at least 3 years [8]
Between 2007 and 2010, 942 of the 1150 eligible LTCFs implemented the LTCFs program, which corresponds to a participation rate of more than 80% (Table 3)
Summary
A fall and fracture prevention program was started in nearly 1000 LTCFs in Bavaria/Germany between 2007 and 2010. Long-term care facilities (LTCFs) are settings with a high risk for falls. In this setting, the fall rate is reported to be about 2 falls per resident-year [1], which is considerably higher than the fall rate observed in older people living in the community [2]. One of the most serious complications of falls are femoral fractures [4] They are frequent in residents of LTCFs. In Germany, more than 20% of hip fractures are caused by residents from LTCFs even though their corresponding person-years under observation account only for 4% [5]. In total nearly 1000 LTCFs started with the BF2P2 after having signed a contract to participate in the program for at least 3 years [8]
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