Reduce Fall Rates Research Articles

Cost-Effectiveness of an Exercise Programme That Provided Group or Individual Training to Reduce the Fall Risk in Healthy Community-Dwelling People Aged 65-80: A Secondary Data Analysis.

Research has demonstrated that some exercise programs are effective for reducing fall rates in community-dwelling older people; however, the literature is limited in providing clear recommendations of individual or group training as a result of economic evaluation. The objective of this study was to assess the cost-effectiveness of the Otago Exercise Program (OEP) for reducing the fall risk in healthy, non-institutionalized older people. An economic evaluation of a multicenter, blinded, randomized, non-inferiority clinical trial was performed on 498 patients aged over 65 in primary care. Participants were randomly allocated to the treatment or control arms, and group or individual training. The program was delivered in primary healthcare settings and comprised five initial sessions, ongoing encouragement and support to exercise at home, and a reinforcement session after six months. Our hypothesis was that the patients who received the intervention would achieve better health outcomes and therefore need lower healthcare resources during the follow-up, thus, lower healthcare costs. The primary outcome was the incremental cost-effectiveness ratio, which used the timed up and go test results as an effective measure for preventing falls. The secondary outcomes included differently validated tools that assessed the fall risk. The cost per patient was USD 51.28 lower for the group than the individual sessions in the control group, and the fall risk was 10% lower when exercises had a group delivery. The OEP program delivered in a group manner was superior to the individual method. We observed slight differences in the incremental cost estimations when using different tools to assess the risk of fall, but all of them indicated the dominance of the intervention group. The OEP group sessions were more cost-effective than the individual sessions, and the fall risk was 10% lower.

One-year outcomes of an osteoporosis liaison services program initiated within a healthcare system.

A significant gap exists in the care of patients with osteoporosis and fragility fractures. This study aimed to evaluate 1-year outcomes of an osteoporosis liaison service (OLS) program that includes two independent components: medication management services (MMS) to improve medication adherence and fracture liaison services (FLS) for secondary prevention. Patients with new hip fracture or untreated vertebral fractures enrolled in the FLS program (n = 600), and those with osteoporosis medication management issues but not necessarily fragility fractures enrolled in the MMS program (n = 499) were included. To evaluate outcomes, care coordinators assessed baseline items adapted from the 13 Best Practices Framework (BPF) standards of the International Osteoporosis Foundation, with telephone follow-up every 4 months for 1 year. Mean age of this cohort was 76.2 ± 10.3 years, 78.8% were female. After 1-year participation in the program, all patients had received bone mineral density tests, and medication adherence for the entire cohort at 12 months was 91.9 ± 19.6%, with significant improvement in fall rates (23.4% reduction), exercise rates (16.8% increase), calcium intake (26.5% increase), vitamin D intake (26.4% increase), and adequate protein intake (17.3% increase) (all p < 0.05). After 1-year OLS program, the overall rates of mortality, incident fracture, and falls were 6.6%, 4.0%, and 24.3%, respectively. The OLS program is associated with improved osteoporosis care, including increased medication adherence, calcium/vitamin D and protein intake, and reduced fall rate.

Environmental Features Contributing to Falls in Persons With Vision Impairment: The Role of Home Lighting and Home Hazards

To evaluate whether home hazards and lighting levels are associated with higher fall rates in adults with varying degrees of visual field (VF) damage from glaucoma. Participants with diagnosed or suspected glaucoma provided three years of prospective falls data via monthly falls diaries. A post-fall telephone questionnaire determined fall locations. Seven home areas were evaluated for hazards and lighting via an in-home assessment. Multivariate models adjusting for relevant confounders, including age, sex, comorbidity, and severity of VF damage, evaluated the influence of hazards and lighting on fall rates in each home region. Mean baseline age for the 170 participants was 71.0 (7.6) years and 78 (46%) of participants were female. Fifty-nine participants experienced a total of 83 home falls, with the greatest number of falls occurring on the indoor stairs (n=24, 29%) and bedroom (n=17, 21%). Neither the number nor the percentage of hazardous items graded as hazardous was associated with the rate of falls (P > .26). Each 10-fold increase in room lighting was associated with 35% fewer falls in that home region (P=.02). The relation between lighting and the rate of falls did not differ with the degree of visual field damage (P > .3), and a lower fall rate was noted with better lighting even in participants with mild or no VF damage (rate ratio=0.52/10-fold better lighting; P=0.01). Fewer home falls were found with better lighting, but not with fewer home hazards. Lighting improvements at home may reduce fall rates in older adults. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

The Effects of Bicycle Simulator Training on Anticipatory and Compensatory Postural Control in Older Adults: Study Protocol for a Single-Blind Randomized Controlled Trial.

Background: Falls are the leading cause of fatal and non-fatal injuries among older adults. Perturbation-Based-Balance Training (PBBT) is a promising approach to reduce fall rates by improving reactive balance responses. PBBT programs are designed for older adults who are able to stand and walk on a motorized treadmill independently. However, frail older adults, whose fall rates are higher, may not have this ability and they cannot participate. Thus, there is a critical need for innovative perturbation exercise programs to improve reactive balance and reduce the fall risks among older adults in a wider range of functioning. Trunk and arms are highly involved in reactive balance reactions. We aim to investigate whether an alternative PBBT program that provides perturbations during hands-free bicycling in a sitting position, geared to improve trunk and arm reactive responses, can be transferred to reduce fall risks and improve balance function among pre-frail older adults.Methods: In a single-blinded randomized-controlled trial, 68 community-dwelling pre-frail older adults are randomly allocated into two intervention groups. The experimental group receives 24-PBBT sessions over 12-weeks that include self-induced internal and machine-induced external unannounced perturbations of balance during hands-free pedaling on a bicycle-simulator system, in combination with cognitive dual-tasks. The control group receives 24 pedaling sessions over 12-weeks by the same bicycle-simulator system under the same cognitive dual-tasks, but without balance perturbations. Participants' reactive and proactive balance functions and gait function are assessed before and after the 12-week intervention period (e.g., balance reactive responses and strategies, voluntary step execution test, postural stability in upright standing, Berg Balance Test, Six-meter walk test, as well as late life function and fear of falling questionnaires).Discussion: This research addresses two key issues in relation to balance re-training: (1) generalization of balance skills acquired through exposure to postural perturbations in a sitting position investigating the ability of pre-frail older adults to improve reactive and proactive balance responses in standing and walking, and (2) the individualization of perturbation training to older adults' neuromotor capacities in order to optimize training responses and their applicability to real-life challenges.Clinical Trial Registration: www.clinicaltrials.gov, NCT03636672 / BARZI0104; Registered: July 22, 2018; Enrolment of the first participant March: 1, 2019. See Supplementary File.

EFFECTIVENESS OF EDUCATIONAL INTERVENTIONS FOR FALL PREVENTION: A SYSTEMATIC REVIEW

ABSTRACT Objective: to assess the effectiveness of educational interventions for fall prevention implemented in hospitals, at homes and nursing homes. Method: this is a systematic review, carried out based on the guiding question: what is the effectiveness of isolated educational interventions for preventing falls in adults and the elderly developed in experimental studies? The search took place in the electronic databases: Scopus, PubMed/PMC, Web of Science, CINAHL, SciELO, Cochrane and EMBASE. The exposure factor was the educational intervention on preventing falls, and as outcomes: reducing fall rates, improving knowledge, awareness and adherence to preventive care for adult and elderly patients. Only randomized controlled trials, in all languages and published between 2011 and 2020 were included. Results: 1,474 articles were identified, of which 16 were included. Four studies did not show effectiveness related to fall prevention. As common characteristics, these studies were carried out with elderly patients and without one-to-one follow-up. The others were effective in reducing falls and/or improving knowledge and were mostly studies with personalized interventions, carried out by nurses and mediated by educational technologies. Conclusion: educational interventions are effective for preventing falls in the home, hospital and nursing homes. Studies have shown a reduction in fall rates, improved knowledge and engagement in prevention strategies.

Aquatic exercise training for falls and potentially modifiable risk factors of falls in older people: A blinded randomized controlled trial protocol

IntroductionThere is a lack of randomized clinical trials involving hydrotherapy to prevent falls in people over the age of 65 years. This trial aims to verify the effects of hydrotherapy on falls and potentially modifiable risk factors of falls in community-dwelling people aged 65 years and over. MethodsA single-blind randomized controlled trial will be conducted with 60 people aged 65 years and over, without cognitive impairment. The participants will be randomly allocated to one of two groups (Hydrotherapy Group and Control Group). The Hydrotherapy Group will perform a multicomponent protocol consisting of a warm-up, muscular resistance and activation, balance, aerobic capacity, and cool-down exercises. The Control Group will not perform any intervention. The Hydrotherapy training will have progressive intensity, lasting 16 weeks, and will include two 1 h sessions per week on non-consecutive days. All participants will be assessed at baseline, after 16 weeks of training, and after 6 weeks of detraining. The assessment will consist of medical history, neuropsychological measures (cognitive functions, depressive symptoms, fear of falling, behavior), and motor measurements (muscle strength, balance, mobility). In addition, the occurrences of falls will be collected over 22 weeks through a falls calendar and monthly phone calls to verify the effects of training and short- term detraining. ResultsWe expect that the aquatic multicomponent exercise protocol associated with dual tasks will reduce fall rates and improve some motor and neuropsychological risk factors compared to the Control Group after training and short-term detraining. ConclusionsHydrotherapy warrants investigation as a falls prevention strategy in older people. Clinical trial registrationREBEC (RBR-48z4vp).

The Effects of Physical Exercise on Balance and Prevention of Falls in Older People: A Systematic Review and Meta-Analysis.

The aims of this systematic review and meta-analysis were to evaluate the effects of physical exercise on static and dynamic balance in the elderly population, and to analyze the number of falls and fallers. A systematic literature search was conducted using PubMed–Medline, Cochrane Central, and Google Scholar to select randomized clinical trials that analyzed the role of exercise on balance and fall rate in patients aged 65 or older. Sixteen articles were included in this review. Applying the Cochrane risk-of-bias tool, three studies were determined to be at low risk of bias, nine at unclear risk of bias, and four at high risk of bias. The meta-analysis showed improvements in dynamic balance (p = 0.008), static balance (p = 0.01), participants’ fear of falling (p = 0.10), balance confidence (p = 0.04), quality of life (p = 0.08), and physical performance (p = 0.30) in patients who underwent physical exercise compared to controls. The analysis of the total numbers of falls showed a decreased likelihood of falls in patients who participated in exercise programs (p = 0.0008). Finally, the number of patients who fell at least once was significantly reduced in the intervention group (p = 0.02). Physical exercise is an effective treatment to improve balance and reduce fall rates in the elderly.

Complex Movement Control in a Rat Model of Parkinsonian Falls: Bidirectional Control by Striatal Cholinergic Interneurons.

Older persons and, more severely, persons with Parkinson's disease (PD) exhibit gait dysfunction, postural instability and a propensity for falls. These dopamine (DA) replacement-resistant symptoms are associated with losses of basal forebrain and striatal cholinergic neurons, suggesting that falls reflect disruption of the corticostriatal transfer of movement-related cues and their striatal integration with movement sequencing. To advance a rodent model of the complex movement deficits of Parkinsonian fallers, here we first demonstrated that male and female rats with dual cortical cholinergic and striatal DA losses (DL rats) exhibit cued turning deficits, modeling the turning deficits seen in these patients. As striatal cholinergic interneurons (ChIs) are positioned to integrate movement cues with gait, and as ChI loss has been associated with falls in PD, we next used this task, as well as a previously established task used to reveal heightened fall rates in DL rats, to broadly test the role of ChIs. Chemogenetic inhibition of ChIs in otherwise intact male and female rats caused cued turning deficits and elevated fall rates. Spontaneous turning was unaffected. Furthermore, chemogenetic stimulation of ChIs in DL rats reduced fall rates and restored cued turning performance. Stimulation of ChIs was relatively more effective in rats with viral transfection spaces situated lateral to the DA depletion areas in the dorsomedial striatum. These results indicate that striatal ChIs are essential for the control of complex movements, and they suggest a therapeutic potential of stimulation of ChIs to restore gait and balance, and to prevent falls in PD.SIGNIFICANCE STATEMENT In persons with Parkinson's disease, gait dysfunction and the associated risk for falls do not benefit from dopamine replacement therapy and often result in long-term hospitalization and nursing home placement. Here, we first validated a new task to demonstrate impairments in cued turning behavior in rodents modeling the cholinergic-dopaminergic losses observed in Parkinsonian fallers. We then demonstrated the essential role of striatal cholinergic interneurons for turning behavior as well as for traversing dynamic surfaces and avoiding falls. Stimulation of these interneurons in the rat model rescued turning performance and reduced fall rates. Our findings indicate the feasibility of investigating the neuronal circuitry underling complex movement control in rodents, and that striatal cholinergic interneurons are an essential node of such circuitry.

Force accuracy rather than high stiffness is associated with faster learning and reduced falls in human balance

Balance requires the centre of mass to be maintained within the base of support. This can be achieved by minimising position sway (stiffness control: SC) or minimising force error (force accuracy control: FAC). Minimising sway reduces exploration of system properties, whereas minimising force error maximizes accurate mapping of the force vs position. We hypothesise that (i) FAC is associated with faster learning and fewer falls whereas (ii) SC is not. Fifteen participants used myoelectric signals from their legs to maintain balance of an actuated, inverted pendulum, to which they were strapped. Using challenging perturbations, participants were trained to maintain balance without falling within five sessions and tested before (PRE) and after (POST) training. We quantified FAC as ‘change (POST-PRE) in correlation of force with position’ and SC as ‘change in sway’. PRE training, five measures (sway, acceleration, co-contraction, effort, falls) showed no correlation with either FAC or SC. POST training, reduced fall rate, effort and acceleration correlated with FAC metric. SC correlated only with reduced sway. Unlike sway minimisation, development of force accuracy was associated with learning and reduced falls. These results support that accurate force estimation allowing movement is more relevant than stiffness to improve balance and prevent falls.

Evaluating the effects of an exercise program (Staying UpRight) for older adults in long-term care on rates of falls: study protocol for a randomised controlled trial

BackgroundFalls are two to four times more frequent amongst older adults living in long-term care (LTC) than community-dwelling older adults and have deleterious consequences. It is hypothesised that a progressive exercise program targeting balance and strength will reduce fall rates when compared to a seated exercise program and do so cost effectively.Methods/designThis is a single blind, parallel-group, randomised controlled trial with blinded assessment of outcome and intention-to-treat analysis. LTC residents (age ≥ 65 years) will be recruited from LTC facilities in New Zealand. Participants (n = 528 total, with a 1:1 allocation ratio) will be randomly assigned to either a novel exercise program (Staying UpRight), comprising strength and balance exercises designed specifically for LTC and acceptable to people with dementia (intervention group), or a seated exercise program (control group). The intervention and control group classes will be delivered for 1 h twice weekly over 1 year. The primary outcome is rate of falls (per 1000 person years) within the intervention period.Secondary outcomes will be risk of falling (the proportion of fallers per group), fall rate relative to activity exposure, hospitalisation for fall-related injury, change in gait variability, volume and patterns of ambulatory activity and change in physical performance assessed at baseline and after 6 and 12 months. Cost-effectiveness will be examined using intervention and health service costs.The trial commenced recruitment on 30 November 2018.DiscussionThis study evaluates the efficacy and cost-effectiveness of a progressive strength and balance exercise program for aged care residents to reduce falls. The outcomes will aid development of evidenced-based exercise programmes for this vulnerable population.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12618001827224. Registered on 9 November 2018. Universal trial number U1111-1217-7148.

Thai dance exercises benefited functional mobility and fall rates among community-dwelling older individuals.

Background:With dramatic increase in the number of older individuals, special efforts have been made to promote the levels of independence and reduce fall rates among these individuals.Objective:To investigate the effects of Thai dance exercises over 6 weeks on functional mobility and fall rates in community-dwelling older individuals.Methods:Sixty-one community-dwelling older adults were interviewed and assessed for their demographics and fall data during 6 months prior to participation in the study. Then they completed the quasi-experimental Thai dance exercise program for 50 minutes/day, 3 days/week over 6 weeks. Their functional mobility relating to levels of independence and safety were assessed prior to training, at 3-week and 6-week training. After completing the program at 6 weeks, participants were prospectively monitored for fall data over 6 months.Results:Participants improved their functional mobility significantly after 3- and 6-week training . The number of faller individuals obviously decreased from 35% prior to training to only 8% after training .Conclusion:The current findings further extend benefits of Thai dance as an alternative musical exercise program to promote levels of independence and safety among community-dwelling older adults.

Culturally Safe Falls Prevention Program for Inuvialuit Elders in Inuvik, Northwest Territories, Canada: Considerations for Development and Implementation—ERRATUM

Using post-colonial theory, we sought to determine what current falls prevention recommendations are offered by local falls prevention programmers (LFPPs) to reduce fall rates among Inuvialuit Elders in Inuvik, Northwest Territories, Canada, and to understand how falls prevention programs for Inuvialuit Elders can be co-created with participants to be culturally safe. The findings showed that Inuvialuit Elders and LFPPs in Inuvik recommend adding environment assessments and modifications, physical activity, and education for Elders and caregivers to existing programs. They also felt that for culturally safe falls prevention programs to occur, LFPPs must include the following strategies: establishing trust and rapport within the community, including both Indigenous and non-Indigenous interventions in falls prevention programs, and training others on cultural safety practices.

Assessing the Effect of Unit Champion-Initiated Audits on Fall Rates: Improving Awareness.

Inpatient falls remain challenging with repercussions that can include patient injury and increased hospital expense. Fall rates were consistently above the national benchmark. An initiative to reduce fall rates was use of Fall Champion Audits (FCAs). The aim of this study was to assess the effect of FCAs on patient fall rates. FCAs were piloted on a medical-oncology unit. An interrupted time series design was used to assess the effect of FCAs on fall rates. FCA is an audit conducted by the unit fall champion that assesses fall risk, interventions, and barriers among staff and patients. Analysis suggested a significant decrease in fall rates from pre- (3.75) to postimplementation (1.62). FCAs worked in conjunction with a division-wide fall program in reducing fall rate. FCAs, in conjunction with a fall program, are a feasible intervention in reducing fall rates.

Pharmacist services in nursing homes: A systematic review and meta-analysis.

Pharmacists have been contributing to the care of residents in nursing homes and play a significant role in ensuring quality use of medicine. However, the changing role of pharmacist in nursing homes and their impact on residents is relatively unknown. Six electronic databases were searched from inception until November 2018 for articles published in English examining the services offered by pharmacists in nursing homes. Studies were included if it examined the impact of interventions by pharmacists to improve the quality use of medicine in nursing homes. Fifty-two studies (30 376 residents) were included in the current review. Thirteen studies were randomised controlled studies, while the remainder were either pre-post, retrospective or case-control studies where pharmacists provided services such as clinical medication review in collaboration with other healthcare professionals as well as staff education. Pooled analysis found that pharmacist-led services reduced the mean number of falls (-0.50; 95% confidence interval: -0.79 to -0.21) among residents in nursing homes. Mixed results were noted on the impact of pharmacists' services on mortality, hospitalisation and admission rates among residents. The potential financial savings of such services have not been formally evaluated by any studies thus far. The strength of evidence was moderate for the outcomes of mortality and number of fallers. Pharmacists contribute substantially to patient care in nursing homes, ensuring quality use of medication, resulting in reduced fall rates. Further studies with rigorous design are needed to measure the impact of pharmacist services on the economic benefits and other patient health outcomes.

Multicentre, randomised controlled trial of PDSAFE, a physiotherapist-delivered fall prevention programme for people with Parkinson’s

ObjectiveTo estimate the effect of a physiotherapist-delivered fall prevention programme for people with Parkinson’s (PwP).MethodsPeople at risk of falls with confirmed Parkinson’s were recruited to this multicentre, pragmatic, investigator blind,...

Exercise for reducing falls in people living with and beyond cancer.

Current treatment modalities for cancer have been successful in achieving improved survivorship; however, they come with a number of long-term adverse effects. Accidental falls are a common and clinically significant adverse event in people living with and beyond cancer and rates are higher than in the rest of the population. To assess the effects of prescribed or provided exercise for reducing accidental falls, and falls risk factors of strength, flexibility and balance, in people living with and beyond cancer. We searched the following electronic databases from inception to 10 July 2018, with no restrictions: CENTRAL, MEDLINE, Embase, and seven other databases. We searched clinicaltrials.gov and the World Health Organization International Clinical Trials Registry Platform (ICTRP) for ongoing trials, and reference lists of reviews and retrieved articles for additional studies. We included all randomised controlled trials investigating exercise interventions versus no treatment, usual care or non-exercise interventions on falls incidence or falls risk factors in adults living with and beyond cancer (18 years of age or older at diagnosis). We excluded cross-over studies and studies in acute or inpatient hospice care. At least two review authors independently completed data extraction for included papers. We used Covidence software to manage screening, data collection and extraction. We assessed evidence using GRADE and presented results in a 'Summary of findings' table. Eleven studies (835 participants) compared exercise to usual care. No studies compared exercise with no treatment or non-exercise interventions. The quality of the evidence was very low for the primary outcome rates of falls, and very low to low for the secondary outcomes. We downgraded the evidence due to study limitations (risk of bias), and issues of imprecision due to small sample sizes, inconsistency and indirectness. All studies were at high risk of bias for blinding of participants and personnel due to inability to blind participants to an exercise intervention. Risk of bias was generally low or unclear for other categories.There was generally little information on the important outcomes comparing exercise to usual care.Rates of falls and number of fallers: one study (223 participants) measured accidental falls, but reported neither the rate of falls or the number of fallers; there was no difference in the number of falls between exercise and usual care (very low-quality evidence).Strength: 10 studies (813 participants) reported on strength outcomes. Two analyses favoured exercise over usual care: quadriceps strength (2 studies, 72 participants; mean difference (MD) 8.99 kg, 95% confidence interval (CI) 1.29 to 16.70; low-quality evidence), and leg press (4 studies, 388 participants; MD 21.1 kg, 95% CI 8.47 to 33.74; low-quality evidence). In one analysis of the Sit-to-Stand Test, there was no difference between exercise and usual care (4 studies, 214 participants; standardised mean difference (SMD) -0.45, 95% CI -1.05 to 0.14; very low-quality evidence).Flexibility: one study (21 participants) reported on flexibility for Sit-and-Reach Distance (MD 2.05 cm, 95% CI 0.59 to 3.51; very low-quality evidence).Balance: five studies (350 participants) measured three different balance outcomes. Two analyses favoured exercise over usual care: postural balance (4 studies, 127 participants; standardised mean difference (SMD) 0.44, 95% CI 0.08 to 0.79; very low-quality evidence), and Backward Walk Test (2 studies, 280 participants; SMD -0.24, 95% CI -0.48 to -0.01; low-quality evidence). There was no difference between exercise and usual care for the Timed Up-and-Go Test (1 study, 15 participants; MD -0.35 seconds, 95% CI -1.47 to 0.77; low-quality evidence).Number of people sustaining a fall-related fracture: the quality of the evidence for exercise reducing fall-related fractures was very low.Adverse events: a single study (223 participants) noted some temporary muscle soreness on initiation of exercise or when there was an increase in the weight lifted. As no occurrence data were reported, we could not assess this variable further. No studies reported musculoskeletal injury. Analysis indicated that there was very low-quality evidence that exercise did not increase fatigue. There is a paucity of evidence for exercise training to reduce fall rates in people living with and beyond cancer. Exercise training may improve strength, flexibility and balance for people in this population, but the evidence is very low quality.

The Perceptions and Rehabilitation Experience of Older People After Falling in the Hospital.

Falls are a major cause of disability and mortality due to injury. To reduce fall rates and improve health outcomes, it is important to design services based on patient experience and engagement. This study aimed to explore the experiences of older patients who fell during their hospital stay. Five patients from two rehabilitation wards in the United Kingdom participated in this qualitative study. Semistructured interviews, incident reports, and medical records provided information about each fall. Thematic, discourse, and descriptive analysis were used to analyze data. The data demonstrated how a fall impacted patients' experience of rehabilitation and resulted in changes to mobility, self-confidence, management of falls risk, avoidance of daily activities, and increased assistance from others. Falling in hospital can influence patients' ability to reach their potential of an optimal level of functioning. There is a need to place an equal and mutual understanding on the physical, psychological, and social impact of falling to reduce falls and improve functional outcomes.

Falls prevention strategies for patients over 65 years in a neurology ward: a best practice implementation project.

The aim of this project was to promote evidence-based practice with regard to fall prevention and management, by implementing the recommendations from the best available evidence to reduce fall rates. Falls are a main cause of disability in older people and the most common adverse event in all hospital patients. It is essential to implement the recommendations from evidence-based interventions to reduce these events. A pre and post implementation audit method was used in a neurology ward, which employed the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) and Getting Research Into Practice (GRiP) module. The 15-month project evaluated between 20-30 patients from a sample at each audit (baseline in April 2016 and during three follow-up cycles in December 2016, March 2017 and June 2017). The data were inputted into an informatics system from nursing records and audited according to evidence-based processes and outcomes criteria. The baseline outcomes identified five barriers: incomplete fall registration, lack of an established fall prevention protocol for at-risk patients, limited knowledge about the fall prevention protocol, lack of a fall risk assessment scale and lack of multifactorial individual plans for fall prevention. Strategies were carried out and implemented following GRiP and all the criteria improved from baseline. The project successfully increased evidence-based practice on falls and provided mechanisms for sustaining evidence-based practice changes. Further audits are needed to improve some outcomes.

Effectiveness of complex falls prevention interventions in residential aged care settings: a systematic review.

The objective of this review was to synthesize the best available evidence for the effectiveness of complex falls prevention interventions delivered at two or more of the following levels: resident, facility or organization, on fall rates in the residential aged care (RAC) population. Preventing falls in the high risk RAC population is a common global goal with acknowledged complexity. Previous meta-analyses have not specifically addressed complexity, described as falls prevention intervention delivery at multiple levels of a RAC organization, to determine its effect on fall outcomes. The current review considered studies that included participants who were aged 65 years and over residing in long-term care settings providing 24-hour supervision and/or care assistance.Studies that evaluated complex falls prevention interventions delivered by single discipline or multidisciplinary teams across at least two or all of the following levels: residents, RAC facility and RAC organization were eligible. Experimental study designs including randomized controlled trials, controlled clinical trials and quasi-experimental trials that reported on measures related to fall incidence were considered, namely, rate of falls (expressed as the number of falls per 1000 occupied bed days), the number of participants who became fallers (expressed as the number of participants who fell once or more) and the rate of injurious falls (expressed as the number of falls with injury per 1000 occupied bed days). A three-step search strategy was undertaken, commencing with an initial scoping search of MEDLINE and CINAHL databases prior to an extensive search of all relevant published literature, clinical trial registries and gray literature. Two independent reviewers assessed selected studies for methodological validity using the standardized critical appraisal instrument from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Data were extracted from the selected studies using the standardized data extraction tool from JBI SUMARI. Quantitative data were pooled in statistical meta-analysis for rate of falls, the number of participants who became fallers and the rate of injurious falls. Meta-analysis was conducted using a random-effect model with heterogeneity assessed using the standard Chi-squared and I index. Where statistical pooling was not possible, study findings were presented in narrative form. Twelve studies were included in this review with seven being eligible for meta-analysis. Complex falls prevention interventions delivered at multiple levels in RAC populations did not show a significant effect in reducing fall rates (MD = -1.29; 95% CI [-3.01, 0.43]), or the proportion of residents who fell (OR = 0.76; 95% CI [0.42, 1.38]). However, a sensitivity analysis suggested complex falls prevention interventions delivered with additional resources at multiple levels had a significant positive effect in reducing fall rates (MD = -2.26; 95% CI [-3.72, -0.80]). Complex falls prevention interventions delivered at multiple levels in the RAC population may reduce fall rates when additional staffing, expertise or resources are provided. Organizations may need to determine how resources can be allocated to best address falls prevention management. Future research should continue to investigate which combinations of multifactorial interventions are effective.

Improving Patient Safety Through Video Monitoring

Abstract Purpose: Falls are a major safety issue in rehabilitation settings. Patients receive mixed messages—try to be as independent as possible, but don’t do anything in your room without calling for assistance. Despite the use of multiple falls interventions at this facility, the fall rate remained high. To impact this rate, the facility implemented a video monitoring system. This system allows for patients at risk for falling to be monitored from a remote location. The monitor technician is able to speak to the patient directly and/or contact staff members to respond to the room, preventing a fall. Design: Sequential cohort design. Method: Fifteen video monitoring units were installed on high-risk units in a 115-bed inpatient rehabilitation facility. Total falls and falls rates were tracked and reported pre- and postimplementation. Findings: Over a 21-month period prior to implementing the video monitoring system, the average hospital-wide rate of falls was 6.34 per 1,000 patient-days (SD = 1.7488). After a year of usage, that average has decreased to 5.099 falls per 1,000 patient-days (SD = 1.524). The reduction in falls was statistically significant. In addition, there have been significant cost savings by reducing sitter usage. Conclusions: Video monitoring can improve patient safety by decreasing falls; decreasing sitter usage and cost; and improving patient, family, and staff satisfaction. Clinical Relevance: Falls are a significant issue in rehabilitation settings, and current fall prevention strategies fall short of reducing fall rates. Implementation of new video monitoring technology can help reduce fall rates in inpatient rehabilitation settings.