PEARLS 234, March 2010, written by Brian R McAvoy

Clinical question

How effective are interventions designed to prevent falls in older people in nursing care facilities and hospitals?  

Bottom line

There is evidence multifactorial interventions reduce falls and risk of falling in hospitals and may do so in nursing care facilities, but no recommendations can be made regarding any particular component of these programmes. Vitamin D supplementation was effective in reducing the rate of falls in nursing care facilities, as was a review of medication by a pharmacist. There was no evidence other interventions targeting single risk factors reduced falls and this included exercise interventions. However, exercise in the subacute hospital setting appeared effective.  

Caveat

Limitations of the review included the small number of hospital studies, difficulty isolating effects of individual components of treatments that involved multiple components, and the variability of interventions. Falls prevention programmes that include exercises for frail nursing care facility residents should carefully assess each individualÕs suitability, as there is the possibility exercise programmes may increase some peopleÕs risk of falls.  

Context

Falls by older people in nursing care facilities and hospitals are common events that may cause loss of independence, injuries, and sometimes death as a result of injury. Effective interventions are important as they will have significant health benefits.  

Cochrane Systematic Review

Cameron ID et al. Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Reviews 2010, Issue 1. Article No. CD005465. DOI: 10.1002/14651858. CD005465.pub2. This review contains 41 studies involving 25,422 participants in 13 countries.