Clinical Practice in Long-Term Care
Fall Prevention and Injury Protection for Nursing Home Residents

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Recognizing that risk factors for falls are multifactorial and interacting, providers require guidance on the components, intensity, dose, and duration for an effective fall and fall injury prevention program. Administrators of health care facilities require guidance on resources needed for these programs. Clear guidance does not exist for specifying the right combination of interventions to adequately protect specific at-risk populations, such as nursing home residents with dementia or osteoporosis. Staff education about fall prevention and resident fall risk assessment and reassessments has become part of standards of practice; however, the selection, specificity, and combination of fall prevention and injury protection interventions are not standardized. To address these gaps, this team of researchers conducted a critical examination of selected intervention studies relevant to nursing home populations. The objectives of this literature review were to (1) examine the selection and specificity of fall prevention and injury protection interventions described in the literature since 1990; (2) evaluate the strength of evidence for interventions that both prevent falls and protect residents from fall-related injury; and, (3) provide clinical and policy guidance to integrate specific interventions into practice.

Section snippets

Objectives

The objectives of this literature review were the following:

  • (1)

    to examine the selection and specificity of fall prevention and injury protection interventions described in the literature since 1990;

  • (2)

    to evaluate the strength of evidence for interventions that both prevent falls and protect residents from fall-related injury; and,

  • (3)

    to provide clinical and policy guidance to integrate specific interventions into practice.

Vu et al4 completed a differential effect analysis of multifaceted intervention

Method

Eligible studies were limited to multifactorial intervention studies conducted in long-term care settings since 1990, and in English. All articles were reviewed by 2 research geriatricians, 2 research nurse scientists, 1 policy analyst, and 1 health science specialist. To build on prior analyses,5 this review differed from other systematic reviews in that we used 2 rating scales for our analysis: The Agency for Healthcare Research and Quality (AHRQ)6 Types of Research: Evidence Hierarchy (Table

Definition of Terms

Fall Prevention is the multifaceted approach that has been tested in nursing homes to modify intrinsic and extrinsic fall risk factors such as modifying medications to reduce fall risk. In contrast, Injury Protection includes interventions (such as hip protectors, floor mats, low beds, and elimination of sharp edges) to mitigate physical injury, such as fracture, hemorrhage, and head trauma, when a fall occurs. We focused on physical injury because of the potential for loss of function and loss

Results

Article sources included databases (ie, Journals@Ovid, PsycINFO, Ovid MEDLINE(R), HAPI, Your Journals@Ovid, HealthSTAR, and Google Scholar) and hand searching of references from clinical guidelines and literature reviews. Separate searches were also conducted to locate publications for economic consequences of nursing home falls and injuries and in dissertation abstracts to capture relevant new research. Using key words (fall prevention and injurious falls or loss of life, and nursing home and

Discussion

Based on this detailed review of the multifaceted interventions, the interventions clearly vary in specificity, dose, intensity, and duration. Several studies show a beneficial effect of the program on fall and/or injury prevention, whereas several others do not. It seems apparent that no one study provides a definitive multifactorial model to guide clinical practice programs in nursing homes. Studies that included reducing serious injuries in nursing home residents focused on fractures,

Summary and Recommendations

Our approach to this review builds on and is supported by the recommendations of Cusimano et al5 who evaluated 5 rigorous trials of multifaceted programs. They recommended more well-designed research to assess the effectiveness of intervention on reducing injuries, quality of life, cost-effectiveness, and sustainability.

Thus, we propose testing a model that is a population-based approach and includes both fall prevention and injury protection, which could potentially mobilize changes on a large

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    Disclaimer: This material is based on work supported by the Office of Research and Development, Department of Veterans Affairs, Health Services Research and Development award #IIR –03–003–1 and the Patient Safety Center of Inquiry, James A. Haley VAMC. The views expressed in this article are those of the authors and do not necessarily represent the views of the Veterans Healthcare Administration or Department of Veterans Affairs.

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