Abstract
Falls in older people are a common problem and carry significant consequences for individuals and society. Falls can result in serious injury, hospitalization, death, anxiety and depression, and reduction in quality of life. The risk of falls and falls-related complications is associated with age, and given the population is aging, the incidence of falls is expected to rise. Older people living in long-term care facilities, or nursing homes, and those who are hospitalized are at significantly higher risk than the general population and commonly are cognitively impaired. This chapter will review the specific risk factors for falls in these populations focusing in cognitively impaired populations. Interventions to assess falls risk and initiate falls-prevention interventions will be discussed.
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Gill TM, Murphy TE, Gahbauer EA, Allore HG. Association of injurious falls with disability outcomes and nursing home admissions in community-living older persons. Am J Epidemiol. 2013;178(3):418–25.
Siracuse JJ, Odell DD, Gondek SP, et al. Health care and socioeconomic impact of falls in the elderly. Am J Surg. 2012;203(3):335–8.
Kumar A, Carpenter H, Morris R, et al. Which factors are associated with fear of falling in community-dwelling older people? Age Ageing. 2014;43(1):76–84.
Burns ER, Stevens JA, Lee R. The direct costs of fatal and non-fatal falls among older adults - United States. J Saf Res. 2016;58:99–103.
Nurmi I, Luthje P. Incidence and costs of falls and fall injuries among elderly in institutional care. Scand J Prim Health Care. 2002;20(2):118–22.
Rubenstein LZ, Josephson KR, Robbins AS. Falls in the nursing home. Ann Int Med. 1994;121(6):442–51.
Nyberg L, Gustafson Y, Janson A, et al. Incidence of falls in three different types of geriatric care. A Swedish prospective study. Scand J Social Med. 1997;25(1):8–13.
Rapp K, Becker C, Cameron ID, et al. Epidemiology of falls in residential aged care: analysis of more than 70,000 falls from residents of Bavarian nursing homes. J Am Med Dir Assoc. 2012;13(2):187.e1–6.
Lord SR, March LM, Cameron ID, et al. Differing risk factors for falls in nursing home and intermediate-care residents who can and cannot stand unaided. J Am Geriatr Soc. 2003;51(11):1645–50.
Oliver D, Daly F, Martin FC, McMurdo ME. Risk factors and risk assessment tools for falls in hospital in-patients: a systematic review. Age Ageing. 2004;33(2):122–30.
Vieira ER, Freund-Heritage R, da Costa BR. Risk factors for geriatric patient falls in rehabilitation hospital settings: a systematic review. Clin Rehabil. 2011;25(9):788–99.
Chartered Society of Physiotherapy. Falls prevention economic model. http://www.Csp.Org.Uk/professional-union/practice/your-business/evidence-base/cost-falls. Accessed 15 Jan 2018.
Kojima G, Kendrick D, Skelton DA, et al. Frailty predicts short-term incidence of future falls among british community-dwelling older people: a prospective cohort study nested within a randomised controlled trial. BMC Geriatr. 2015;15:155.
Cooper R. Reducing falls in a care home. BMJ Qual Improv Rep. 2017;6(1):u214186.w5626.
Cameron ID, Dyer SM, Panagoda CE, et al. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Datab Sys Rev. 2018;(9):Cd005465.
Tricco AC, Thomas SM, Veroniki AA, et al. Comparisons of interventions for preventing falls in older adults: a systematic review and meta-analysis. JAMA. 2017;318(17):1687–99.
Shimada H, Obuchi S, Furuna T, Suzuki T. New intervention program for preventing falls among frail elderly people: the effects of perturbed walking exercise using a bilateral separated treadmill. Am J Phys Med Rehabil. 2004;83(7):493–9.
Sihvonen S, Sipila S, Taskinen S, Era P. Fall incidence in frail older women after individualized visual feedback-based balance training. Gerontol. 2004;50(6):411–6.
Sakamoto K, Nakamura T, Hagino H, et al. Effects of unipedal standing balance exercise on the prevention of falls and hip fracture among clinically defined high-risk elderly individuals: a randomized controlled trial. J Orthop Sci. 2005;11(5):467–72.
Faber MJ, Bosscher RJ, Chin APMJ, van Wieringen PC. Effects of exercise programs on falls and mobility in frail and pre-frail older adults: a multicenter randomized controlled trial. Arch Phys Med Rehabil. 2006;87(7):885–96.
Kerse N, Peri K, Robinson E, et al. Does a functional activity programme improve function, quality of life, and falls for residents in long term care? Cluster Randomised Controlled Trial. BMJ. 2008;337:a1445.
Choi JH, Moon JS, Song R. Effects of sun-style tai chi exercise on physical fitness and fall prevention in fall-prone older adults. J Advanc Nurs. 2005;51(2):150–7.
Nowalk MP, Prendergast JM, Bayles CM, et al. A randomized trial of exercise programs among older individuals living in two long-term care facilities: the fallsfree program. J Am Geriatr Soc. 2001;49(7):859–65.
Mulrow CD, Gerety MB, Kanten D, et al. Effects of physical therapy on functional status of nursing home residents. J Am Geriatr Soc. 1993;41(3):326–8.
Littbrand H, Carlsson M, Lundin-Olsson L, et al. Effect of a high-intensity functional exercise program on functional balance: preplanned subgroup analyses of a randomized controlled trial in residential care facilities. J Am Geriatr Soc. 2011;59(7):1274–82.
Schoenfelder DP. A fall prevention program for elderly individuals. Exercise in long-term care settings. J Gerontol Nurs. 2000;26(3):43–51.
Serra-Rexach JA, Bustamante-Ara N, Hierro Villaran M, et al. Short-term, light- to moderate-intensity exercise training improves leg muscle strength in the oldest old: a randomized controlled trial. J Am Geriatr Soc. 2011;59(4):594–602.
Toulotte C, Fabre C, Dangremont B, et al. Effects of physical training on the physical capacity of frail, demented patients with a history of falling: a randomised controlled trial. Age Ageing. 2003;32(1):67–73.
Crotty M, Rowett D, Spurling L, et al. Does the addition of a pharmacist transition coordinator improve evidence-based medication management and health outcomes in older adults moving from the hospital to a long-term care facility? Results of a randomized, controlled trial. Am J Geriatr Pharmacother. 2004;2(4):257–64.
Lapane KL, Hughes CM, Daiello LA, et al. Effect of a pharmacist-led multicomponent intervention focusing on the medication monitoring phase to prevent potential adverse drug events in nursing homes. J Am Geriatr Soc. 2011;59(7):1238–45.
Zermansky AG, Alldred DP, Petty DR, et al. Clinical medication review by a pharmacist of elderly people living in care homes--randomised controlled trial. Age Ageing. 2006;35(6):586–91.
Patterson SM, Hughes CM, Crealey G, et al. An evaluation of an adapted US model of pharmaceutical care to improve psychoactive prescribing for nursing home residents in northern Ireland. J Am Geriatr Soc. 2010;58(1):44–53.
Wallerstedt SM, Kindblom JM, Nylen K, et al. Medication reviews for nursing home residents to reduce mortality and hospitalization: systematic review and meta-analysis. Br J Clin Pharmacol. 2014;78(3):488–97.
Holick MF. Vitamin d deficiency. New Eng J Med. 2007;357(3):266–81.
DeLuca GC, Kimball SM, Kolasinski J, et al. Review: the role of vitamin d in nervous system health and disease. Neuropathol Appl Neurobiol. 2013;39(5):458–84.
Feron F, Burne TH, Brown J, et al. Developmental vitamin d3 deficiency alters the adult rat brain. Brain Res Bull. 2005;65(2):141–8.
Tomlinson PB, Joseph C, Angioi M. Effects of vitamin d supplementation on upper and lower body muscle strength levels in healthy individuals. A systematic review with meta-analysis. J Sci Med Sport. 2015;18(5):575–80.
Bischoff HA, Stahelin HB, Dick W, et al. Effects of vitamin d and calcium supplementation on falls: a randomized controlled trial. J Bone Min Res. 2003;18(2):343–51.
Broe KE, Chen TC, Weinberg J, et al. A higher dose of vitamin d reduces the risk of falls in nursing home residents: a randomized, multiple-dose study. J Am Geriatr Soc. 2007;55(2):234–9.
Chapuy MC, Pamphile R, Paris E, et al. Combined calcium and vitamin d3 supplementation in elderly women: confirmation of reversal of secondary hyperparathyroidism and hip fracture risk: the decalyos II study. Osteoporos Int. 2002;13(3):257–64.
Flicker L, MacInnis RJ, Stein MS, et al. Should older people in residential care receive vitamin d to prevent falls? Results of a randomized trial. J Am Geriatr Soc. 2005;53(11):1881–8.
Law M, Withers H, Morris J, Anderson F. Vitamin d supplementation and the prevention of fractures and falls: results of a randomised trial in elderly people in residential accommodation. Age Ageing. 2006;35(5):482–6.
Grieger JA, Nowson CA, Jarman HF, et al. Multivitamin supplementation improves nutritional status and bone quality in aged care residents. Eur J Clin Nutr. 2009;63(4):558–65.
Cox H, Puffer S, Morton V, et al. Educating nursing home staff on fracture prevention: a cluster randomised trial. Age Ageing. 2008;37(2):167–72.
Meyer G, Kopke S, Haastert B, Muhlhauser I. Comparison of a fall risk assessment tool with nurses’ judgement alone: a cluster-randomised controlled trial. Age Ageing. 2009;38(4):417–23.
Ward JA, Harden M, Gibson RE, Byles JE. A cluster randomised controlled trial to prevent injury due to falls in a residential aged care population. Med J Aust. 2010;192(6):319–22.
Chenoweth L, King MT, Jeon YH, et al. Caring for aged dementia care resident study (cadres) of person-centred care, dementia-care mapping, and usual care in dementia: a cluster-randomised trial. Lancet Neurol. 2009;8(4):317–25.
Huang TT, Chung ML, Chen FR, et al. Evaluation of a combined cognitive-behavioural and exercise intervention to manage fear of falling among elderly residents in nursing homes. Aging Ment Health. 2016;20(1):2–12.
van het Reve E, de Bruin ED. Strength-balance supplemented with computerized cognitive training to improve dual task gait and divided attention in older adults: a multicenter randomized-controlled trial. BMC Geriatr. 2014;14:134.
Bates-Jensen BM, Alessi CA, Al-Samarrai NR, Schnelle JF. The effects of an exercise and incontinence intervention on skin health outcomes in nursing home residents. J Am Geriatr Soc. 2003;51(3):348–55.
Durvasula S, Kok C, Sambrook PN, et al. Sunlight and health: attitudes of older people living in intermediate care facilities in southern Australia. Arch Gerontol Geriatr. 2010;51(3):e94–9.
Becker C, Kron M, Lindemann U, et al. Effectiveness of a multifaceted intervention on falls in nursing home residents. J Am Geriatr Soc. 2003;51(3):306–13.
Dyer CA, Taylor GJ, Reed M, et al. Falls prevention in residential care homes: a randomised controlled trial. Age Ageing. 2004;33(6):596–602.
Jensen J, Lundin-Olsson L, Nyberg L, Gustafson Y. Fall and injury prevention in older people living in residential care facilities. A cluster randomized trial. Ann Int Med. 2002;136(10):733–41.
Kerse N, Butler M, Robinson E, Todd M. Fall prevention in residential care: a cluster, randomized, controlled trial. J Am Geriatr Soc. 2004;52(4):524–31.
McMurdo ME, Millar AM, Daly F. A randomized controlled trial of fall prevention strategies in old peoples’ homes. Gerontol. 2000;46(2):83–7.
Neyens JC, Dijcks DP, Twisk J, et al. A multifactorial intervention for the prevention of falls in psychogeriatric nursing home patients, a randomised controlled trial (RCT). Age Ageing. 2009;38(2):194–9.
Ray WA, Taylor JA, Meador KG, et al. A randomized trial of a consultation service to reduce falls in nursing homes. JAMA. 1997;278(7):557–62.
Rubenstein LZ, Robbins AS, Josephson KR, et al. The value of assessing falls in an elderly population. A randomized clinical trial. Ann Int Med. 1990;113(4):308–16.
Shaw FE, Bond J, Richardson DA, et al. Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: randomised controlled trial. BMJ. 2003;326(7380):73.
Hempel S, Newberry S, Wang Z, et al. Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness. J Am Ger Soc. 2013;61(4):483–94.
Growdon ME, Shorr RI, Inouye SK. The tension between promoting mobility and preventing falls in the hospital. JAMA Int Med. 2017;177(6):759–60.
Brown CJ, Redden DT, Flood KL, Allman RM. The underrecognized epidemic of low mobility during hospitalization of older adults. J Am Geriatr Soc. 2009;57(9):1660–5.
National Institute of Clinical Excellence. Falls in older people. Quality standard: NICE, 2017. https://www.nice.org.uk/guidance/qs86/resources/falls-in-older-people-pdf-2098911933637. Accessed 16 Jan 2018.
Morse JM, Black C, Oberle K, Donahue P. A prospective study to identify the fall-prone patient. Soc Sci Med. 1989;28(1):81–6.
Morse JM, Morse RM, Tylko SJ. Development of a scale to identify the fall-prone patient. Can J Aging. 2010;8(4):366–77.
Donald IP, Pitt K, Armstrong E, Shuttleworth H. Preventing falls on an elderly care rehabilitation ward. Clin Rehabil. 2000;14(2):178–85.
Jarvis N, Kerr K, Mockett S. Pilot study to explore the feasibility of a randomised controlled trial to determine the dose effect of physiotherapy on patients admitted to hospital following a fall. Prac Evid. 2007;2(2):4–12.
Burleigh E, McColl J, Potter J. Does vitamin d stop inpatients falling? A randomised controlled trial. Age Ageing. 2007;36(5):507–13.
Michalek C, Wehling M, Schlitzer J, et al. Effects of “Fit fOR The Aged” (FORTA) on pharmacotherapy and clinical endpoints - a pilot randomized controlled study. Eur J Clin Pharm. 2014;70(10):1261–7.
Haines TP, Bell RA, Varghese PN. Pragmatic, cluster randomized trial of a policy to introduce low-low beds to hospital wards for the prevention of falls and fall injuries. J Am Geriatr Soc. 2010;58(3):435–41.
Mayo NE, Gloutney L, Levy AR. A randomized trial of identification bracelets to prevent falls among patients in a rehabilitation hospital. Arch Phys Med Rehabil. 1994;75(12):1302–8.
Tideiksaar R, Feiner CF, Maby J. Falls prevention: the efficacy of a bed alarm system in an acute-care setting. Mt Sin J Med. 1993;60(6):522–7.
Shorr RI, Chandler AM, Mion LC, et al. Effects of an intervention to increase bed alarm use to prevent falls in hospitalized patients: a cluster randomized trial. Ann Int Med. 2012;157(10):692–9.
Wolf KH, Hetzer K, Zu Schwabedissen HM, Wiese B, et al. Development and pilot study of a bed-exit alarm based on a body-worn accelerometer. Z Gerontol Geriatr. 2013;46(8):727–33.
Dykes PC, Carroll DL, Hurley A, et al. Fall prevention in acute care hospitals: a randomized trial. JAMA. 2010;304(17):1912–8.
Wald HL, Glasheen JJ, Guerrasio J, et al. Evaluation of a hospitalist-run acute care for the elderly service. J Hosp Med. 2011;6(6):313–21.
Mador JE, Giles L, Whitehead C, Crotty M. A randomized controlled trial of a behavior advisory service for hospitalized older patients with confusion. Int J Geriatr Psychiatry. 2004;19(9):858–63.
Koh SL, Hafizah N, Lee JY, et al. Impact of a fall prevention programme in acute hospital settings in Singapore. Singap Med J. 2009;50(4):425–32.
van Gaal BG, Schoonhoven L, Mintjes JA, et al. The safe or sorry? Programme. Part ii: Effect on preventive care. Int J Nurs Stud. 2011;48(9):1049–57.
Ang E, Mordiffi SZ, Wong HB. Evaluating the use of a targeted multiple intervention strategy in reducing patient falls in an acute care hospital: a randomized controlled trial. J Adv Nurs. 2011;67(9):1984–92.
Haines TP, Hill AM, Hill KD, et al. Patient education to prevent falls among older hospital inpatients: a randomized controlled trial. Arch Int Med. 2011;171(6):516–24.
Haines TP, Bennell KL, Osborne RH, Hill KD. Effectiveness of targeted falls prevention programme in subacute hospital setting: randomised controlled trial. BMJ. 2004;328(7441):676.
Stenvall M, Olofsson B, Lundstrom M, et al. A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture. Osteoporos Int. 2007;18(2):167–75.
Hshieh TT, Yue J, Oh E, et al. Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis. JAMA Int Med. 2015;175(4):512–20.
Aizen E, Lutsyk G, Wainer L, Carmeli S. Effectiveness of individualized fall prevention program in geriatric rehabilitation hospital setting: a cluster randomized trial. Aging Clin Exp Res. 2015;27(5):681–8.
Barker AL, Morello RT, Ayton DR, et al. Development of an implementation plan for the 6-PACK falls prevention programme as part of a randomised controlled trial: protocol for a series of preimplementation studies. Inj Prevent. 2016;22(6):446–52.
Inouye SK, Bogardus ST, Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. New Eng J Med. 1999;340(9):669–76.
Inouye SK, Bogardus ST, Baker DI, et al. The hospital elder life program: a model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital elder life program. J Am Geriatr Soc. 2000;48(12):1697–706.
Inouye SK. Prevention of delirium in hospitalized older patients: risk factors and targeted intervention strategies. Ann Med. 2000;32(4):257–63.
Hshieh TT, Yue J, Oh E, et al. Effectiveness of multi-component non-pharmacologic delirium interventions: a meta-analysis. JAMA Int Med. 2015;175(4):512–20.
Brown CJ, Foley KT, Lowman JD, et al. Comparison of posthospitalization function and community mobility in hospital mobility program and usual care patients: a randomized clinical trial. JAMA Int Med. 2016;176(7):921–7.
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Zanker, J., Duque, G. (2020). Approaches for Falls Prevention in Hospitals and Nursing Home Settings. In: Montero-Odasso, M., Camicioli, R. (eds) Falls and Cognition in Older Persons. Springer, Cham. https://doi.org/10.1007/978-3-030-24233-6_14
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