Effectiveness of a multifaceted intervention on falls in nursing home residents

J Am Geriatr Soc. 2003 Mar;51(3):306-13. doi: 10.1046/j.1532-5415.2003.51103.x.


Objectives: To evaluate the effectiveness of a multifaceted, nonpharmaceutical intervention on incidence of falls and fallers.

Design: Prospective, cluster-randomized, controlled 12-month trial.

Setting: Six community nursing homes in Germany.

Participants: Long-stay residents (n = 981) aged 60 and older; mean age 85; 79% female.

Interventions: Staff and resident education on fall prevention, advice on environmental adaptations, progressive balance and resistance training, and hip protectors.

Measurements: Falls, fallers, and fractures.

Results: The incidence density rate of falls per 1,000 resident years (RY) was 2,558 for the control group (CG) and 1,399 for the intervention group (IG) (relative risk (RR) = 0.55, 95% confidence interval (CI) = 0.41-0.73). Two hundred forty-seven (52.3%) fallers were detected in the CG and 188 (36.9%) in the IG (RR = 0.75, 95% CI = 0.57-0.98). The incidence density rate of frequent fallers (>2/year) was 115 (24.4%) for the CG and 66 (13.0%) for the IG (RR = 0.56, 95% CI = 0.35-0.89). The incidence density rate of hip fractures per 1,000 RY was 39 for the CG and 43 for the IG (RR = 1.11, 95% CI = 0.49-2.51). Other fractures were diagnosed with an incidence density rate of 52 per 1,000 RY for CG and 41 per 1,000 RY for IG (RR = 0.78, 95% CI = 0.57-1.07).

Conclusion: The incidence density rate of falls and fallers differed considerably between the control and intervention groups. The study was underpowered to demonstrate a significant difference of hip or nonhip fractures. Because of a low fracture rate in both groups, the investigation of fracture rates would have required a larger sample size to detect an effect of the intervention.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidental Falls / prevention & control*
  • Accidental Falls / statistics & numerical data
  • Aged
  • Aged, 80 and over
  • Female
  • Follow-Up Studies
  • Frail Elderly*
  • Homes for the Aged
  • Humans
  • Male
  • Nursing Homes
  • Prospective Studies