Background
Falls in nursing care facilities and hospitals are common events that cause considerable morbidity and mortality for older people.

Objectives
To assess the effectiveness of interventions designed to reduce falls by older people in nursing care facilities and hospitals.

Search methods
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (January 2009); the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 2); MEDLINE, EMBASE, and CINAHL (all to November 2008); trial registers and reference lists of articles.

Selection criteria
Randomised controlled trials of interventions to reduce falls in older people in nursing care facilities or hospitals. Primary outcomes were rate of falls and risk of falling.

Data collection and analysis
Two review authors independently assessed trial quality and extracted data. Data were pooled where appropriate.

Main results
We included 41 trials (25,422 participants).

In nursing care facilities, the results from seven trials testing supervised exercise interventions were inconsistent. This was the case too for multifactorial interventions, which overall did not significantly reduce the rate of falls (rate ratio (RaR) 0.82, 95% CI 0.62 to 1.08; 7 trials, 2997 participants) or risk of falling (risk ratio (RR) 0.93, 95% CI 0.86 to 1.01; 8 trials, 3271 participants). A post hoc subgroup analysis, however, indicated that where provided by a multidisciplinary team, multifactorial interventions reduced the rate of falls (RaR 0.60, 95% CI 0.51 to 0.72; 4 trials, 1651 participants) and risk of falling (RR 0.85, 95% CI 0.77 to 0.95; 5 trials, 1925 participants). Vitamin D supplementation reduced the rate of falls (RaR 0.72, 95% CI 0.55 to 0.95; 4 trials, 4512 participants), but not risk of falling (RR 0.98, 95% CI 0.89 to 1.09; 5 trials, 5095 participants).

In hospitals, multifactorial interventions reduced the rate of falls (RaR 0.69, 95% CI 0.49 to 0.96; 4 trials, 6478 participants) and risk of falling (RR 0.73, 95% CI 0.56 to 0.96; 3 trials, 4824 participants). Supervised exercise interventions showed a significant reduction in risk of falling (RR 0.44, 95% CI 0.20 to 0.97; 3 trials, 131 participants).

Authors' conclusions
There is evidence that multifactorial interventions reduce falls and risk of falling in hospitals and may do so in nursing care facilities. Vitamin D supplementation is effective in reducing the rate of falls in nursing care facilities. Exercise in subacute hospital settings appears effective but its effectiveness in nursing care facilities remains uncertain.

Interventions for preventing falls in older people in nursing care facilities and hospitals

Cochrane review, hvor hensikten var a vurdere effekten av intervensjoner designet for reduksjon av fall blant eldre mennesker i sykehjem og sykehus.

Interventions for preventing falls in older people in care facilities and hospitals

Sarcopenia

SARC-F: a simple questionnaire to rapidly diagnose sarcopenia.

Frailty and the Prediction of Negative Health Outcomes: A Meta-Analysis

Background
Disability in Activities of Daily Living (ADL) is an adverse outcome of frailty that places a burden on frail elderly people, care providers and the care system. Knowing which physical frailty indicators predict ADL disability is useful in identifying elderly people who might benefit from an intervention that prevents disability or increases functioning in daily life. The objective of this study was to systematically review the literature on the predictive value of physical frailty indicators on ADL disability in community-dwelling elderly people.

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Predicting ADL disability in community-dwelling elderly people using physical frailty indicators: a systematic review

Malnutrition is associated with an increased risk of falls and impaired activity in elderly patients in Dutch residential long-term care (LTC): A cross-sectional study

Rapportage resultaten Landelijke Prevalentiemeting Zorgproblemen

Effectiveness and implementation aspects of interventions for preventing falls in elderly people in long-term care facilities: a systematic review of RCTs.

To investigate the role of malnutrition, impaired mobility and care dependency in predicting fallers in older Dutch home care clients. This study is a secondary analysis of data of the annual independent National Prevalence Measurement of Care Problems of Maastricht University. The design involves a cross-sectional, multicentre point prevalence measurement (malnutrition, mobility), and a 30 days incidence measurement (falls). Dutch home care organisations. 2971 clients (older than 65 years) from 22 home care organizations participated. A standardized questionnaire was used to register amongst others data of weight, height, number and type of diseases (like for example neurologic diseases, dementia, CVA, COPD, eye/ear disorders, musculoskeletal disorders), nutritional intake, use of psychopharmaca, undesired weight loss, fall history, mobility, and care dependency. The study was able to show that fallers are more often malnourished than non-fallers in the univariate analysis. Most importantly the study indicated by multivariate analysis that fallers could be predicted by the risk factors immobility ((OR 2.516 95% CI 1.144–5.532), high care dependency (OR 1.684 95% CI 1.121–2.532) and malnutrition (OR 1.978 95% CI 1.340–2.920). The findings of this study stress that malnutrition, impaired mobility and care dependency are potential reversible factors related to falls. Therefore early identification and management of nutritional status, impaired mobility and care dependency are important aspects for a possible fall prevention strategy.

Jacques C. L. Neyens

Papers

Predicting ADL disability in community-dwelling elderly people using physical frailty indicators: a systematic review

Malnutrition is associated with an increased risk of falls and impaired activity in elderly patients in Dutch residential long-term care (LTC): A cross-sectional study

Rapportage resultaten Landelijke Prevalentiemeting Zorgproblemen

Effectiveness and implementation aspects of interventions for preventing falls in elderly people in long-term care facilities: a systematic review of RCTs.

Predicting falls in elderly receiving home care: The role of malnutrition and impaired mobility