Cluster randomised trial of a targeted multifactorial intervention to prevent falls among older people in hospital

Abstract

Objective: To determine the efficacy of a targeted multifactorial falls prevention programme in elderly care wards with relatively short lengths of stay. Design: Cluster randomised trial. Setting: 24 elderly care wards in 12 hospitals in Sydney, Australia. Participants: 3999 patients, mean age 79 years, with a median hospital stay of seven days. Interventions: A nurse and physiotherapist each worked for 25 hours a week for three months in all intervention wards. They provided a targeted multifactorial intervention that included a risk assessment of falls, staff and patient education, drug review, modification of bedside and ward environments, an exercise programme, and alarms for selected patients. Main outcome measure: Falls during hospital stay. Results: Intervention and control wards were similar at baseline for previous rates of falls and individual patient characteristics. Overall, 381 falls occurred during the study. No difference was found in fall rates during follow-up between intervention and control wards: respectively, 9.26 falls per 1000 bed days and 9.20 falls per 1000 bed days (P=0.96). The incidence rate ratio adjusted for individual lengths of stay and previous fall rates in the ward was 0.96 (95% confidence interval 0.72 to 1.28). Conclusion: A targeted multifactorial falls prevention programme was not effective among older people in hospital wards with relatively short lengths of stay. Trial registration: Australian New Zealand Clinical Trials Registry ACTRNO 12605000467639.