Multifaceted Interventions, Hip Protectors: Fall and Fracture Programs

[center]Falls are the leading cause of unintentional
death among Canadians. According to a report of the Canadian Task Force
on Preventive Health Care, falls resulting in serious injury or death
are much more frequent among those age 55 and over; 70% of fatal falls
occurred among persons 75 years and over. Ninety-five percent of
injuries among older adults living in long-term care facilities were
due to falls. One percent of falls by individuals aged 65 and over
result in hip fracture.[1] Given these statistics, studies examining
the efficacy of interventions to prevent falls and/or address the
negative sequelae of falls are of significant interest to health care
practitioners working with an older adult patient population.

A recent study has analyzed strategies employed in long-term care
facilities and hospitals to prevent falls and fractures, as well as the
evidence on the effects of cognitive impairment on fall risk.[2] The
authors conducted a systematic review and meta-analysis, using
meta-regression to investigate the effects of dementia. Researchers
found that some interventions employed in hospitals lead to falls
reduction, and that the use of hip protectors in care facilities
prevents hip fractures. However, the evidence detected for the use of
other single interventions was not significant.

Fall prevention strategies, the authors point out, are often derived
from procedures and models suited for the community-dwelling, which do
not precisely map on to the needs for fall and injury prevention among
transient and institutionalized segments of the population. One
particular reason that this is so is that many of those in hospital or
long-term care have varying degrees of cognitive impairment. The authors
suggest that awareness of the effect of cognitive impairment in
incidences of falls should guide the development of best practice in
order to avoid the implementation of ineffective prevention strategies.

The range of the 43 studies examined included multifaceted incorporated
programs in hospitals and care settings that evaluated a wide range of
items from risk factor assessment to medication review to education
and exercise programs. The single-intervention programs studied tended
to be components represented in the multi-intervention programs.

Among the key findings were that the multifaceted approach programs to
prevent falls in hospital yielded the highest benefits, with
meta-analysis showing a rate of falls reduction of 18%, but no
significant effects on fracture (rate ratio of 0.82 [95% confidence
interval 0.68 to 0.997]). Review of 11 studies of the effect of hip
protectors showed an overall positive effect of the use of the devices:
the rate ratio for hip fractures was 0.67 (0.46 to 0.98), but there was
no significant effect on falls and, the authors asserted, not enough
studies on fallers. There was no evidence as to the efficacy of exercise
as a single intervention; however, it was a component of successful
multifaceted programs. There was no evidence to suggest that removal of
physical restraints was efficacious. However, the authors did find two
studies in which oral supplementation with calcium and vitamin D
reduced rates of falls and fractures in long-term care facilities.
Importantly, they found no evidence that effect size of interventions
were modified by the prevalence of dementia.

The authors concluded that significant gaps remain in the data yielded
by studies of fall reduction interventions. They singled out the need
for studies specifically examining programs for the cognitively
impaired, the cost-effectiveness of single interventions, and
alterations of physical environment, among others, as sources of needed
evidence. They surmise that at present health care providers are
incurring significant costs by using injury prevention strategies of
unproven value.

Source: http://www.medscape.com/viewarticle/555219?src=mp