Resumen de Prevention of Falls in Nursing Homes: Subgroup Analyses of a Randomized Fall Prevention Trial
Kilian Rapp, Sarah E. Lamb, Gisela Büchele, Ranjit Lall, Ulrich Lindemann, Clemens Becker
OBJECTIVES: To evaluate the effectiveness of a multifactorial fall prevention program in prespecified subgroups of nursing home residents.
DESIGN: Secondary analysis of a cluster-randomized, controlled trial.
SETTING: Six nursing homes in Germany.
PARTICIPANTS: Seven hundred twenty-five long-stay residents; median age 86; 80% female.
INTERVENTION: Staff and resident education on fall prevention, advice on environmental adaptations, recommendation to wear hip protectors, and progressive balance and resistance training.
MEASUREMENTS: Time to first fall and the number of falls. Falls were assessed during the 12-month intervention period. Univariate regression analyses were performed, including a confirmatory test of interaction.
RESULTS: The intervention was more effective in people with cognitive impairment (hazard ratio (HR)=0.49, 95% confidence interval (CI)=0.35\u20130.69) than in those who were cognitively intact (HR=0.91, 95% CI=0.68\u20131.22), in people with a prior history of falls (HR=0.47, 95% CI=0.33\u20130.67) than in those with no prior fall history (HR=0.77, 95% CI=0.58\u20131.01), in people with urinary incontinence (HR=0.59, 95% CI=0.45\u20130.77) than in those with no urinary incontinence (HR=0.98, 95% CI=0.68\u20131.42), and in people with no mood problems (incidence rate ratio (IRR)=0.41, 95% CI=0.27\u20130.61) than in those with mood problems (IRR=0.74, 95% CI=0.51\u20131.09).
CONCLUSION: The effectiveness of a multifactorial fall prevention program differed between subgroups of nursing home residents. Cognitive impairment, a history of falls, urinary incontinence, and depressed mood were important in determining response.
