Interventions to reduce falls in hospitals: a systematic review and meta-analysis.

Humans Cognitive Dysfunction Exercise Hospitals Risk Assessment Accidental Falls / prevention & control
education exercise falls hospital older people physiotherapy prevention systematic review

Journal

Age and ageing
ISSN: 1468-2834
Titre abrégé: Age Ageing
Pays: England
ID NLM: 0375655

Informations de publication

Date de publication:
01 05 2022
Historique:
received: 17 11 2021
entrez: 7 5 2022
pubmed: 8 5 2022
medline: 11 5 2022
Statut: ppublish

Résumé

Falls remain a common and debilitating problem in hospitals worldwide. The aim of this study was to investigate the effects of falls prevention interventions on falls rates and the risk of falling in hospital. Systematic review and meta-analysis. Hospitalised adults. Prevention methods included staff and patient education, environmental modifications, assistive devices, policies and systems, rehabilitation, medication management and management of cognitive impairment. We evaluated single and multi-factorial approaches. Falls rate ratios (rate ratio: RaR) and falls risk, as defined by the odds of being a faller in the intervention compared to control group (odds ratio: OR). There were 43 studies that satisfied the systematic review criteria and 23 were included in meta-analyses. There was marked heterogeneity in intervention methods and study designs. The only intervention that yielded a significant result in the meta-analysis was education, with a reduction in falls rates (RaR = 0.70 [0.51-0.96], P = 0.03) and the odds of falling (OR = 0.62 [0.47-0.83], P = 0.001). The patient and staff education studies in the meta-analysis were of high quality on the GRADE tool. Individual trials in the systematic review showed evidence for clinician education, some multi-factorial interventions, select rehabilitation therapies, and systems, with low to moderate risk of bias. Patient and staff education can reduce hospital falls. Multi-factorial interventions had a tendency towards producing a positive impact. Chair alarms, bed alarms, wearable sensors and use of scored risk assessment tools were not associated with significant fall reductions.

Sections du résumé

BACKGROUND
Falls remain a common and debilitating problem in hospitals worldwide. The aim of this study was to investigate the effects of falls prevention interventions on falls rates and the risk of falling in hospital.
DESIGN
Systematic review and meta-analysis.
PARTICIPANTS
Hospitalised adults.
INTERVENTION
Prevention methods included staff and patient education, environmental modifications, assistive devices, policies and systems, rehabilitation, medication management and management of cognitive impairment. We evaluated single and multi-factorial approaches.
OUTCOME MEASURES
Falls rate ratios (rate ratio: RaR) and falls risk, as defined by the odds of being a faller in the intervention compared to control group (odds ratio: OR).
RESULTS
There were 43 studies that satisfied the systematic review criteria and 23 were included in meta-analyses. There was marked heterogeneity in intervention methods and study designs. The only intervention that yielded a significant result in the meta-analysis was education, with a reduction in falls rates (RaR = 0.70 [0.51-0.96], P = 0.03) and the odds of falling (OR = 0.62 [0.47-0.83], P = 0.001). The patient and staff education studies in the meta-analysis were of high quality on the GRADE tool. Individual trials in the systematic review showed evidence for clinician education, some multi-factorial interventions, select rehabilitation therapies, and systems, with low to moderate risk of bias.
CONCLUSION
Patient and staff education can reduce hospital falls. Multi-factorial interventions had a tendency towards producing a positive impact. Chair alarms, bed alarms, wearable sensors and use of scored risk assessment tools were not associated with significant fall reductions.

Identifiants

DOI: 10.1093/ageing/afac077 PMID: 35524748 PMC: PMC9078046
pubmed: 35524748
pii: 6581612
doi: 10.1093/ageing/afac077
pmc: PMC9078046
pii:
doi:

Types de publication

Journal Article Meta-Analysis Research Support, Non-U.S. Gov't Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© The Author(s) 2022. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

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Auteurs

Meg E Morris (ME)

La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia.
The Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Victoria, Australia.

Kate Webster (K)

School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.

Cathy Jones (C)

La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia.

Anne-Marie Hill (AM)

Western Australian Centre for Health & Ageing, School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia.

Terry Haines (T)

School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia.

Steven McPhail (S)

Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia Australia.
Digital Health and Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia.

Debra Kiegaldie (D)

Holmesglen Institute and Monash University, Melbourne, Victoria, Australia.

Susan Slade (S)

La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia.

Dana Jazayeri (D)

La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia.

Hazel Heng (H)

La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia.

Ronald Shorr (R)

Geriatric Research Education and Clinical Center, Malcom Randall VAMC, Department of Epidemiology, University of Florida, Gainesville, FL, USA.
Department of Epidemiology, University of Florida, Gainesville, FL, USA.

Leeanne Carey (L)

School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.
Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.

Anna Barker (A)

School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia.
Silver Chain, Melbourne, Victoria, Australia.

Ian Cameron (I)

John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and The University of Sydney, Sydney, NSW, Australia.

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