BMJ  2007;334:82 (13 January), doi:10.1136/bmj.39049.706493.55 (published 8 December 2006)

Research

Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses

¹ University of Reading Institute of Health Sciences, Reading RG1 5AG, ² Institute for Ageing and Health, University of Newcastle upon Tyne, Newcastle NE4 6BE, ³ University of Reading Medical and Pharmaceutical Statistics Research Unit, Reading RG6 6FN, ⁴ Department of Biostatistics, Faculty of Medicine, Ankara University, 06100 Ankara, Turkey, ⁵ Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle NE2 4AA, ⁶ Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH

Objectives To evaluate the evidence for strategies to prevent falls or fractures in residents in care homes and hospital inpatients and to investigate the effect of dementia and cognitive impairment.

Design Systematic review and meta-analyses of studies grouped by intervention and setting (hospital or care home). Meta-regression to investigate the effects of dementia and of study quality and design.

Data sources Medline, CINAHL, Embase, PsychInfo, Cochrane Database, Clinical Trials Register, and hand searching of references from reviews and guidelines to January 2005.

Results 1207 references were identified, including 115 systematic reviews, expert reviews, or guidelines. Of the 92 full papers inspected, 43 were included. Meta-analysis for multifaceted interventions in hospital (13 studies) showed a rate ratio of 0.82 (95% confidence interval 0.68 to 0.997) for falls but no significant effect on the number of fallers or fractures. For hip protectors in care homes (11 studies) the rate ratio for hip fractures was 0.67 (0.46 to 0.98), but there was no significant effect on falls and not enough studies on fallers. For all other interventions (multifaceted interventions in care homes; removal of physical restraints in either setting; fall alarm devices in either setting; exercise in care homes; calcium/vitamin D in care homes; changes in the physical environment in either setting; medication review in hospital) meta-analysis was either unsuitable because of insufficient studies or showed no significant effect on falls, fallers, or fractures, despite strongly positive results in some individual studies. Meta-regression showed no significant association between effect size and prevalence of dementia or cognitive impairment.

Conclusion There is some evidence that multifaceted interventions in hospital reduce the number of falls and that use of hip protectors in care homes prevents hip fractures. There is insufficient evidence, however, for the effectiveness of other single interventions in hospitals or care homes or multifaceted interventions in care homes.

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Rapid Responses:

Read all Rapid Responses

Assistance with interpretation

Ian D Cameron
bmj.com, 16 Dec 2006 [Full text]

Re: Assistance with interpretation

David Oliver
bmj.com, 19 Dec 2006 [Full text]

Falls in the elderly

B Harwod
bmj.com, 9 Jan 2007 [Full text]

Re: Assistance with interpretation

David Oliver
bmj.com, 10 Jan 2007 [Full text]

Hip protectors

Roger Silverstein
bmj.com, 12 Jan 2007 [Full text]

Fall causes fracture or vice versa

Guy F Nash
bmj.com, 14 Jan 2007 [Full text]

Needs further research

Kaushik Sanyal
bmj.com, 15 Jan 2007 [Full text]

new studies needed

Stephanie Haggard
bmj.com, 15 Jan 2007 [Full text]

Falls are a non specific symptom needing individual management but fractures and injury are a matter for risk management

Clive E Bowman
bmj.com, 15 Jan 2007 [Full text]

Individualized fall risk assessment and management

S Kapoor
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Behavioural Correlates

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Fall risk

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dementia and falls

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