Environmental Domain

Falls Prevention Literature Review

Fleming BE, Pendergast DR. Physical condition, activity pattern, and environment as factors in falls by adult care facility residents. Archives of Physical Medicine and Rehabilitation 1993;74(6):627-630.
Variable Studied: Environmental resident risk factors.
Setting-Situation: Adult care facility.
Sample Size: N=294 fall incident reports over a 3-year period. N=95 residents.
Study Design: Retrospective observational study. Risk factors: pieces of furniture, physical condition of resident, specific physical activities. Outcomes: frequencies of fall locations; precipitating factors.
Results: More than half (57%) of falls occurred in residents' rooms; private or shared bathrooms were the next most frequent locus. Half (50.3%) of fall descriptions implicated environmental features (pieces of furniture the most frequently mentioned). The physical condition of the resident contributed to 24.3% of falls. Specific physical activities were implicated in 7.9% of falls. Multiple factors accounted for 6.5% of total falls and 17% of cases had no clear indication as to cause of fall.
Conclusions: Despite adaptations to lessen environmental hazards, a large number of reportable falls due to environmental factors occurred in the given facility, which was for elderly individuals who were in relatively good health commensurate with their age.

Ejaz FK, Jones JA, Rose MS. Falls among nursing home residents: an examination of incident reports before and after restraint reduction programs. Journal of the American Geriatric Society 1994;42(9):960-964.
Variable Studied: Environmental treatment risk factors; restraint reduction.
Setting-Situation: Seven nursing homes.
Sample Size: N=295 total subjects (184 intervention; 111 controls).
Study Design: Quasi-experimental, multiple time-series, single-subject study. Risk factors: resident characteristics. Intervention: restraint reduction. Control: 111 subjects with no orders for restraints. Outcome: rate of falls per week. Done over a 50-week period (25 preintervention, 25 after initiation of intervention).
Results: Most experimental subjects reached optimum restraint elimination/reduced status within 2 weeks of intervention initiation. Implementation periods ranged from 4 months to more than a year. Serious falls did not increase, but nonserious falls increased significantly after restraints were removed or reduced in experimental subjects. The total mean weekly fall rate for the experimental group increased from 1.87% of residents falling per week during preintervention to 3.01% during postintervention. The mean weekly fall rate of the control group was 3.18% at pretest and did not change statistically over time.
Conclusions: The increase in nonserious falls among the experimental group may be attributed to restraint reduction. The mean weekly fall rate in the experimental group postintervention (25 weeks) became comparable to the mean weekly fall rate for the control group during the entire study (50 weeks). In light of such findings, policymakers have to confront the ethical choice between tying some frail, elderly subjects to beds and chairs versus exposing them to the risks of freedom in their old age.

Carrick FR, Kinney J, Eakes E. Fall prevention in a geriatric nursing home setting using the music of Nolwenn Leroy. http://www.clinicaltrials.gov/ct2/show/NCT00272272; 2007.
Variable Studied: Environmental treatment to reduce risk; music.
Setting-Situation: Dementia unit of geriatric nursing home facility.
Sample Size: N=200 unhealthy full-time facility residents. Age ≥50, all genders.
Study Design: Randomized double-blind controlled trial. Risk factor: dementia. Intervention: daily 5- to 10-minute exposure to Nolwenn Leroy CD for 1 month. Control: previously established fall statistics based on usual care. Outcome: changes in fall rate.
Results: Preliminary observations found a decreased rate of falls in intervention dementia unit compared with previously documented fall rates.
Conclusions: Incorporation of daily music exposure will demonstrate a cost-effective method to reduce falls that might save lives, evoke societal change, and act as a model for other geriatric nursing home settings.

Current as of February 2010
Internet Citation: Environmental Domain: Falls Prevention Literature Review. February 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/injuries/fallspxlitrev/fallspxlitrev4.html