Swedish Agency for Health Technology Assessment and Assessment of Social Services
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Effect on falls among elderly persons after training elderly care staff
In general, every person aged 65 years or older, experience at least one fall per year. Falls are common reasons for injuries, and even death. Fall prevention among elderly persons is important due to reasons such as reduced functioning, individual suffering and societal costs. Staff training is one, frequently used, intervention.
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Question
Does staff training in fall prevention, medication or nutrition effect falls among elderly persons?
Tables with identified studies
| Included studies | Population | Outcome |
|---|---|---|
| Balzer et al 2012 [1] | ||
| Interventions to improve competencies of professionals working in long-term care institutions: Four studies report results for this type of interventions. The heterogeneous interventions include different health care professions and vary in their focus. | Elderly persons (>60 years), living in their own housing or in long term care facilities. | Fall incidence and fall related injuries |
| Authors' conclusion: “Overall, the results indicate that interventions that aim at improving competencies of professionals are not effective for fall prevention”. |
||
| Low et al 2015 [2] | ||
| 11 out of 63 studies concerned fall prevention. 1 study concerned appropriate medication. Aimed at changing the care practices of staff for the benefit of the residents. The intervention or components of the intervention were not delivered directly to residents by the research team or other external clinicians. |
Nursing homes, i.e. facilities catering for permanent residential care of older people including providing house-keeping, personal care, meals, activities and nursing home. | Falls, injuries and wellbeing. |
| Authors' conclusion: “Changing staff practice in nursing homes is possible but complex. Interventionists should consider barriers and feasibility of program components to impact on each intended outcome”. |
||
| Vlaeyen et al 2015 [3] | ||
| 14 studies in total. Two studies examined the effect of staff training and education, single interventions, that focused on dissemination of information on falls prevention, fall risk assessment and potential modifications of risk factors and post fall management review. | 22 915 nursing home residents with an overall mean age range of 82 to 88 years. | Number of falls. |
| Authors' conclusion: “In conclusion, multifactorial fall prevention programs can reduce the number of falls and recurrent fallers in residential facilities that provide 24-hour-a-day surveillance, personal care, and limited clinical care for persons who are typically elderly and infirm, whereas single interventions, such as education, may be harmful”. |
||
| Rimland et al 2016 [4] | ||
| Staff training (4 RCTs not pooled) in care facilities and hospitals. | Persons aged 60 years or more in the community, care facilities and hospitals. | Falls comprising fall rate and number of fallers. |
| Authors' conclusion: “Social environment modifications (staff training and service model changes) did not influence falls in care facilities and hospitals. Knowledge or educational interventions were ineffective”. |
||
| Population | Intervention and control | Outcome |
|---|---|---|
| Juola et al 2015 [5] | ||
| Residents of assisted living facilities in Helsinki, Finland. Assisted living facilities and nursing homes both provide a similar level of care, but assisted living facilities are designed to be more homelike. Number of participants: I=118, C=109 |
The intervention was an educational intervention. Nursing staff working in the intervention wards received two 4-hour interactive training sessions based on constructive learning theory to recognize harmful medications and adverse drug events. The sessions involved interactive discussion about the list of harmful medications and suitable alternatives. Nurses were encouraged to present and discuss actual resident cases from their own wards. The educational intervention was based on problem-based learning and the learner-centered approach [37, 38]. Nurses working in the control wards were free to participate in any other continuing education, including programs relating to medication use. Staff of the control wards received our training after the study was completed. | Resident falls and cognition. |
| Authors' conclusion: “Relatively light educational intervention with activating learning methods may improve nursing staff’s knowledge of older people’s harmful medications. It is possible to reduce number of falls among older people in institutional settings by reducing their use of harmful medication”. |
||
References
- Balzer K, Bremer M, Schramm S, Luhmann D, Raspe H. Falls prevention for the elderly. GMS Health Technol Assess 2012;8:Doc01.
- Low LF, Fletcher J, Goodenough B, Jeon YH, Etherton-Beer C, MacAndrew M, et al. A Systematic Review of Interventions to Change Staff Care Practices in Order to Improve Resident Outcomes in Nursing Homes. PLoS One 2015;10:e0140711.
- Vlaeyen E, Coussement J, Leysens G, Van der Elst E, Delbaere K, Cambier D, et al. Characteristics and effectiveness of fall prevention programs in nursing homes: a systematic review and meta-analysis of randomized controlled trials. J Am Geriatr Soc 2015;63:211-21.
- Rimland JM, Abraha I, Dell'Aquila G, Cruz-Jentoft A, Soiza R, Gudmusson A, et al. Effectiveness of Non-Pharmacological Interventions to Prevent Falls in Older People: A Systematic Overview. The SENATOR Project ONTOP Series. PLoS One 2016;11:e0161579.
- Juola AL, Bjorkman MP, Pylkkanen S, Finne-Soveri H, Soini H, Kautiainen H, et al. Nurse Education to Reduce Harmful Medication Use in Assisted Living Facilities: Effects of a Randomized Controlled Trial on Falls and Cognition. Drugs Aging 2015;32:947-55.
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Gunilla Fahlström and Sally Saad at SBU.
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