Fall prevention in hospitals and nursing homes: Clinical practice guideline.
Daniela Schoberer, Helga Elisabeth Breimaier, Julia Zuschnegg and 3 others
PMID 35262271WHAT IT FOUND
Hospital and nursing-home falls can be reduced by tailored multifactorial programmes, patient education and therapist-led exercise.
Do not rely on a fall-risk score alone or low-floor beds. Avoid exercise in frail residents because it may increase falls.
Key findings
01Multifactorial fall-prevention programmes reduced falls in hospital settings and reduced fallers and hip fractures in long-term care.
02Fall-risk assessment tools were not recommended because a large trial showed no effect on falls or fall-related injuries and commonly used tools lacked required sensitivity and specificity.
03Exercise interventions reduced falls in hospital settings when additional physiotherapy was used, but in frail long-term-care residents they increased falls.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for RNs
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What it does not show
The evidence search was limited to publications up to March 2018. Many recommendations had low or very low confidence, especially low-floor beds, alarm and sensor devices, medication review and staff education in hospitals. Some topics had no randomised trials and were based on expert opinion, including environment or external risk adaptation, post-fall analysis, measures restricting freedom and increased observation. The guideline used a three-stage recommendation system, so 'no recommendation' may be misread as proof that an intervention does not work. Frail residents had increased falls with exercise, so exercise recommendations do not apply to that group. Patient-relevant outcomes such as quality of life and fear of falling were rarely measured.
Declared interests
The guideline panel reported no conflicts of interest and no external sponsorship.
The easy way to misread this
Do not read the strong recommendations as proof that every fall-prevention tool or exercise programme works. Fall-risk assessment tools did not reduce falls, and exercise increased falls in frail residents; several effects were based on low or very low confidence evidence.