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Wayne A. Ray; Jo A. Taylor, RN, MPH; Keith G. Meador, MD, MPH; Purushottam B. Thapa, MBBS, MPH; Anne K. Brown, OTR, MS; Henry K. Kajihara, OTR; Claudia Davis, TNSN, RNC; Patricia Gideon, RN; Marie R. Griffin, MD, MPH

JAMA. 1997;278(7):557-562.

Abstract
Context.
—Falls are a major health problem in nursing homes, but no interventions have been shown to prevent falls in nursing home residents.

Objective.
—To evaluate an intervention program designed to prevent falls and associated injuries in high-risk nursing home residents.

Design.
—Randomized controlled trial.

Setting and Participatnts.
—Seven pairs of middle Tennessee nursing homes with 1 facility in each pair randomly assigned to the intervention. Facilities had 482 (261 control, 221 intervention) residents who qualified for the study because they had high risk of falls and a potential safety problem that could be addressed by the intervention.

Intervention.
—Comprehensive structured individual assessment with specific safety recommendations that targeted suboptimal practices for environmental and personal safety, wheelchair use, psychotropic drug use, and transferring and ambulation. Facility staff were encouraged to implement the individual recommendations and to improve overall facility safety.

Main Outcome Measures.
—The mean proportion of recurrent fallers and incidence rate of injurious falls in the facility in the year following the intervention.

Results.
—The mean proportion of recurrent fallers in intervention facilities (43.8%) was 19.1% (95% confidence interval, 2.4%-35.8%) lower than that in control facilities (54.1%, P=.03). Intervention facilities had a nonsignificant trend toward a lower mean rate of injurious falls (13.7 vs 19.9 per 100 person-years, reduction of 31.2%, P=.22). Subgroup analyses suggested greatest benefits for residents for whom the recommended interventions were carried out or who had 3 or more falls in the preceding year.

Conclusion.
—The high rate of falls and related injuries in nursing homes should not be viewed as inevitable, but as outcomes that can be substantially improved through structured safety programs.

Author Affiliations
From the Division of Pharmacoepidemiology, Department of Preventive Medicine, Vanderbilt University School of Medicine (Drs Ray, Thapa, and Griffin; Mss Taylor, Davis, and Gideon; and Mr Kajihara), and the Department of Occupational Therapy, Belmont University (Ms Brown), Nashville, Tenn; and the Department of Psychiatry, Veterans Affairs Medical Center, Duke University, Durham, NC (Dr Meador).

Footnotes
Reprints: Wayne A. Ray, PhD, Division of Pharmacoepidemiology, Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232.

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