Interventions for preventing falls in acute- and chronic-care hospitals : a systematic review and meta-analysis

OBJECTIVES: To determine the characteristics and the effectiveness of hospital fall prevention programs. DESIGN: Systematic literature search of multiple databases (Medline, Cinahl, Precinahl, Invert, the Cochrane Library) and of the reference list of each identified publication. SETTING: Inclusion of prospective controlled-design studies reporting the effectiveness of fall prevention programs in hospitals. PARTICIPANTS: Two reviewers. MEASUREMENTS: The methodological qualities of the studies were assessed based on 10 criteria. For the meta-analysis, the relative risk of a fall per occupied bed day (RR(fall)) and the relative risk of being a faller (RR(faller)) were calculated. RESULTS: Eight studies met the inclusion criteria, of which four studies tested multifactorial interventions. Although these studies took place in hospitals, most were conducted on long-stay (mean length of stay (LOS) <1.5 years) and rehabilitation units (mean LOS 36.9 days). For analysis of the number of falls, one unifactorial and two multifactorial studies showed a significant reduction of 30% to 49% in the intervention group, with the greatest effect obtained in the unifactorial study that assessed a pharmacological intervention. The pooled RR(fall) for the four multifactorial studies became nonsignificant after adjustment for clustering (RR(fall)=0.82, 95% confidence interval (CI)=0.65-1.03). No studies reported a significant reduction, either single or pooled, in the number of fallers in the intervention group (pooled RR(faller)-0.87, 95% CI=0.70-1.08). CONCLUSION: This meta-analysis found no conclusive evidence that hospital fall prevention programs can reduce the number of falls or fallers, although more studies are needed to confirm the tendency observed in the analysis of individual studies that targeting a patient's most important risk factors for falls actively helps in reducing the number of falls. These interventions seem to be useful only on long-stay care units.