Additional exercise for older subacute hospital inpatients to prevent falls: benefits and barriers to implementation and evaluation

Abstract

This exercise programme provided in addition to usual care may assist in the prevention of falls in the subacute hospital setting.

Inconsistent results in meta-analyses for the prevention of falls are found between study-level data and patient-level data

“…Various risk factors have been measured using different techniques, each with variable impact on the association between the risk factor being measured and falls [24]. Intervention strategies that have the same broad classification (e.g., exercise programs) have been vastly different in terms of their content [34,35]. Thus, in light of these concerns, reviewers should seriously question whether presenting pooled results in this field is likely to be more beneficial than simply conducting a systematic review and critiquing the results of individual studies.…”

A Randomized Trial Comparing Digital Video Disc with Written Delivery of Falls Prevention Education for Older Patients in Hospital

“…Rates of between 2.2 and 21.4 falls per 1000 patient days, [1][2][3][4][5] are reported. Up to 30% of these falls cause injury, [2][3][4]6 and falls are a preventable cause of mortality. 6 In-hospital falls are associated with reduced quality of life, increased disability, prolonged hospital stay and resource use and increased risk of institutionalization.…”

“…A majority of studies included have been multi-factorial intervention programs which have yielded inconsistent results. 3,5,12,13 Compositional differences between intervention programs examined may explain some of this variability, indicating the need to identify individual elements / interventions that could be used to prevent falls.…”

“…Patient education has been frequently cited as one component of multi-factorial falls prevention interventions, 3,5,12,13,14 though has not been examined as a single intervention in this setting. A subgroup analysis found patient education to be the most effective component of a successful multi-factorial intervention.…”

Older patients and falls in hospital

“…Additionally, for patients whose stay in a rehabilitation unit is likely to exceed around seven weeks, tailored programmes of strength and balance training have also been shown to reduce falls. 8 The complexity and challenge of falls prevention is illustrated through the relatively modest 20-30% reductions in falls rates achieved in these studies, and the long periods (often 1 or 2 years) of sustained effort they required to embed changes in culture and practice. 9 Although anecdotal accounts of more substantial reductions are frequently reported, these are likely to arise from misinterpretation of seasonal patterns in whole-hospital falls rates or random variation affecting small numbers of falls in individual wards or departments.…”