Preventing falls among older people with mental health problems: a systematic review

Abstract

BackgroundFalls are a leading cause of mortality and morbidity in older people and the risk of falling is exacerbated by mental health conditions. Existing reviews have focused on people with dementia and cognitive impairment, but not those with other mental health conditions or in mental health settings. The objective of this review is to evaluate the effectiveness of fall prevention interventions for older people with mental health problems being cared for across all settings.MethodsA systematic review of fall prevention interventions for older people with mental health conditions. We undertook electronic database and lateral searches to identify studies reporting data on falls or fall related injuries. Searches were initially conducted in February 2011 and updated in November 2012 and October 2013; no date restrictions were applied. Studies were assessed for risk of bias. Due to heterogeneity results were not pooled but are reported narratively.ResultsSeventeen RCTs and four uncontrolled studies met the inclusion criteria; 11 involved single interventions and ten multifactorial. Evidence relating to fall reduction was inconsistent. Eight of 14 studies found a reduction in fallers (statistically significant in five), and nine of 14 reported a significant reduction in rate or number of falls. Four studies found a non-significant increase in falls. Multifactorial, multi-disciplinary interventions and those involving exercise, medication review and increasing staff awareness appear to reduce the risk of falls but evidence is mixed and study quality varied. Changes to the environment such as increased supervision or sensory stimulation to reduce agitation may be promising for people with dementia but further evaluation is needed. Most of the studies were undertaken in nursing and residential homes, and none in mental health hospital settings.ConclusionsThere is a dearth of falls research in mental health settings or which focus on patients with mental health problems despite the high number of falls experienced by this population group. This review highlights the lack of robust evidence to support practitioners to implement practices that prevent people with mental health problems from falling.

Predicting falls from behavioral and psychological symptoms of dementia in older people residing in facilities

“…7,8 These results show a high possibility of improvement of BPSD, although it is difficult to fundamentally improve core symptoms at the present moment, so it is important to focus on and respond individually to BPSD with the prevention of falls for older adults with dementia. 11,12 In contrast, in other studies about people with dementia falling, BPSD were assessed by a total score. 9,10 To prevent people with dementia from falling, it is important to clarify the relationships between falling and each problem as BPSD with dementia.…”

There is more to life than risk avoidance – elderly people’s experiences of falls, fall-injuries and compliant flooring

“…Preventative measures such as exercise, education and vitamin D supplements have been shown to have a non- or inconclusive effect in the residential care facility population (Avenell, Mak, & O’Connell, 2014; Bunn et al, 2014; Cameron et al, 2012). Although a review of complex multifactorial intervention programs has shown a reduction of recurrent fallers (Vlaeyen et al, 2015), there are considerable barriers for implementation outside the highly controlled circumstances of a study (Vlaeyen et al, 2017).…”

Investigating the fall-injury reducing effect of impact absorbing flooring among female nursing home residents: initial results

“…Evidence-based interventions have been developed, for example, through improvements in elderly care, training programmes for community dwelling elderly and home safety assessments 4. For elderly living in care facilities or with mental health problems, however, limited interventions have proven to be effective 5 6…”