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A comprehensive program to identify and correct hazards in nursing homes that could cause falls may reduce the rate of falls among the elderly residents. Researchers developed an intervention that was applied to one nursing home in each of seven pairs of nursing homes, while the other facility served as a control group. The intervention consisted of a complete evaluation of hazards such as psychotropic drug use, improperly designed wheelchairs, improper techniques for transferring residents from bed to chair and room design. When these were corrected, the rate of falls fell 20% and there was a slight trend toward a lower injury rate., 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 Participants. -- 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%-35.81%) 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.

Research is needed to determine the most effective ways to prevent bone fractures in nursing home patients. The US spends almost $4 billion annually on bone fractures in these patients, a figure that will increase as the number of elderly people increases.

Low bone density and ability to function independently are risk factors for bone fractures in white female nursing home patients. Fractures in nursing home patients are a major source of illness and health care utilization.

A comprehensive program to eliminate risk factors for falling in elderly nursing home residents may reduce the rate of falls and injuries. Nursing home residents have a high risk of falling because they are old, frail and have chronic diseases that impair their mobility. Visual disorders and certain drugs also increase the risk of falling. A 1997 study found that a comprehensive program to eliminate risk factors which was targeted to those residents most likely to benefit significantly reduced the rate of falls.