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Fall and Injury Prevention in Older People Living in Residential Care Facilities: A Cluster Randomized Trial

Jane Jensen, MSc, RPT; Lillemor Lundin-Olsson, PhD, RPT; Lars Nyberg, PhD, RPT; and Yngve Gustafson, PhD, MD
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From Umeå University, Umeå, Sweden.

Acknowledgments: The authors thank the Social Authorities of the municipality of Umeå for fruitful cooperation; the participants; the physicians (Gösta Bucht, MD, PhD, Inger Bylén, MD, Agnetha Byström, MD, Eva Gagerman, MD, PhD, Börje Hermansson, MD, Mai Mattsson, MD, Olov Sandberg, MD, PhD, and Per-Olov Österlind, MD, PhD); the physiotherapists (Staffan Eriksson, RPT, Ellinor Nordin, RPT, Erik Rosendahl, RPT, and Monica Östensson, RPT); and Hans Stenlund, PhD, for outstanding statistical advice.

Grant Support: By the Federation of County Councils in Sweden, the Vårdal Foundation, the Borgerskapet of Umeå Research Foundation, and the Gun and Bertil Stohne Foundation.

Requests for Single Reprints: Jane Jensen, MSc, RPT, Geriatric Medicine, Umeå University, SE-901 85 Umeå, Sweden; e-mail, jane.jensen@germed.umu.se.

Current Author Addresses: Drs. Jensen, Lundin-Olsson, Nyberg, and Gustafson: Department of Community Medicine and Rehabilitation, Geriatric Medicine and Physiotherapy, Umeå University, SE-901 85, Umeå, Sweden.

Author Contributions: Conception and design: J. Jensen, L. Lundin-Olsson,

L. Nyberg, Y. Gustafson.

Analysis and interpretation of the data: J. Jensen, L. Lundin-Olsson,

L. Nyberg, Y. Gustsafon.

Drafting of the article: J. Jensen.

Critical revision of the article for important intellectual content: J. Jensen, L. Lundin-Olsson, L. Nyberg, Y. Gustafson.

Final approval of the article: J. Jensen, L. Lundin-Olsson, L. Nyberg, Y. Gustafson.

Provision of study materials or patients: Y. Gustafson.

Statistical expertise: J. Jensen, L. Lundin-Olsson, Y. Gustafson.

Obtaining of funding: J. Jensen, L. Lundin-Olsson, L. Nyberg, Y. Gustafson.

Administrative, technical, or logistic support: Y. Gustafson.

Collection and assembly of data: J. Jensen, L. Lundin-Olsson, L. Nyberg, Y. Gustafson.

Ann Intern Med. 2002;136(10):733-741. doi:10.7326/0003-4819-136-10-200205210-00008
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Fewer residents in the intervention group than in the control group fell: 82 of 188 (44%) compared with 109 of 196 (56%); this represents a risk ratio of 0.78 (CI, 0.64 to 0.96). Falls per resident ranged from 0 to 16 in the intervention group and 0 to 26 in the control group. In the logistic regression analysis, the odds ratio for falling for the intervention compared with the control group was 0.62 (CI, 0.42 to 0.91) unadjusted for baseline factors and 0.49 (CI, 0.37 to 0.65) adjusted for baseline factors.

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Figure 2.
Survival curves for time to first fall in residents in the intervention and control groups.

Survival curves were determined by using the multiple Cox regression method with adjustment for baseline factors, unadjusted for clustering (hazard ratio, 0.66 [95% CI, 0.48 to 0.89]). The dotted line denotes the intervention group; the solid line denotes the control group.

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Figure 3.
Interaction analysis by study group comparing the time to first fall of lower- and higher-risk residents.

The lower-risk intervention group is the reference group. Adjusted hazard ratios were as follows: lower-risk residents in the control group, 1.73 (95% CI, 1.17 to 2.55); higher-risk residents in the intervention group, 1.94 (CI, 1.15 to 3.30); and higher-risk residents in the control group, 2.87 (CI, 1.93 to 4.27). The dotted line denotes the intervention group; the solid line denotes the control group.

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Summary for Patients

Preventing Falls in Assisted Living Facilities

The summary below is from the full report titled “Fall and Injury Prevention in Older People Living in Residential Care Facilities. A Cluster Randomized Trial.” It is in the 21 May 2002 issue of Annals of Internal Medicine (volume 136, pages 733-741). The authors are J Jensen, L Lundin-Olsson, L Nyberg, and Y Gustafson.


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