PubMed · 14608706
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Laura M Wagner, David Richards, Marianne Oliver. 2003. Falls: successful programming.. https://pubmed.ncbi.nlm.nih.gov/14608706/
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Slips, trips and falls on the level are considered commonplace and are rarely subjected to in-depth analysis. They occur in highly varied circumstances in an occupational situation. In-depth analysis of these accidents was conducted within a company with the aim of understanding them better, to be able to discuss prevention field possibilities and priorities for the company concerned. Firstly, available data on 'accidents on the level' occurring over the last 4 years were analysed and a typology for these accidents was derived, based on individual activity at the time of the accident and accident location. The three most serious accident-causing situations were analysed in-depth from interviews with injured persons, as well as from activity observation and activity-related verbal information obtained from operatives. These most serious situations involved accidents occurring when climbing down from trucks or when walking either in surroundings outside company premises or from (to) a vehicle to (from) a work location. In-depth accident analysis and characterization of accident-causing situations as a whole enhance our understanding of the accident process and allow us to envisage priorities for action in the prevention field, in operational terms. Each accident-causing situation reveals environmental factors that in fact constitute accident factors (obstacle, stone, etc.), when the individual walks or climbs down from a truck. Analysis shows that other events are necessary for accident occurrence. For example, the individual may be subjected to a time constraint or may be preoccupied. Results obtained here, in a company integrating different trades, are discussed and compared with those referred to in the literature. Generalization of some of these results is also considered.
OBJECTIVES: to evaluate the effectiveness of a policy of making hip protectors available to residents of nursing homes. DESIGN: a cluster randomised controlled trial of the policy in nursing and residential homes, with the home as the unit of randomisation. SETTING: 127 nursing and residential homes in the greater Belfast area of Northern Ireland. PARTICIPANTS: 40 homes in the intervention group (representing 1,366 occupied beds) and 87 homes in the control group (representing 2,751 occupied beds). INTERVENTIONS: a policy of making hip protectors available free of charge to residents of nursing homes and supporting the implementation process by employing a nurse facilitator to encourage staff in the homes to promote their use, over a 72-week period. MAIN OUTCOME MEASURES: the rate of hip fractures in intervention and control homes, and the level of adherence to use of hip protectors. RESULTS: there were 85 hip fractures in the intervention homes and 163 in the control homes. The mean fracture rate per 100 residents was 6.22 in the intervention homes and 5.92 in the control homes, giving an adjusted rate ratio for the intervention group compared to the control group of 1.05 (95% CI 0.77, 1.43, P = 0.76). Initial acceptance of the hip protectors was 37.2% (508/1,366) with adherence falling to 19.9% (272/1,366) at 72 weeks. CONCLUSIONS: making hip protectors available to residents of nursing and residential homes did not reduce the rate of hip fracture. This research does not support the introduction of a policy of providing hip protectors to residents of nursing homes.
OBJECTIVE: to determine the effect of risk factor modification and balance exercise on falls rates in residential care homes. DESIGN: cluster randomised controlled trial. PARTICIPANTS: 196 residents (aged 60 years or over) in 20 residential care homes were enrolled (38% response rate). Homes were randomly allocated to intervention and control arms. A total of 102 residents were consigned to the intervention arm and 94 to the control arm. INTERVENTION: a multifactorial falls prevention programme including 3 months gait and balance training, medication review, podiatry and optometry. MAIN OUTCOME MEASURES: number of falls/recurrent falls per person, number of medications per person, and change in Tinetti gait and balance measure. RESULTS: in the intervention group there was a mean of 2.2 falls per resident per year compared with 4.0 in the control group; this failed to reach statistical significance (P = 0.2) once the intra-cluster correlation (ICC, 0.10) had been accounted for. Several risk factors were reduced in the intervention arm. CONCLUSIONS: falls risk factor reduction is possible in residents of care homes. A modest reduction in falls rates was demonstrated but this failed to reach statistical significance.