Tennessee Fall Prevention Program: A Randomized, Controlled Trial of Staff Education Final rept

摘要

Falls are the second leading cause of death from unintentional injuries and are the leading cause of all nonfatal injuries. In 1985, they accounted for an estimated 12,866 deaths, 783,357 hospitalizations, 11.5 million minor injuries, and resulted in lifetime costs of 37.5 billion dollars. In addition to their substantial adverse economic effects, fall-related injuries (primarily fractures) have major medical and social consequences, including loss of ambulation, precipitation of nursing home entry, and excess mortality. Achievement of the Healthy People 2000 goals requires reduction of fall-related deaths from 2.7 per 100,000 to 2.3 per 100,000 and of hip fractures in persons 65 and older, the most common serious fall-related injury in the elderly, from 714 per 100,000 to 607 per 100,000. Fall-related injuries are a major public health problem in long-term care. In nursing homes, 45%-70% of residents fall annually. Because many residents fall multiple times the incidence is 150 falls per 100 person-years, at least three times the rate for persons dwelling in the community. Approximately 11% of nursing home residents sustain a serious-fall related injury each year. Because of the growing numbers of persons residing in long-term care settings, it will be difficult to meet Healthy People 2000 injury targets unless falls and related injuries are reduced in this vulnerable population. The increased life expectancy of persons attaining age 65 has increased the number of persons who require the regular assistance with activities of daily living that is provided in long-term care settings. Kemper and Murtaugh estimated that nearly one half of those who attain age 65 will spend some time in a long-term care facility. The rapid growth of largely unregulated assisted-living facilities, which often house persons with functional impairment equivalent to that of nursing home residents, reinforces the need to develop effective fall prevention programs for long-term care.