Fall Prevention in Residential Care: A Cluster, Randomized, Controlled Trial Ngaire Kerse, MBChB, PhD, à z Meg Butler, MPH, à Elizabeth Robinson, MSc, w and Maree Todd, FRACP, MBChB § OBJECTIVES: To establish the effectiveness of a fall- prevention program in reducing falls and injurious falls in older residential care residents. DESIGN: Cluster, randomized, controlled trial. SETTING: Fourteen randomly selected residential care homes in Auckland, New Zealand. PARTICIPANTS: All older residents (n 5 628, 95% partic- ipation rate). INTERVENTION: Residential care staff, using existing resources, implemented systematic individualized fall-risk management for all residents using a fall-risk assessment tool, high-risk logo, and strategies to address identified risks. MEASUREMENTS: Number of residents sustaining a fall, falls, and injurious-falls incidence rates. RESULTS: During 12 months of follow-up, 103 (43%) residents in the control group and 173 (56%) residents in the intervention group fell (Po.018). There was a significantly higher incidence rate of falls in intervention homes than in control homes (incident rate ratio 5 1.34, 95% confidence interval 5 1.06–1.72) during the interven- tion period after adjusting for dependency level (type of home), baseline fall rate, and clustering. There was no difference in the injurious fall incidence rate or incidence of serious injuries. CONCLUSION: This fall-prevention intervention did not reduce falls or injury from falls. Low-intensity interven- tion may be worse than usual care. J Am Geriatr Soc 52:524–531, 2004. Key words: fall prevention; residential care; cluster randomized controlled trial F alls are a major health problem in residential care, with up to 50% of residents falling every year. 1–3 Injuries are a common consequence of falls in this disabled group, with hip fracture being the most worrisome. Although risk factors have been identified, 4–6 few successful interventions in residential care are available to practitioners. Successful interventions in long-term care have been intensive, multidisciplinary, and consequently expensive or have targeted a selected residential care population. 7,8 Residential care is complex because staff and facility factors contribute to fall risk, and the population of interest has complex health and disability-related risks for falls. From a literature review, 9 an evidence-based fall- prevention intervention was developed that aimed to change processes in residential care homes toward systema- tic individualized fall-risk management and increase awareness of the staff about falls. Available fall-prevention strategies were suggested, maximizing use of existing resources and evaluation skills of existing staff. The program was based on a risk-assessment tool, to identify those at high risk, 10–15 and use of a high-risk logo, 14,16 along with written suggested strategies for staff to follow with those identified to have a high risk of falls. This program was refined with groups of local experts, including medical, nursing, physical therapy, and occupational therapy, to improve usability and relevance in the residen- tial care setting. The hypothesis was that this intervention would decrease fall incidence rates. METHODS Design A cluster, randomized, controlled trial was used to test the effect of this fall-prevention intervention in a residential care population on falls and fall-related injuries. The trial This work was supported by project grants from the Health Research Council of New Zealand, the Auckland Medical Research Foundation, and the Royal New Zealand College of General Practitioners’ Auckland Faculty Trust, and by a Harkness Fellowship from the Commonwealth Fund. Presented at the International Gerontological Association scientific meeting, Vancouver, 2001, and the New Zealand Gerontological Association, Auckland, 2002. Address correspondence to Dr. Ngaire Kerse, Associate Professor, Department of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland, New Zealand. E-mail: n.kerse@auckland.ac.nz From the Departments of à General Practice and Primary Health Care and w Community Health, University of Auckland, Auckland, New Zealand; z Harkness Fellow in Health Care Policy, Center For Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington; and § Health Services for Older People, Waitemata District Health Board, Auckland, New Zealand. JAGS 52:524–531, 2004 r 2004 by the American Geriatrics Society 0002-8614/04/$15.00