Rate of accidental falls in institutionalised older people with and without cognitive impairment halved as a result of a staff-oriented intervention.

OBJECTIVE: to evaluate the impact of a staff-oriented intervention on the number of accidental falls in residents with and without cognitive impairment. DESIGN: clustered randomised controlled trial. METHODS: ten nursing wards from 7 nursing homes were randomised in a control (5 wards) and intervention (5 wards) group. The nurses from the intervention group received multi-faceted training about the occurrence of accidental falls, risk factors for falls and possible environmental modifications. For each fall they were asked to record the relevant risk factors, to keep a fall diary and to evaluate fall causes and possible preventive actions. For all residents, cognition and mobility were evaluated using a Mini-Mental State Examination (MMSE) and a Timed Up and Go Test (TUGT). Fall rates were recorded in an identical way for 6 months before and after the start of the intervention. MAIN OUTCOME MEASURES: primary outcome measure was the number of participants with at least one accidental fall requiring an intervention by a physician or a nurse during each period of recording. Secondary outcome was the number of falls for each participant during each period of recording. RESULTS: the relative risk of falling at least once in people of the intervention versus the control group adjusted for the pre-intervention results was 0.46 (95% CI: 0.26-0.79). There was no difference between residents with and without cognitive impairment or impaired mobility. In those falling at least once, the difference between the average number of falls in the two intervention arms was not significant (P = 0.10). CONCLUSION: a simple staff-oriented intervention had a substantial effect on the frequency of accidental falls.

Insufficient lighting in nursing homes.

OBJECTIVES: The objective of this study was to measure the level of lighting in nursing homes in a variety of areas to determine its adequacy in meeting the visual needs of elderly residents. DESIGN: Observational study PARTICIPANTS: Eight nursing homes cooperating in an intervention study designed to prevent accidental falls. MEASUREMENTS: The amount of light was measured in eight nursing homes with a lux meter DVM 1300 Velleman. The intensity of light was measured at four moments: a sunny day, a cloudy day, while dusk was falling, and while it was dark. At each moment, the amount of light was measured in 16 different places frequently used by residents. The European Standard for light and lighting of indoor work places (EN 12464-1:2002) was used for reference. Because aged persons require more light than persons twenty years of age, the European Standard was adapted by increasing it 55%. Results were compared to both the European Standard (ES) and the Adapted Standard (AS). RESULTS: On a sunny day, the amount of light met the ES in 5 of the 8 nursing homes and met the AS in 1 of the 8 nursing homes in at least 8 of 16 places. On a cloudy day, the amount of light met the ES in 2 of the 8 nursing homes in at least 8 of 16 places, and no nursing home met the AS in at least 8 of 16 places. According to the AS, the amount of light was insufficient at both other moments in all institutions. CONCLUSION: The amount of light in the nursing homes was seldom sufficient to meet the visual needs of older people. This lack of illumination may induce a higher risk of accidental falls for dementia patients as well as for other residents.

Scoring clock tests for dementia screening: a comparison of two scoring methods.

OBJECTIVE: To compare the dementia screening performance of two scoring systems of the clock drawing test. METHODS: A sample of 1199 elderly subjects was administered the clock drawing test as part of a study on aging and dementia. The clock drawings were scored using published criteria for the two scoring systems that were compared. Additionally, a selection of 103 drawings was scored by three different raters to evaluate inter-rater agreement within each of the two methods. For a selection of 473 drawings the final diagnosis on the presence or absence of dementia was known. For these drawings accuracy for the detection of dementia was compared between the two methods. RESULTS: The four-item scoring system (Kappa 0.76; sensitivity 0.97; specificity 0.32; PPV 0.53; NPV 0.93) was found to be a little more reliable and as accurate as the six-item scoring system (Kappa 0.67; sensitivity 0.96; specificity 0.42; PPV 0.56; NPV 0.94). CONCLUSION: Since both scoring systems showed largely similar results, primary care physicians and other health care providers should be encouraged to use the four-item scoring checklist as it is easier and requires less time than the more elaborate checklist of the six-item system.