Effectiveness of nursing interventions in the prevention of falls in older adults in the community and in health care settings: A systematic review and meta-analysis of RCT.

OBJECTIVE: To estimate the effectiveness of fall prevention programs in people aged 65 years and older involving nursing professionals. METHODS: We included available full-text randomized clinical trials on nurse-led prevention of falls in the community in people over 65 years of age and reporting the incidence of such falls. An extensive search was performed in 14 databases covering the period 2016-2018 for publications in English, French, Portuguese and Spanish. The quality of the papers was assessed independently and blindly by reviewers working in pairs using the risk of bias dominios of the Cochrane Collaboration. The hazard ratio was used as a measure of the effect size of the incidence of falls. A random-effects model was assumed for statistical analyses. The influence of moderator variables of the studies on the effect sizes was performed using ANOVAs and its 95% CI for each moderator category. RESULTS: A total of 31 randomized clinical trials were selected with 25,551 participants. The most frequent type of intervention was education (57.1%), followed by multifactorial models (37.1%). The probability of falling was significantly reduced by 13% in the intervention groups compared to the control groups (RR+=0.87). Multifactorial (RR+=0.89) and education-based (RR=+0.84) interventions significantly reduced the probability of falls by 11% and 16%, respectively. CONCLUSIONS: Discarding publication bias prevention programs carried out by nurses produce a significant 10% reduction in falls. Education-based and multifactorial interventions are the most effective when conducted by nurses.

Older Adults' Experiences, Worries and Preventive Measures Regarding Home Hazards: A Survey on Home Safety in Sweden.

Home safety is important for preventing injuries and accidents among older adults living at home. Feeling safe at home is also essential for older adults' well-being. Thus, this study aimed to explore older adults' perceptions of safety in their homes by examining their experiences, worries and preventive measures in relation to a range of potential home-based health and safety hazards. The study was a national cross-sectional telephone survey of 400 randomly selected adults over 70 years of age living at home in ordinary housing in Sweden. Participants were asked for their experience of, worry about, and preventive measures taken regarding fifteen home hazards. Data were also collected on background variables including age, health, and cohabitation status. Falls and stab/cut injuries were the most experienced hazards and worry was highest for burglary and falls, while preventive measures were most common for fire and burglary. While older adults' experience and worry regarding home hazards were associated with preventive measures, these associations were not strong and other factors were associated with preventive behaviour. Further identification of the main determinants of older adults' preventive behaviour can contribute to policy for effectively reducing home accidents.

Follow-up household assessment for child unintentional injuries two years after the intervention: A community-based study from Karachi, Pakistan.

BACKGROUND: Unintentional childhood injuries are a growing public health concern, and the home is the most common location for non-fatal injuries in children less than 5 years of age. This study describes the long-term effects of two injury prevention educational interventions for caregivers-an educational pamphlet and an in-home tutorial guide-by comparing the change in the prevalence of home injury hazards before and after the interventions. METHODS: This was a pre- (June and July 2010) and post-study with short-term follow-up (November-December 2010) and long-term follow-up (November 2012- January 2013). Neighborhood one included households that received only educational pamphlets after completing a baseline assessment; neighborhood two included households that received an in-home tutorial guide after completing the baseline assessment and receiving the educational pamphlet. The main outcome of this study was the reduction in home injury hazards for children under 5 years of age. RESULTS: A total of 312 households participated in the long-term phase to compare the effect of the interventions. Between the short-term to long-term follow-up, injury hazards significantly reduced in neighborhood two compared to neighborhood one. These included fall hazards (walker use) (IRR 0.24 [95% CI 0.08-0.71]), drowning hazards (open bucket of water in the courtyard and uncovered water pool) (IRR 0.45 [95% CI 0.85-0.98] and IRR 0.46 [95% CI 0.76-0.94]), burn hazards (iron, water heater within reach of child) (IRR 0.56 [95% CI 0.33-0.78] and IRR 0.58 [95% CI 0.32-0.91]), poisoning hazards (shampoo/soap and medicine within reach of child) (IRR 0.53 [95% CI 0.44-0.77] and IRR 0.7 [95% CI 0.44-0.98]) and breakable objects within reach of child (IRR 0.62 [95% CI: 0.39-0.99]). CONCLUSION: An injury prevention tutorial to caretakers of children supplemented with pamphlets could significantly decrease the incidence of falls, drowning, burns, poisoning, and cut injury hazards for children under 5 years of age in their homes in a low-resource setting. This intervention has the potential to be integrated in existing public health programs, such as Lady Health Visitors (LHVs), to disseminate injury prevention information in routine home health visits.

Using threshold analysis to assess the robustness of public health intervention recommendations from network meta-analyses: application to accident prevention in households with children under five.

BACKGROUND: In the appraisal of clinical interventions, complex evidence synthesis methods, such as network meta-analysis (NMA), are commonly used to investigate the effectiveness of multiple interventions in a single analysis. The results from a NMA can inform clinical guidelines directly or be used as inputs into a decision-analytic model assessing the cost-effectiveness of the interventions. However, there is hesitancy in using complex evidence synthesis methods when evaluating public health interventions. This is due to significant heterogeneity across studies investigating such interventions and concerns about their quality. Threshold analysis has been developed to help assess and quantify the robustness of recommendations made based on results obtained from NMAs to potential limitations of the data. Developed in the context of clinical guidelines, the method may prove useful also in the context of public health interventions. In this paper, we illustrate the use of the method in public health, investigating the effectiveness of interventions aiming to increase the uptake of accident prevention behaviours in homes with children aged 0-5. METHODS: Two published random effects NMAs were replicated and carried out to assess the effectiveness of several interventions for increasing the uptake of accident prevention behaviours, focusing on the safe storage of other household products and stair gates outcomes. Threshold analysis was then applied to the NMAs to assess the robustness of the intervention recommendations made based on the results from the NMAs. RESULTS: The results of the NMAs indicated that complex intervention, including Education, Free/low-cost equipment, Fitting equipment and Home safety inspection, was the most effective intervention at promoting accident prevention behaviours for both outcomes. However, the threshold analyses highlighted that the intervention recommendation was robust for the stair gate outcome, but not robust for the safe storage of other household items outcome. CONCLUSIONS: In our case study, threshold analysis allowed us to demonstrate that there was some discrepancy in the intervention recommendation for promoting accident prevention behaviours as the recommendation was robust for one outcome but not the other. Therefore, caution should be taken when considering such interventions in practice for the prevention of poisonings in homes with children aged 0-5. However, there can be some confidence in the use of this intervention in practice to promote the possession of stair gates to prevent falls in homes with children under 5. We have illustrated the potential benefit of threshold analysis in the context of public health and, therefore, encourage the use of the method in practice as a sensitivity analysis for NMA of public health interventions.

Keeping our children safe: piloting a hospital-based home-visitation program in Israel.

BACKGROUND: Unintentional childhood injuries are a leading cause of morbidity and mortality worldwide. Attempts to prevent child home injuries have rarely been implemented in hospital settings which present an important opportunity for intervention. The SHABI ('Keeping our Children Safe; SHomrim Al BetIchut Yeladenu') program recruits at-risk families presenting with child injury to the Emergency Department. Medical/nursing students conduct two home visits and provide safety equipment and guidance. The objective of this study was to investigate the impact of SHABI on participating families' home-safety. METHODS: The pilot was conducted between May 2019 and March 2020 in northern Israel, an area with high child injury rates. Eligibility included families with preschool children who incurred a home injury. Home-safety was assessed by observation through the 'Beterem' checklist. Parents' views, knowledge, awareness of dangers and report of home injuries were assessed at the start of each visit. RESULTS: 352 of 773 eligible families agreed to be contacted. 135 participated, 98 completed both home visits. Significant improvement in home-safety items was observed 4 months after the first visit (14 [IQR12-16]) vs. (17 [IQR15-19]; p < 0.001), accompanied by an overall increase in home safety (Mean ± SD 71.9% ± 9.5% vs. 87.1% ± 8.6%; p < 0.001). 64% reported greater awareness of dangers, 60% affirmed home was safer, and 70% valued the equipment. No difference was found in the prevalence of injuries (14 of 98 families prior and 8 after the visit; p = 0.17). Home visitors reported benefiting from the experience of working with disadvantaged families. CONCLUSION: The program, which included recruitment in a hospital emergency setting and use of healthcare students as home visitors, was successfully implemented and accompanied by significant improvement in home safety with a non-significant trend of child injury decrease.

Risk Reduction Education to Prevent Preschool Children's Home Accidents: A Pilot Study.

OBJECTIVE: Preschool-age children experience many home accidents, and school nurses play a role in preventing these accidents. METHODS: Accordingly, this study aimed to evaluate the effectiveness of training preschool-age children through an imagined hide-and-seek game using a model home environment, in cases that may pose an accident risk. This pretest-posttest control-group study was conducted between March and June 2019. In total, 72 preschool students were included in the study. The study group's education through the model home environment and game was assessed using the Determination of Home Environment Risks Form. RESULTS: The post-education mean accident risk scores of the children in the study group increased in the kitchen (pre-education: 4.89 ± 3.258; post-education: 9.56 ± 3.549), children's room (pre-education: 6.17 ± 3.776; post-education: 8.56 ± 3.722), and garden (pre-education: 4.39 ± 2.697; post-education: 6.72 ± 2.953). In the study group, the mean scores of children for recognizing the circumstances that pose a risk of accident in the home environment were determined to increase significantly (P < 0.001). The corresponding scores of the children in the control group did not change in the kitchen (pre-education: 3.89 ± 2.025; post-education: 3.44 ± 2.006), children's room (pre-education: 3.72 ± 1.667; post-education: 3.50 ± 2.158), or garden (pre-education: 2.83 ± 1.813; post-education: 2.17 ± 2.049). CONCLUSIONS: The new techniques, which will help children learn while having fun, should be integrated into preschool children's education programs to reduce home accidents.

Impact of the national home safety equipment scheme 'Safe At Home' on hospital admissions for unintentional injury in children under 5: a controlled interrupted time series analysis.

BACKGROUND: Unintentional home injuries are a leading cause of preventable death in young children. Safety education and equipment provision improve home safety practices, but their impact on injuries is less clear. Between 2009 and 2011, a national home safety equipment scheme was implemented in England (Safe At Home), targeting high-injury-rate areas and socioeconomically disadvantaged families with children under 5. This provided a 'natural experiment' for evaluating the scheme's impact on hospital admissions for unintentional injuries. METHODS: Controlled interrupted time series analysis of unintentional injury hospital admission rates in small areas (Lower Layer Super Output Areas (LSOAs)) in England where the scheme was implemented (intervention areas, n=9466) and matched with LSOAs in England and Wales where it was not implemented (control areas, n=9466), with subgroup analyses by density of equipment provision. RESULTS: 57 656 homes receiving safety equipment were included in the analysis. In the 2 years after the scheme ended, monthly admission rates declined in intervention areas (-0.33% (-0.47% to -0.18%)) but did not decline in control areas (0.04% (-0.11%-0.19%), p value for difference in trend=0.001). Greater reductions in admission rates were seen as equipment provision density increased. Effects were not maintained beyond 2 years after the scheme ended. CONCLUSIONS: A national home safety equipment scheme was associated with a reduction in injury-related hospital admissions in children under 5 in the 2 years after the scheme ended. Providing a higher number of items of safety equipment appears to be more effective in reducing injury rates than providing fewer items.

Prevention of domestic accidents in childhood: knowledge of caregivers at a health care facility.

OBJECTIVE: To analyze caregivers' knowledge about prevention of domestic accidents in early childhood and its association with education level. METHODS: This is a cross-sectional study conducted in a Primary Care Unit in Niterói with caregivers (convenience sample) of children under 6 years old. To classify the knowledge, we adopted the Positivity Index; to verify the association between the variable "schooling" and knowledge, the chi square test was used; statistically significant results: p < 0.05. RESULTS: A total of 256 caregivers participated; 93.5% showed adequate knowledge. In the individual items, the knowledge (100%) about prevention of accidents with sharp toys, firearms, intoxication by products stood out; and less frequently (64.5%), the knowledge of the information contained in the Child's Health Booklet. There was no statistically significant association (p = 0.237) between education and knowledge. Conclusion: The caregivers presented knowledge about the prevention of domestic accidents, and this was not associated with the level of education.

Home modifications to prevent home fall injuries in houses with Maori occupants (MHIPI): a randomised controlled trial.

BACKGROUND: As with many Indigenous populations internationally, Maori in New Zealand suffer health inequity. We aimed to assess the rate of fall injuries at home with and without home modifications in houses with Maori occupants. METHODS: We did a single-blind randomised controlled trial in the Wellington and Taranaki regions of New Zealand and enrolled owner-occupied households with at least one Maori occupant. Only households who stated they intended to live at that address for the subsequent 3 years were eligible for participation. We randomly assigned (1:1) households to either the intervention group, who received home modifications (handrails for outside steps and internal stairs, grab rails for bathrooms, outside lighting, repairs to window catches, high-visibility and slip-resistant edging for outside steps, fixing of lifted edges of carpets and mats, non-slip bath mats, and slip-resistant surfacing for outside areas such as decks) immediately, or the control group, who received the modifications 3 years later. Data on home injuries were obtained from the Accident Compensation Corporation and coded by study team members, who were masked to study group allocation. The primary outcome was the rate of medically treated fall injuries at home per household per year, analysed according to intention to treat. This Maori Home Injury Prevention Intervention (MHIPI) trial is now completed, and is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12613000148774. FINDINGS: Between Sept 3, 2013, and Oct 1, 2014, 824 households were assessed for eligibility and 254 were enrolled, of which 126 (50%) were assigned to the intervention group and 128 (50%) were assigned to the control group. After adjustment for previous falls and geographical region, there was an estimated 31% reduction in the rate of fall injuries at home per year exposed to the intervention compared with households in the control group (adjusted relative rate 0·69 [95% CI 0·47-1·00]). INTERPRETATION: Low-cost home modifications and repairs can be an effective means to reduce injury disparities. The high prevalence of modifiable safety issues in Maori homes merits considerable policy and community effort. FUNDING: Health Research Council of New Zealand.

Interventions for preventing falls and fall-related fractures in community-dwelling older adults: A systematic review and network meta-analysis.

OBJECTIVE: To compare the effectiveness of single, multiple, and multifactorial interventions to prevent falls and fall-related fractures in community-dwelling older persons. METHODS: MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were systematically searched for randomized controlled trials (RCTs) evaluating the effectiveness of fall prevention interventions in community-dwelling adults aged ≥65 years, from inception until February 27, 2019. Two large RCTs (published in 2020 after the search closed) were included in post hoc analyses. Pairwise meta-analysis and network meta-analysis (NMA) were conducted. RESULTS: NMA including 192 studies revealed that the following single interventions, compared with usual care, were associated with reductions in number of fallers: exercise (risk ratio [RR] 0.83; 95% confidence interval [CI] 0.77-0.89) and quality improvement strategies (e.g., patient education) (RR 0.90; 95% CI 0.83-0.98). Exercise as a single intervention was associated with a reduction in falls rate (RR 0.79; 95% CI 0.73-0.86). Common components of multiple interventions significantly associated with a reduction in number of fallers and falls rate were exercise, assistive technology, environmental assessment and modifications, quality improvement strategies, and basic falls risk assessment (e.g., medication review). Multifactorial interventions were associated with a reduction in falls rate (RR 0.87; 95% CI 0.80-0.95), but not with a reduction in number of fallers (RR 0.95; 95% CI 0.89-1.01). The following single interventions, compared with usual care, were associated with reductions in number of fall-related fractures: basic falls risk assessment (RR 0.60; 95% CI 0.39-0.94) and exercise (RR 0.62; 95% CI 0.42-0.90). CONCLUSIONS: In keeping with Tricco et al. (2017), several single and multiple fall prevention interventions are associated with fewer falls. In addition to Tricco, we observe a benefit at the NMA-level of some single interventions on preventing fall-related fractures.

Evaluation of a mobile safety center's impact on pediatric home safety behaviors.

BACKGROUND: A Mobile Safety Center (MSC) provides safety resources to families to prevent pediatric injury. The primary objective of this study was to assess the impact of an MSC on home safety behaviors. METHODS: We conducted a prospective observational study with 50 parents and guardians recruited at community events attended by an MSC. Participants completed a pre-test assessing demographics and home safety behaviors prior to participating in the MSC's home safety educational program. We conducted follow-up with participants 4 weeks (follow-up 1) and 6 months (follow-up 2) after their visit to the MSC to reassess home safety behaviors. We used descriptive statistics in addition to Friedman, Wilcoxon sum-rank, and Fisher's exact testing to analyze respondent demographics and changes in home safety practices. Friedman and Wilcoxon sum-rank testing was performed only for participants who completed all surveys. RESULTS: Of our 50 participants, 29 (58%) completed follow-up 1, 30 (60%) completed follow-up 2, and 26 (52%) completed both. Participants were more likely to have a fire-escape plan at follow-up 1 than on the pre-test (p = 0.014). They were also more likely to have the Poison Control Hotline number accessible in their cellphone or near a home phone at follow-up 1 compared to the pre-test (p = 0.002) and follow-up 2 compared to the pre-test (p < 0.001). Families with at least one household member who smoked or used e-cigarettes at any point during the study (n = 16 for the total population, n = 9 for those who completed both surveys) were less likely to have more than two smoke detectors installed at home during the pre-test (p = 0.049). However, this significantly changed across timepoints (p = 0.018), and while 44.4% reported more than two detectors during the pre-test, 88.9% reported this at both follow-ups. CONCLUSIONS: Home safety education through an MSC positively changed some reported safety behaviors and maintained these changes at long-term follow-up. By encouraging the adoption of better home safety practices, education at an MSC may decrease pediatric injury rates.

Accidentes infantiles. Valoración del grado de supervisión de los padres a sus hijos por parte de los pediatras de Atención Primaria / Unintentional injuries in children: assessment of parental supervision of children by Primary Care paediatricians

INTRODUCCIÓN: los accidentes infantiles son una de las mayores causas de morbimortalidad en la edad pediátrica, y pueden ser prevenibles si se conoce y se actúa sobre los factores de riesgo que los propician. El grado de supervisión parental es un factor que puede influir, entre otros, en la aparición de estos. El objetivo de este estudio ha sido la comparación entre el grado de supervisión parental atribuido de forma subjetiva por los profesionales sanitarios, y el medido de forma objetiva mediante la utilización de un cuestionario validado para este fin. La finalidad es valorar la necesidad de utilizar cuestionarios para actuar de forma más eficiente frente a los factores de riesgo. MATERIAL Y MÉTODOS: estudio observacional, trasversal y analítico, para comparar la concordancia entre el grado de supervisión parental estimado por los pediatras de Atención Primaria y el medido de forma objetiva mediante el Parental Supervision Attributes Profile Questionnaire (PSAPQ), adaptado y validado a lengua española. RESULTADOS: se ha demostrado que no existe concordancia entre el grado de supervisión parental expresado de forma subjetiva por parte de los profesionales sanitarios y el medido de forma objetiva mediante la utilización del cuestionario PSAPQ. CONCLUSIONES: es necesaria la utilización de metodología validada para la medición de forma objetiva de los diversos factores de riesgo de accidentes infantiles, entre ellos el grado de supervisión, para de esta forma evitar sesgos de percepción y actuar de la forma más eficiente posible

INTRODUCTION: unintentional injuries are one of the leading causes of morbidity and mortality in the paediatric population and can be prevented if the risk factors that make them more likely are identified and addressed. The degree of parental supervision is one of the factors that may affect the occurrence of unintentional injuries. The aim of our study was to compare the degree of parental supervision estimated subjectively by health care professionals and the degree measured objectively using a questionnaire validated for this purpose. The ultimate objective was to determine the need to use questionnaires to act more efficiently to address risk factors. MATERIAL AND METHODS: we conducted an observational, cross-sectional and analytic study to assess the agreement between the degree of parental supervision perceived by paediatricians and the degree measured using the Parental Supervision Attributes Profile Questionnaire (PSAPQ), which has been adapted and validated for use in Spanish translation. RESULTS: we found no correlation between the agreement between the degree of parental supervision perceived by paediatricians and the degree measured using the PSAPQ. CONCLUSIONS: validated methods need to be used to objectively measure the risk factors involved in unintentional injuries in children, including the degree of parental supervision, in order to avoid perception biases and address these factors as efficiently as possible

Making Microwave Oven Doors Child Resistant to Protect Young Children From Severe Scalds.

Most severe child scalds in the United States involve food and beverages. The wide variety of burn mechanisms, however, makes prevention challenging. Over the past 15 years, we have worked toward protecting young children from 1 specific mechanism: children opening microwave oven doors themselves and spilling the heated contents, resulting in often severe scalds. In our published research, we documented the frequency and severity of these cases and the vulnerability of young toddlers to be burned in this way. We have presented our findings and ideas for prevention at multiple national meetings and enlisted college engineering students to design microwave doors that would thwart a young child from opening them. In 2017, we became active members of a national task group convened by Underwriters Laboratories to address this issue, and two authors became voting members on the Underwriters Laboratories Standards Technical Panel for microwave ovens. We worked with microwave manufacturers and others for >1 year to address concerns of the industry, including those related to potential impacts on older adults. This effort resulted in the task group proposing a change in the standard, requiring "two distinct actions" to open the door of a microwave oven. On September 17, 2018, the panel voted to pass the measure, which will require child-resistant doors for all new microwave ovens in 2023. This report highlights how research can inform and support child injury prevention advocacy. Children will now be protected from this type of scald as microwaves with child-resistant doors replace current models.

Incidence of childhood burn injuries and modifiable household risk factors in rural Ghana: A cluster-randomized, population-based, household survey.

BACKGROUND: We aimed to determine the incidence of childhood burn injuries in rural Ghana and describe modifiable household risk factors to inform prevention initiatives. METHODS: We performed a cluster-randomized, population-based survey of caregivers of children in a rural district in Ghana, representing 2713 households and 14,032 children. Caregivers were interviewed regarding childhood burn injuries within the past 6 months and household risk factors. RESULTS: 357 households were sampled. Most used an open fire with biomass fuel for cooking (85.8%). Households rarely cooked in a separate kitchen (10%). Stove height was commonly within reach of children under five years (<1 m; 96.0%). The weighted annualized incidence of CBI was 63 per 1000 child-years (6.4% of children per year); reported mean age was 4.4 years (SD 4.0). The most common etiology was flame burn. Older age (OR 0.89, 95% CI 0.8-1.0) and households with an older sibling ≥12 years (OR 0.58, 95% CI 0.3-1.3) seemed to be associated with lower odds of CBI. CONCLUSIONS: Childhood burn injury is common in rural Ghana. Opportunities exist to reduce the risk of childhood burn injury childhood burns in rural settings by supporting the transition to safer cooking arrangements, child barrier apparatuses in homes without older children, and/or development of formal childcare programs.

Tailored Exercise and Home Hazard Reduction Program for Fall Prevention in Older People With Cognitive Impairment: The i-FOCIS Randomized Controlled Trial.

BACKGROUND: The evidence to support effective fall prevention strategies in older people with cognitive impairment (CI) is limited. The aim of this randomized controlled trial (RCT) was to determine the efficacy of a fall prevention intervention in older people with CI. METHOD: RCT involving 309 community-dwelling older people with CI. The intervention group (n = 153) received an individually prescribed home hazard reduction and home-based exercise program during the 12-month study period. The control group (n = 156) received usual care. The primary outcome was rate of falls. Secondary outcomes included faller/multiple faller status, physical function, and quality of life. RESULTS: Participants' average age was 82 years (95% CI 82-83) and 49% were female. There was no significant difference in the rate of falls (incidence rate ratio [IRR] 1.05; 95% confidence interval [95% CI] 0.73-1.51). A sensitivity analysis, controlling for baseline differences and capping the number of falls at 12 (4 participants), revealed a nonsignificant reduction in fall rate in the intervention group (IRR 0.78; 95% CI 0.57-1.07). Analyses of secondary outcomes indicated the intervention significantly reduced the number of multiple fallers by 26% (RR 0.74; 95% CI 0.54-0.99) when adjusting for baseline differences. There was a differential impact on falls in relation to physical function (interaction term p-value = .023) with a significant reduction in fall rate in intervention group participants with better baseline physical function (IRR 0.60; 95% CI 0.37-0.98). There were no significant between-group differences for other secondary outcomes. CONCLUSIONS: This intervention did not significantly reduce the fall rate in community-dwelling older people with CI. The intervention did reduce the fall rate in participants with better baseline physical function. CLINICAL TRIALS REGISTRATION NUMBER: Australian and New Zealand Trials Registry ACTRN12614000603617.