What are the ways to reduce the risk of falls in hospital patients?

Hospital Fall Prevention Strategies

Despite widespread implementation, there is insufficient high-quality evidence specifically for hospital inpatient fall prevention programs, though multifactorial interventions combining patient/staff education, medication review, and targeted risk factor management show the most promise based on extrapolation from other settings. 1

Critical Evidence Gap

The American Geriatrics Society explicitly states that "there are no adequate randomized controlled trials of multifactorial intervention studies to reduce falls among hospital inpatients," despite this being a widely implemented strategy. 1 This represents a significant limitation when making evidence-based recommendations specifically for the acute hospital setting.

Recommended Interventions Based on Available Evidence

1. Patient and Staff Education (Strongest Hospital-Specific Evidence)

• Patient and staff education is the only intervention with meta-analytic evidence showing significant reduction in hospital falls (rate ratio 0.70, odds ratio 0.62). 2
• Education programs should include one-on-one patient education covering specific fall risk factors, preventative strategies, and goal-setting. 3
• Staff education alone (without patient involvement) was not effective in community settings but showed benefit in long-term care when combined with comprehensive assessment. 1

2. Medication Management (High Priority)

• Review and reduce medications, particularly in patients taking ≥4 medications or any psychotropic drugs (neuroleptics, benzodiazepines, antidepressants). 1
• Psychotropic medications show consistent association with falls across all settings (community, long-term care, hospital, rehabilitation). 1
• Medication reduction was a prominent component of effective fall-reducing interventions in multifactorial studies. 1
• No clear difference exists between long- and short-acting benzodiazepines for fall risk. 1

3. Medical Assessment and Targeted Interventions

• Comprehensive medical assessment with specific treatment of identified problems reduces falls. 1
• Priority targets based on evidence:
  • Postural hypotension management (effective in multiple studies) 1
  • Cardiovascular disorders including carotid sinus syndrome and vasovagal syndrome 1
  • Visual problems 1
  • Balance, gait, and transfer deficits 1

4. Multifactorial Programs (Moderate Evidence)

• Multifactorial interventions combining multiple components show tendency toward benefit in hospitals. 2, 4
• Effective programs should include: 4
  • Fall-risk assessments
  • Door/bed/patient fall-risk alerts
  • Environmental and equipment modifications
  • Staff and patient safety education
  • Medication management
  • Additional assistance with transfers and toileting

5. Exercise and Rehabilitation

• Older people with recurrent falls should receive long-term exercise and balance training. 1
• Target interventions to improve balance, transfers, gait, strength, and range of motion of lower extremities. 1
• Non-selective exercise programs for all patients are not effective. 1

Interventions NOT Supported by Evidence

Ineffective Strategies to Avoid:

• Bed alarms, chair alarms, and wearable sensors show no significant fall reduction. 2
• Scored risk assessment tools alone without linked interventions are ineffective. 2
• Home environmental hazard modification alone (without other interventions) shows equivocal or no benefit. 1
• Advice alone about fall risk factors without implementation measures is ineffective. 1
• Self-management programs were not beneficial. 1

Implementation Considerations

Critical Success Factors:

• Leadership support and engagement of front-line staff in program design 5
• Multidisciplinary committee guidance 5
• Use of information technology systems for fall data tracking 5
• Sustained compliance with interventions (effectiveness requires ongoing adherence) 1

Common Pitfalls:

• Avoid relying solely on assistive devices (bed alarms, canes, walkers) without addressing other risk factors—there is no direct evidence these prevent falls when used in isolation. 1
• Do not implement staff education programs alone in acute hospital settings—these were ineffective in community settings. 1
• Beware of potential harms: increased use of restraints, sedating drugs, and decreased mobilization efforts. 5

Practical Algorithm for Hospital Fall Prevention

1. Immediate medication review for all at-risk patients:

   • Reduce total medications if ≥4 drugs 1
   • Discontinue or minimize psychotropic medications 1

2. Targeted medical assessment focusing on:

   • Postural hypotension 1
   • Cardiovascular disorders 1
   • Visual impairment 1

3. Patient education (one-on-one, structured program) 2, 3

4. Physical therapy consultation for patients with:

   • Balance deficits 1
   • Gait abnormalities 1
   • Transfer difficulties 1

5. Environmental assessment at discharge with facilitated home modifications for high-risk patients 1