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Age and Ageing Advance Access originally published online on May 12, 2009
Age and Ageing 2009 38(4):417-423; doi:10.1093/ageing/afp049
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© The Author 2009. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Comparison of a fall risk assessment tool with nurses’ judgement alone: a cluster-randomised controlled trial

Gabriele Meyer1,2, Sascha Köpke1, Burkhard Haastert3 and Ingrid Mühlhauser1

1 Unit of Health Sciences and Education, University of Hamburg, Martin-Luther-King-Platz 6, 20146 Hamburg, Germany
2 Faculty of Medicine, Institute of Nursing Science, University of Witten/Herdecke, Stockumer Strasse 12, 58453 Witten, Germany
3 mediStatistica, Lambertusweg 1b, 58809 Neuenrade, Germany

Address correspondence to: G. Meyer. Tel: (+49) 2302 926 317; Fax: (+49) 2302 926 318. Email: Gabriele.Meyer{at}uni-wh.de

Background: the impact of fall risk assessment tools on clinical endpoints is unknown.

Objective: we compared a standardised fall risk assessment tool alongside nurses’ clinical judgement with nurses’ judgement alone.

Design: a 12-month cluster-randomised controlled trial.

Setting: nursing homes in Hamburg (29 per study group).

Subjects: 1,125 residents (n = 574 intervention group, IG; n = 551 control group, CG).

Interventions: all homes received structured information on fall prevention before randomisation. The IG monthly administered the Downton Index, and the CG did not use a tool. Measurements were number of participants with at least one fall, falls, fall-related injuries and medical attention, fall preventive measures, physical restraints.

Results: the mean follow-up was 10.8 ± 2.9 months in both groups: 105 (IG) and 114 (CG) residents died or moved away. There was no difference between the groups concerning the number of residents with at least one fall (IG: 52%, CG: 53%, mean difference –0.7, 95% confidence interval –10.3 to 8.9, P = 0.88) and the number of falls (n = 1,016 and n = 1,014). All other outcomes were also comparable between the IG and CG.

Conclusions: application of a fall risk assessment tool in nursing homes does not result in the better clinical outcome than reliance on nurses’ clinical judgement alone.

Keywords: accidental falls/prevention and control, risk assessment, nursing assessment, residential facilities, randomised controlled trial, elderly

Received 21 May 2008; accepted in revised form 12 March 2009.


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