gms | German Medical Science

Falls and, in particular, falls-related hip fractures among older people cause serious problems. In Germany, in subjects aged 65 years or older, the incidence of hip fractures increases by about 4% per year. Subjects in residential care facilities have a particularly high risk.

Aims of the project, which started in the end of 2004, are (1) avoiding falls and related injuries, in particular, hip fractures in residents of care facilities in North-Rhine district, (2) promoting mobility and independence, (3) promoting cooperation between all involved professional groups, in particular the residents' physicians.

• strength and balance training in groups of 6 to 8 residents, offered by specifically educated trainers at least weekly (Becker 2003)
• recommendation of hip protectors, accompanied by a structured education program (Meyer 2003)
• information, education and continuous consultation for the care givers, with recommendations for further activities (e.g. adaption of residents' environment)
• integration of residents' physicians
• implementation of a standardized documentation of project processes, falls, and hip fractures in the care facilities (basis for project evaluation and internal bench mark).

The integration of physicians, who are important reference persons for residents and their relatives, is a specific component of the project. Physicians are comprehensively informed, and continuous education is offered. The aim is for the physicians to be informed in detail about the project, so that they can support the care givers, advise residents and their relatives, and motivate them to participate in the fall prevention activities on offer. Since 2005, physicians can assess the risk of falls within a geriatric assessment, which has become part of the physicians' fee system for general practitioners.

Actually, the project takes place in 22 residential care facilities in 4 regions in North-Rhine. Between 4 and 25% of the residents participate in the training. The documentation is implemented.

About 150 physicians care for the residents of the 22 facilities. 60% answered to a postal questioning about their experiences with the project one year after beginning. 80% knew the project. About 50% were involved: In cooperation with nurses and trainers, they perform the assessment of risk of falls, inform residents and relatives about falls prevention activities, and decide if residents are capable to participate in the strength and balance training.

The first results concerning acceptance and feasibility of the project are encouraging. The cooperation between care givers in care facilities and physicians needs to be implemented in routine practice. An extension of the project is actually discussed.