Older people with mental health issues should be offered strategies with several components to help reduce their risk of falling

Bunn F, Dickinson A, Simpson C, et al.  Preventing falls among older people with mental health problems: A systematic review BMC Nursing. 2014;13(1):4.

Review question

What interventions are effective in preventing and managing falls among older people with mental health conditions?

Background

Falls are the most commonly reported patient-safety incident in mental health settings for older adults.

Risk of falling among older adults is increased when they have mental health problems or impaired mental status due to dementia, depression, mania and anxiety.

Treatments for mental health problems (e.g. medication and electroconvulsive therapy) can also increase the risk of falling.

How the review was done

The review identified all published and unpublished English-language studies conducted up to October 2013 that evaluated interventions that aimed to prevent or reduce falls among older adults with a mental health problem.

4,614 studies were identified during electronic searches, and after the authors assessed these for inclusion, 27 papers that reported on 21 individual studies were included in the review.

Funding for the review was provided by the University of Hertfordshire, Hatfield, United Kingdom.

What the researchers found

The interventions used to reduce the risk and prevent falls among older adults vary considerably, and involve several components including physical activity and exercise, risk assessment, environmental changes, staff training, increased supervision, patient education and sensory interventions.

Interventions that combine exercise with several additional components (e.g. staff training, environmental/home hazard assessments, physical assessments, medication reviews) can be effective at reducing the number of falls among older people with mental health problems.

There is a lack of evidence to suggest that physical activity and exercise alone will be effective in reducing falls among older adults with mental health problems.

Interventions that aim to increase healthcare staff knowledge and awareness regarding the causes and prevention of falls, in addition to supervision of and strategies to help reduce agitation among older adults (e.g. through psychosocial care or aromatherapy), are promising.

Conclusion

Older adults with mental health problems should be offered a mix of strength and balance training, home hazard assessment, vision assessment and medication review, and staff working with older people should be provided with knowledge and skills regarding causes and prevention of falls.