Sensory impairment in hip-fracture patients 65 years or older and effects of hearing/vision interventions on fall frequency

Abstract

Aim: Examine the effect of nursing interventions to improve vision and hearing, systematic assessment, and referral to sensory specialists on falling.

Methods: Controlled intervention trial targeting hip fracture patients, 65 years and older, living at home and having problems seeing/reading regular print (VI) or hearing normal speech (HI). Intervention group = 200, control group = 131. The InterRAI-AcuteCare (RAI-AC) and the Combined-Serious-Sensory-Impairment interview guide (KAS-Screen) were used. Follow-up telephone calls were done every third month for one year.

Results: Mean age was 84.2 years, 79.8% were female, and 76.7% lived alone. HI was detected in 80.7% and VI in 59.8%. Falling was more frequent among the intervention group (P = 0.003) and they also more often moved to a nursing home (P < 0.001) and were dependent walking up stairs (P = 0.003).

Conclusions: This study could not document the effect of intervention on falling, possibly because of different base line characteristics (more females, P = 0.018, and more living alone P = 0.011 in the intervention group), differences in nursing care between subjects, and different risk factors. Interventions to improve sensory function remain important in rehabilitation, but have to be studied further.

Keywords: falls; hearing; hip fracture; hospital; intervention; vision.

Figure 1

Flow chart showing the number of interventions and controls at time of inclusion and follow-up periods and the inclusion and exclusion criteria.

Figure 2

Kaplan–Meier curves presenting time to first fall for the intervention group (n = 200 participants) versus the control group (n = 131 participants) controlled for by age, gender, delirium, and urine incontinence. Abbreviations: OR, odds ratio; 95% CI, 95% confidence interval for OR; P, P value.

Figure 3

Kaplan–Meier curves presenting time to first fall of persons who received sensory treatment versus persons who did not, controlled for by age, gender, delirium, and urine incontinence. Sensory treatment group, n = 117; nonsensory treatment group, n = 214. Abbreviations: OR, odds ratio; 95% CI, 95% confidence interval for OR; P, P value.