Does delirium prevention reduce risk of in-patient falls among older adults? A systematic review and trial sequential meta-analysis.

OBJECTIVES: To determine whether delirium prevention interventions reduce the risk of falls among older hospitalised patients. METHODS: A systematic search of health-care databases was undertaken. Given the frequency of small sample sized trials, a trial sequential meta-analysis was conducted to present estimate summary effects to date. A Bayesian approach was used to estimate the posterior probability of the delirium prevention interventions reducing falls risk by various clinically relevant levels. RESULTS: Five randomised controlled trials were included in our final meta-analysis. There was a 43% reduction in the risk of falls among participants in the delirium prevention intervention arm, compared to the control; however, confidence intervals were wide (RE RR = 0.57, 95% CI 0.32; 1.00, p = 0.05). This result was found to be statistically significant, according to traditional significance levels (z > 1.96) and the more conservative trial sequential analysis monitoring boundaries. The posterior probabilities of the delirium prevention intervention reducing the risk of falls by 10%, 20% and 30% were 0.86, 0.63 and 0.29 respectively. CONCLUSIONS: The results of this systematic review and trial sequential meta-analysis suggest that delirium prevention trials may reduce the risk of in-hospital falls among older patients by 43%. However, despite significant risk reduction found upon meta-analysis, the variation among study populations and intervention components raised questions around its application in clinical practice. Further research is required to investigate what the necessary components of a multifactorial intervention are to reduce both delirium and fall incidence among older adult in-patients.

Perceptions of multidisciplinary case conferencing in residential aged care facilities.

OBJECTIVE: To explore the understanding about and perceptions of, multidisciplinary case conferencing in residential aged care from the perspective of residential facility staff, residents, carers and general practitioners. METHODS: Focus groups and in-depth interviews were conducted with nurses, residents, carers, allied health workers and general practitioners from two residential aged care facilities during February-March 2008. Conversations were analysed using thematic analysis techniques. RESULTS: Thematic analyses highlighted four key themes. Most notably, respondents identified a degree of confusion regarding the purpose of case conferencing and its role in resident health care. The ad hoc development of the conferencing model led to unclear role descriptions for participants that contributed to role confusion and the lack of a collaborative culture. Underpinning much of the discussion was the need for a framework to support the organisation of the conference process. CONCLUSIONS: While the process of multidisciplinary case conferencing in residential aged care has significant potential to improve resident care and health outcomes, the development of an explicit framework is required to support the effective conduct of these meetings. Key stakeholders need to be engaged to develop a team approach to conducting case conferences that facilitates the active participation of providers, residents and their carers.