Intervention trial for prevention and management of multirisk events among people living in geriatric facilities

Background: Undesirable risk events, such as falls, aspiration pneumonia and pressure ulcers, are associated with functional decline and cause low quality of life among the elderly. This study analyzed and compared the frequency of major risk events and the effect of standard risk management on their prevention. Methods: Subjects: This study recruited elderly persons with disabilities using Japanese geriatric intermediate care facilities (GICFs); these individuals provided written informed consent. Intervention: A standardized intervention process of risk management was in place in half of the facilities. The other half provided conventional risk-prevention models. Outcome variable: The six-month preadmission incidence and three-month postadmission incidence of undesirable events, including falls, aspiration pneumonia, pressure ulcers, dehydration, and fever, were collected. Analysis: The effect of multidisciplinary care management on the reduction of undesirable events was analyzed. Results: Overall, 862 elderly persons from 132 facilities using geriatric intermediate care facilities in Japan participated in this study. Falls (35.2%), fever (21.9%), bone fractures (18.2%), and pressure ulcers (12.1%) were frequent undesirable events. There was no reduction in postadmission incidence in the intervention group in any of the patients regardless of the previous incidence. The intervention reduced the occurrence of postadmission pressure ulcers among patients with a previous incidence (odds ratio: 0.34). There were no reductions in falls, fever, or dehydration. Conclusions: The effect of standardized risk-management implementation is limited to pressure ulcers. The improvement of risk-management processes is needed to understand their limitations in long-term care facilities.