Falls prevention and management for older adults in home care services in Norway: a retrospective patient record review

TL;DR

This study evaluates how well Norwegian home care services follow guidelines for preventing falls in older adults and finds gaps in implementing interventions for high-risk patients.

Contribution

The study provides empirical evidence on adherence to fall prevention guidelines in Norwegian home care services and suggests reallocating resources for better intervention in high-risk patients.

Findings

61% of intermediate-risk patients received multifactorial fall risk assessments, but only 19% received multifactorial interventions.

40% of high-risk patients received multifactorial interventions, suggesting a need for better resource allocation.

Exercise was the most common intervention, but fewer than half of patients received it.

Abstract

To evaluate Norwegian home care services’ adherence to the World Falls Guidelines 2022 recommendations on assessment and management of falls among older adults with a history of falling, and to evaluate the degree to which identified fall risk factors were addressed with interventions to prevent falls.

Of the 225 patient records reviewed, 54 older patients had intermediate fall-risk, of which 61% received multifactorial fall risk assessments and 19% received multifactorial interventions. Of the 171 patients with high fall-risk, 70% received multifactorial fall risk assessments, and 40% received multifactorial interventions.

Overall, our results suggest reallocating home care resources from performing multifactorial fall risk assessments on all patients to better addressing identified fall risk factors in high-risk patients.

The online version contains supplementary material available at 10.1007/s41999-025-01224-w.

To evaluate Norwegian home care services’ adherence to the World Falls Guidelines 2022 (WFG2022) recommendations on assessment and management of falls among older adults with a history of falling, and to evaluate the degree to which identified fall risk factors were addressed with interventions to prevent falls.

We conducted a retrospective patient record review of older adults who receive home care services and have a history of falls from four municipal home care service city districts in Oslo, Norway. We collected data from electronic patient records on patient characteristics, the assessed fall risk factors, and implemented interventions to prevent falls. Adherence was analysed as the proportion of patients who received fall prevention care in line with WGF2022 recommendations.

The records of 225 patients were reviewed, of which 157 (70%) patients were between the ages of 70 and 89 years, and 131 (58%) were women. A total of 54 (24%) patients had intermediate fall-risk and 171 (76%) patients had high fall-risk. Of the 54 patients with intermediate fall-risk, 50% received an assessment of balance, gait, or muscle strength, and 22% were subsequently offered exercise. Sixty-one percent of intermediate-risk patients received multifactorial fall risk assessments, and 19% received multifactorial interventions. Exercise was the most used intervention to prevent falls, but it was provided to fewer than half of the patients. Other relevant interventions, such as osteoporosis treatment and medication management, were provided to fewer than 10% of patients.

The results highlight substantial gaps in the comprehensive management of fall prevention where considerably fewer patients received follow-up interventions to prevent falls compared to those who had fall risk factors identified. These results underscore the urgent need for enhanced implementation of fall prevention care within municipal home care services.

The online version contains supplementary material available at 10.1007/s41999-025-01224-w.

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