Community-based intervention to optimise falls risk management: a randomised controlled trial

Background: falls are the leading causes of accidental death and fragility fractures in older adults. Interventions that assess and reduce falls risk are underutilised. Objective: to evaluate the impact of a multifaceted community-based programme aimed at optimising evidence-based management of pati...

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Published in:	Age and ageing Vol. 38; no. 6; pp. 724 - 730
Main Authors:	Ciaschini, P.M., Straus, S.E., Dolovich, L.R., Goeree, R.A., Leung, K.M., Woods, C.R., Zimmerman, G.M., Majumdar, S.R., Spadafora, S., Fera, L.A., Lee, H.N.
Format:	Journal Article
Language:	English
Published:	England Oxford University Press 01-11-2009 Oxford Publishing Limited (England)
Subjects:	Accidental falls Accidental Falls - prevention & control Activities of Daily Living Aged Aged, 80 and over At risk Care and treatment Early intervention Elderly Evidence-Based Medicine Falls Falls (Accidents) falls assessment and prevention Female Fractures Geriatric Assessment Humans knowledge translation Logistic Models Male Middle Aged Older people Ontario Outcome Assessment (Health Care) Patient Education as Topic Patients Physiotherapy Prevention Risk assessment Risk Factors Risk Management - organization & administration Risk reduction Ontario Canada Ontario Canada Canada, Ontario falls assessment and prevention elderly knowledge translation
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Summary:	Background: falls are the leading causes of accidental death and fragility fractures in older adults. Interventions that assess and reduce falls risk are underutilised. Objective: to evaluate the impact of a multifaceted community-based programme aimed at optimising evidence-based management of patients at risk for fall-related fractures. Design: this was a randomised trial performed from 2003 to 2006. Setting: community-based intervention in Ontario, Canada Participants: eligible patients were community-dwelling, aged ≥55 years and identified to be at risk for fall-related fractures. A total of 201 patients were allocated to the intervention group or to usual care. Intervention: components of the intervention included assessment of falls risk, functional status and home environment, and patient education. Measurements: primary outcome was the implementation of appropriate falls risk assessment at 6 months. Secondary outcomes included falls and fractures at 6 and 12 months. Results: the mean age of participants was 72 years, and 41% had fallen with injury in the previous year. Compared to usual care, the intervention increased the number of referrals made to physiotherapy [21% (21/101) vs 6.0% (6/100); relative risk (RR) 3.47, 95% confidence interval (CI) 1.46–8.22] and occupational therapy [15% (15/101) vs 0%; RR 30.7, 95% CI 1.86 to >500]. At 12 months, the number of falls in the intervention group was greater than in the usual care group [23% (23/101) vs 11% (11/100); RR 2.07, 95% CI 1.07–4.02]. Conclusions: compared to usual care, a multi-faceted intervention increased referrals to physiotherapy and occupational therapy but did not reduce risk of falls. Similar falls reduction interventions cannot be recommended based on the results of this study.
Bibliography:	ark:/67375/HXZ-X5B4G3TD-P ArticleID:afp176 istex:366564AE2FCC92B08BF7B4323DC70BA87AB245EC ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-News-1 ObjectType-Feature-3 ObjectType-Feature-1
ISSN:	0002-0729 1468-2834
DOI:	10.1093/ageing/afp176