Patients with recurrent falls attending Accident & Emergency benefit from multifactorial intervention—a randomised controlled trial

• Published in: Age and ageing 2005-03, Vol.34 (2), p.162-168
• Main Authors: Davison, John, Bond, John, Dawson, Pamela, Steen, I. Nicholas, Kenny, Rose Anne
• Format: Article
• Language: English
• Subjects: Accident & Emergency; Accident and emergency departments; Accidental falls; Accidental Falls - prevention & control; Aged; Aged, 80 and over; Assessment; Care and treatment; Causality; Combined Modality Therapy; Elderly; Elderly people; Emergency Service, Hospital; fall-related injury; Falls; Falls (Accidents); Female; Follow-Up Studies; Hospitals, General; Hospitals, University; Humans; Injuries; Interdisciplinary approach; Male; Medical treatment; Mental Status Schedule; Occupational Therapy; Older people; older persons; Outcome Assessment (Health Care); Patient Care Team; Patient Readmission - statistics & numerical data; Physical therapy; Physical therapy for the aged; Physical Therapy Modalities; Prevention; randomised controlled trial; Randomized controlled trials; Recurrent; recurrent falls; Risk Factors; Survival Rate; Therapeutics, Physiological; treatment; Wounds and Injuries - prevention & control; Wounds and Injuries - rehabilitation
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/afi053

Objectives: to determine the effectiveness of multifactorial intervention to prevent falls in cognitively intact older persons with recurrent falls. Design: randomised controlled trial of multifactorial (medical, physiotherapy and occupational therapy) post-fall assessment and intervention compared with conventional care. Setting: Accident & Emergency departments in a university teaching hospital and associated district general hospital. Subjects: 313 cognitively intact men and women aged over 65 years presenting to Accident & Emergency with a fall or fall-related injury and at least one additional fall in the preceding year; 159 randomised to assessment and intervention and 154 to conventional care. Outcome measures: primary outcome was the number of falls and fallers in 1 year after recruitment. Secondary outcomes included injury rates, fall-related hospital admissions, mortality and fear of falling. Results: there were 36% fewer falls in the intervention group (relative risk 0.64, 95% confidence interval 0.46–0.90). The proportion of subjects continuing to fall (65% (94/144) compared with 68% (102/149) relative risk 0.95, 95% confidence interval 0.81–1.12), and the number of fall-related attendances and hospital admissions was not different between groups. Duration of hospital admission was reduced (mean difference admission duration 3.6 days, 95% confidence interval 0.1–7.6) and falls efficacy was better in the intervention group (mean difference in Activities Specific Balance Confidence Score of 7.5, 95% confidence interval 0.72–14.2). Conclusion: multifactorial intervention is effective at reducing the fall burden in cognitively intact older persons with recurrent falls attending Accident & Emergency, but does not reduce the proportion of subjects still falling.