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

• Published in: Age and ageing 2009-11, Vol.38 (6), p.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: Article
• Language: English
• 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
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/afp176

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.