OBJECTIVES: To assess the effectiveness of a community-based falls-and-fracture nurse coordinator and multifactorial intervention in reducing falls in older people. DESIGN: Randomized, controlled trial. SETTING: Screening for previous falls in family practice followed by community-based intervention. PARTICIPANTS: Three hundred twelve community-living people aged 75 and older who had fallen in the previous year. INTERVENTION: Home-based nurse assessment of falls-and-fracture risk factors and home hazards, referral to appropriate community interventions, and strength and balance exercise program. Control group received usual care and social visits. MEASUREMENTS: Primary outcome was rate of falls over 12 months. Secondary outcomes were muscle strength and balance, falls efficacy, activities of daily living, self-reported physical activity level, and quality of life (Medical Outcomes Study 36-item Short Form Questionnaire). RESULTS: Of the 3,434 older adults screened for falls, 312 (9%) from 19 family practices were enrolled and randomized. The average age was 81+/-5, and 69% (215/312) were women. The incidence rate ratio for falls for the intervention group compared with the control group was 0.96 (95% confidence interval=0.70-1.34). There were no significant differences in secondary outcomes between the two groups. CONCLUSION: This nurse-led intervention was not effective in reducing falls in older people who had fallen previously. Implementation and adherence to the fall-prevention measures was dependent on referral to other health professionals working in their usual clinical practice. This may have limited the effectiveness of the interventions.
RCT Entities:
OBJECTIVES: To assess the effectiveness of a community-based falls-and-fracture nurse coordinator and multifactorial intervention in reducing falls in older people. DESIGN: Randomized, controlled trial. SETTING: Screening for previous falls in family practice followed by community-based intervention. PARTICIPANTS: Three hundred twelve community-living people aged 75 and older who had fallen in the previous year. INTERVENTION: Home-based nurse assessment of falls-and-fracture risk factors and home hazards, referral to appropriate community interventions, and strength and balance exercise program. Control group received usual care and social visits. MEASUREMENTS: Primary outcome was rate of falls over 12 months. Secondary outcomes were muscle strength and balance, falls efficacy, activities of daily living, self-reported physical activity level, and quality of life (Medical Outcomes Study 36-item Short Form Questionnaire). RESULTS: Of the 3,434 older adults screened for falls, 312 (9%) from 19 family practices were enrolled and randomized. The average age was 81+/-5, and 69% (215/312) were women. The incidence rate ratio for falls for the intervention group compared with the control group was 0.96 (95% confidence interval=0.70-1.34). There were no significant differences in secondary outcomes between the two groups. CONCLUSION: This nurse-led intervention was not effective in reducing falls in older people who had fallen previously. Implementation and adherence to the fall-prevention measures was dependent on referral to other health professionals working in their usual clinical practice. This may have limited the effectiveness of the interventions.
Authors: Margaret G Stineman; Neville Strumpf; Jibby E Kurichi; Jeremy Charles; Jeane Ann Grisso; Ravishankar Jayadevappa Journal: Gerontologist Date: 2011-06
Authors: David A Ganz; Sung-Bou Kim; David S Zingmond; Karina D Ramirez; Carol P Roth; Lee A Jennings; Takahiro Mori; Emmett B Keeler; Neil S Wenger; David B Reuben Journal: J Am Geriatr Soc Date: 2015-01 Impact factor: 5.562
Authors: Samantha Turner; Geri Arthur; Ronan A Lyons; Alison L Weightman; Mala K Mann; Sarah J Jones; Ann John; Simon Lannon Journal: Cochrane Database Syst Rev Date: 2011-02-16
Authors: Denise Kendrick; Arun Kumar; Hannah Carpenter; G A Rixt Zijlstra; Dawn A Skelton; Juliette R Cook; Zoe Stevens; Carolyn M Belcher; Deborah Haworth; Sheena J Gawler; Heather Gage; Tahir Masud; Ann Bowling; Mirilee Pearl; Richard W Morris; Steve Iliffe; Kim Delbaere Journal: Cochrane Database Syst Rev Date: 2014-11-28