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Age and Ageing 2005 34(2):162-168; doi:10.1093/ageing/afi053
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Age and Ageing Vol. 34 No. 2 © British Geriatrics Society 2005; all rights reserved

Research Paper

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

John Davison1, John Bond2, Pamela Dawson3, I. Nicholas Steen2 and Rose Anne Kenny1

1 Falls and Syncope Service and Institute for Ageing and Health, Newcastle General Hospital, Newcastle upon Tyne, UK
2 Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
3 Division of Allied Health Studies, University of Northumbria at Newcastle, Newcastle upon Tyne, UK

Address correspondence to: R. A. Kenny, Falls and Syncope Service and Institute for Ageing and Health, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK. Fax: (+44) 191 222 5638. Email: r.a.kenny{at}ncl.ac.uk

Abstract

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.

Keywords: recurrent falls, older persons, Accident & Emergency, fall-related injury, randomised controlled trial, elderly, treatment

Received September 14, 2004; Revision received December 21, 2004. accepted in revised form December 21, 2004.


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