Lack of Effectiveness of a Multidisciplinary Fall-Prevention Program in Elderly People at Risk: A Randomized, Controlled Trial

Authors

  • Marike R. C. Hendriks MSc,

    1. From the *Department of Social MedicineSchool for Public Health and Primary Care (Caphri)Department of Health Organization, Policy and EconomicsDepartment of Health Care and Nursing Science#Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands§Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, the Netherlands**Department of Internal Medicine, Division Medicine and Geriatrics‡‡Department of Rehabilitation, Maastricht University Hospital, Maastricht, the Netherlands††Faculty of Health and Technology, Professional University Zuyd, Heerlen, the Netherlands.
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  • Michel H. C. Bleijlevens MSc,

    1. From the *Department of Social MedicineSchool for Public Health and Primary Care (Caphri)Department of Health Organization, Policy and EconomicsDepartment of Health Care and Nursing Science#Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands§Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, the Netherlands**Department of Internal Medicine, Division Medicine and Geriatrics‡‡Department of Rehabilitation, Maastricht University Hospital, Maastricht, the Netherlands††Faculty of Health and Technology, Professional University Zuyd, Heerlen, the Netherlands.
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  • Jolanda C. M. Van Haastregt PhD,

    1. From the *Department of Social MedicineSchool for Public Health and Primary Care (Caphri)Department of Health Organization, Policy and EconomicsDepartment of Health Care and Nursing Science#Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands§Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, the Netherlands**Department of Internal Medicine, Division Medicine and Geriatrics‡‡Department of Rehabilitation, Maastricht University Hospital, Maastricht, the Netherlands††Faculty of Health and Technology, Professional University Zuyd, Heerlen, the Netherlands.
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  • Harry F. J. M. Crebolder PhD, MD,

    1. From the *Department of Social MedicineSchool for Public Health and Primary Care (Caphri)Department of Health Organization, Policy and EconomicsDepartment of Health Care and Nursing Science#Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands§Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, the Netherlands**Department of Internal Medicine, Division Medicine and Geriatrics‡‡Department of Rehabilitation, Maastricht University Hospital, Maastricht, the Netherlands††Faculty of Health and Technology, Professional University Zuyd, Heerlen, the Netherlands.
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  • Joseph P. M. Diederiks PhD,

    1. From the *Department of Social MedicineSchool for Public Health and Primary Care (Caphri)Department of Health Organization, Policy and EconomicsDepartment of Health Care and Nursing Science#Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands§Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, the Netherlands**Department of Internal Medicine, Division Medicine and Geriatrics‡‡Department of Rehabilitation, Maastricht University Hospital, Maastricht, the Netherlands††Faculty of Health and Technology, Professional University Zuyd, Heerlen, the Netherlands.
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  • Silvia M. A. A. Evers PhD,

    1. From the *Department of Social MedicineSchool for Public Health and Primary Care (Caphri)Department of Health Organization, Policy and EconomicsDepartment of Health Care and Nursing Science#Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands§Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, the Netherlands**Department of Internal Medicine, Division Medicine and Geriatrics‡‡Department of Rehabilitation, Maastricht University Hospital, Maastricht, the Netherlands††Faculty of Health and Technology, Professional University Zuyd, Heerlen, the Netherlands.
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  • Wubbo J. Mulder PhD, MD,

    1. From the *Department of Social MedicineSchool for Public Health and Primary Care (Caphri)Department of Health Organization, Policy and EconomicsDepartment of Health Care and Nursing Science#Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands§Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, the Netherlands**Department of Internal Medicine, Division Medicine and Geriatrics‡‡Department of Rehabilitation, Maastricht University Hospital, Maastricht, the Netherlands††Faculty of Health and Technology, Professional University Zuyd, Heerlen, the Netherlands.
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  • Gertrudis I. J. M. Kempen PhD,

    1. From the *Department of Social MedicineSchool for Public Health and Primary Care (Caphri)Department of Health Organization, Policy and EconomicsDepartment of Health Care and Nursing Science#Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands§Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, the Netherlands**Department of Internal Medicine, Division Medicine and Geriatrics‡‡Department of Rehabilitation, Maastricht University Hospital, Maastricht, the Netherlands††Faculty of Health and Technology, Professional University Zuyd, Heerlen, the Netherlands.
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  • Erik Van Rossum PhD,

    1. From the *Department of Social MedicineSchool for Public Health and Primary Care (Caphri)Department of Health Organization, Policy and EconomicsDepartment of Health Care and Nursing Science#Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands§Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, the Netherlands**Department of Internal Medicine, Division Medicine and Geriatrics‡‡Department of Rehabilitation, Maastricht University Hospital, Maastricht, the Netherlands††Faculty of Health and Technology, Professional University Zuyd, Heerlen, the Netherlands.
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  • Joop M. Ruijgrok PhD, MD,

    1. From the *Department of Social MedicineSchool for Public Health and Primary Care (Caphri)Department of Health Organization, Policy and EconomicsDepartment of Health Care and Nursing Science#Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands§Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, the Netherlands**Department of Internal Medicine, Division Medicine and Geriatrics‡‡Department of Rehabilitation, Maastricht University Hospital, Maastricht, the Netherlands††Faculty of Health and Technology, Professional University Zuyd, Heerlen, the Netherlands.
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  • Paul A. Stalenhoef PhD, MD,

    1. From the *Department of Social MedicineSchool for Public Health and Primary Care (Caphri)Department of Health Organization, Policy and EconomicsDepartment of Health Care and Nursing Science#Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands§Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, the Netherlands**Department of Internal Medicine, Division Medicine and Geriatrics‡‡Department of Rehabilitation, Maastricht University Hospital, Maastricht, the Netherlands††Faculty of Health and Technology, Professional University Zuyd, Heerlen, the Netherlands.
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  • Jacques Th. M. Van Eijk PhD

    1. From the *Department of Social MedicineSchool for Public Health and Primary Care (Caphri)Department of Health Organization, Policy and EconomicsDepartment of Health Care and Nursing Science#Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands§Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, the Netherlands**Department of Internal Medicine, Division Medicine and Geriatrics‡‡Department of Rehabilitation, Maastricht University Hospital, Maastricht, the Netherlands††Faculty of Health and Technology, Professional University Zuyd, Heerlen, the Netherlands.
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  • Parts of the results described in this paper were presented at the 59th Annual Meeting of the Gerontological Society of America, Dallas, Texas, November 2006. The symposium presentation was entitled: “Effects of a multidisciplinary fall prevention program among community-dwelling elderly people: implications for practice.”

  • [See editorial comments by Dr. Mary Tinetti on pp 1563–1565]

Address correspondence to Marike Hendriks, Maastricht University, Faculty of Health, Medicine and Life Sciences, Department of Health Organization, Policy and Economics, P.O. Box 616, 6200 MD Maastricht, the Netherlands. E-mail: Marike.Hendriks@beoz.unimaas.nl

Abstract

OBJECTIVES: To assess whether a pragmatic multidisciplinary fall-prevention program was more effective than usual care in preventing new falls and functional decline in elderly people.

DESIGN: A two-group, randomized, controlled trial with 12 months of follow-up.

SETTING: University hospital and home-based intervention, the Netherlands.

PARTICIPANTS: Three hundred thirty-three community-dwelling Dutch people aged 65 and over who were seen in an emergency department after a fall.

INTERVENTION: Participants in the intervention group underwent a detailed medical and occupational-therapy assessment to evaluate and address risk factors for recurrent falls, followed by recommendations and referral if indicated. People in the control group received usual care.

MEASUREMENTS: Number of people sustaining a fall (fall calendar) and daily functioning (Frenchay Activity Index).

RESULTS: Results showed no statistically significantly favorable effects on falls (odds ratio=0.86, 95% confidence interval (CI)=0.50–1.49) or daily functioning (regression coefficient=0.37, CI=−0.90 to 1.63) after 12 months of follow-up.

CONCLUSION: The multidisciplinary fall-prevention program was not effective in preventing falls and functional decline in this Dutch healthcare setting. Implementing the program in its present form in the Netherlands is not recommended. This trial shows that there can be considerable discrepancy between the “ideal” (experimental) version of a program and the implemented version of the same program. The importance of implementation research in assessing feasibility and effectiveness of such a program in a specific healthcare setting is therefore stressed.

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