A Randomized Controlled Trial of a Multifactorial Falls Prevention Intervention for Older Fallers Presenting to Emergency Departments

Authors

  • Melissa A. Russell PhD,

    1. From the *Preventive and Public Health Division, National Ageing Research Institute, Parkville, Victoria, Australia; Department of Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health and Department of General Practice, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia; Musculoskeletal Research Centre, Faculty of Health Sciences, Latrobe University/Northern Health, Bundoora, Victoria, Australia; §Accident Research Centre and ‡‡Department of Forensic Medicine, School of Public Health and Preventive Medicine, **Monash University, Victoria, Australia; #Aged Care Assessment Services, Western Health, Footscray, Victoria, Australia; and ††Aged and Residential Care Department, Austin Health, Heidelberg, Victoria, Australia.
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  • Keith D. Hill PhD,

    1. From the *Preventive and Public Health Division, National Ageing Research Institute, Parkville, Victoria, Australia; Department of Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health and Department of General Practice, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia; Musculoskeletal Research Centre, Faculty of Health Sciences, Latrobe University/Northern Health, Bundoora, Victoria, Australia; §Accident Research Centre and ‡‡Department of Forensic Medicine, School of Public Health and Preventive Medicine, **Monash University, Victoria, Australia; #Aged Care Assessment Services, Western Health, Footscray, Victoria, Australia; and ††Aged and Residential Care Department, Austin Health, Heidelberg, Victoria, Australia.
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  • Lesley M. Day PhD,

    1. From the *Preventive and Public Health Division, National Ageing Research Institute, Parkville, Victoria, Australia; Department of Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health and Department of General Practice, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia; Musculoskeletal Research Centre, Faculty of Health Sciences, Latrobe University/Northern Health, Bundoora, Victoria, Australia; §Accident Research Centre and ‡‡Department of Forensic Medicine, School of Public Health and Preventive Medicine, **Monash University, Victoria, Australia; #Aged Care Assessment Services, Western Health, Footscray, Victoria, Australia; and ††Aged and Residential Care Department, Austin Health, Heidelberg, Victoria, Australia.
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  • Irene Blackberry PhD,

    1. From the *Preventive and Public Health Division, National Ageing Research Institute, Parkville, Victoria, Australia; Department of Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health and Department of General Practice, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia; Musculoskeletal Research Centre, Faculty of Health Sciences, Latrobe University/Northern Health, Bundoora, Victoria, Australia; §Accident Research Centre and ‡‡Department of Forensic Medicine, School of Public Health and Preventive Medicine, **Monash University, Victoria, Australia; #Aged Care Assessment Services, Western Health, Footscray, Victoria, Australia; and ††Aged and Residential Care Department, Austin Health, Heidelberg, Victoria, Australia.
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  • Jenny Schwartz MBBS,

    1. From the *Preventive and Public Health Division, National Ageing Research Institute, Parkville, Victoria, Australia; Department of Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health and Department of General Practice, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia; Musculoskeletal Research Centre, Faculty of Health Sciences, Latrobe University/Northern Health, Bundoora, Victoria, Australia; §Accident Research Centre and ‡‡Department of Forensic Medicine, School of Public Health and Preventive Medicine, **Monash University, Victoria, Australia; #Aged Care Assessment Services, Western Health, Footscray, Victoria, Australia; and ††Aged and Residential Care Department, Austin Health, Heidelberg, Victoria, Australia.
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  • Melita J. Giummarra BA (Hons),

    1. From the *Preventive and Public Health Division, National Ageing Research Institute, Parkville, Victoria, Australia; Department of Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health and Department of General Practice, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia; Musculoskeletal Research Centre, Faculty of Health Sciences, Latrobe University/Northern Health, Bundoora, Victoria, Australia; §Accident Research Centre and ‡‡Department of Forensic Medicine, School of Public Health and Preventive Medicine, **Monash University, Victoria, Australia; #Aged Care Assessment Services, Western Health, Footscray, Victoria, Australia; and ††Aged and Residential Care Department, Austin Health, Heidelberg, Victoria, Australia.
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  • Michael Dorevitch MBBS,

    1. From the *Preventive and Public Health Division, National Ageing Research Institute, Parkville, Victoria, Australia; Department of Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health and Department of General Practice, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia; Musculoskeletal Research Centre, Faculty of Health Sciences, Latrobe University/Northern Health, Bundoora, Victoria, Australia; §Accident Research Centre and ‡‡Department of Forensic Medicine, School of Public Health and Preventive Medicine, **Monash University, Victoria, Australia; #Aged Care Assessment Services, Western Health, Footscray, Victoria, Australia; and ††Aged and Residential Care Department, Austin Health, Heidelberg, Victoria, Australia.
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  • Joseph E. Ibrahim PhD,

    1. From the *Preventive and Public Health Division, National Ageing Research Institute, Parkville, Victoria, Australia; Department of Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health and Department of General Practice, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia; Musculoskeletal Research Centre, Faculty of Health Sciences, Latrobe University/Northern Health, Bundoora, Victoria, Australia; §Accident Research Centre and ‡‡Department of Forensic Medicine, School of Public Health and Preventive Medicine, **Monash University, Victoria, Australia; #Aged Care Assessment Services, Western Health, Footscray, Victoria, Australia; and ††Aged and Residential Care Department, Austin Health, Heidelberg, Victoria, Australia.
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  • Andrew C. Dalton MEcon,

    1. From the *Preventive and Public Health Division, National Ageing Research Institute, Parkville, Victoria, Australia; Department of Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health and Department of General Practice, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia; Musculoskeletal Research Centre, Faculty of Health Sciences, Latrobe University/Northern Health, Bundoora, Victoria, Australia; §Accident Research Centre and ‡‡Department of Forensic Medicine, School of Public Health and Preventive Medicine, **Monash University, Victoria, Australia; #Aged Care Assessment Services, Western Health, Footscray, Victoria, Australia; and ††Aged and Residential Care Department, Austin Health, Heidelberg, Victoria, Australia.
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  • Shyamali C. Dharmage PhD

    1. From the *Preventive and Public Health Division, National Ageing Research Institute, Parkville, Victoria, Australia; Department of Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health and Department of General Practice, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia; Musculoskeletal Research Centre, Faculty of Health Sciences, Latrobe University/Northern Health, Bundoora, Victoria, Australia; §Accident Research Centre and ‡‡Department of Forensic Medicine, School of Public Health and Preventive Medicine, **Monash University, Victoria, Australia; #Aged Care Assessment Services, Western Health, Footscray, Victoria, Australia; and ††Aged and Residential Care Department, Austin Health, Heidelberg, Victoria, Australia.
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  • Trial Registration: ACTRN12605000672651

Address correspondence to Dr. Melissa Russell, The University of Melbourne, 723 Swanston Street, Carlton, Victoria 3053, Australia. E-mail: melissar@unimelb.edu.au

Abstract

OBJECTIVES: To investigate the effect of a referral-based targeted multifactorial falls prevention intervention on the occurrence of recurrent falls and injuries in older people presenting to an emergency department (ED) after a fall and discharged directly home from the ED.

DESIGN: Randomized controlled trial. Assessors of outcomes were unaware of group allocation.

SETTING: Seven EDs in metropolitan Melbourne, Australia.

PARTICIPANTS: Inclusion criteria were community dwelling, aged 60 and older, presenting to an ED after a fall, and discharged directly home. Exclusion criteria were unable to follow simple instructions or walk independently.

INTERVENTION: Targeted referrals to existing community services and health promotion recommendations, based on the falls risk factors found in a baseline assessment.

MEASUREMENTS: Primary outcome measures were falls and resultant injuries occurring over the 12-month follow-up period. Falls and injury data were collected using falls calendars supported by medical record reviews.

RESULTS: Three hundred sixty-one participants were randomized to the standard care group and 351 to the intervention group. No significant difference was found between the two groups over the 12-month follow-up period in number of fallers (relative risk (RR)=1.11, 95% confidence interval (CI)=0.95–1.31] or number of participants sustaining an injury from a fall (RR=1.06, 95% CI=0.86–1.29).

CONCLUSION: This study does not support the use of a referral-based targeted multifactorial intervention program to reduce subsequent falls or fall injuries in older people who present to an ED after a fall.

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