Objective: This study aimed to determine the effectiveness of two interventions at preventing further falls in recurrent fallers. One intervention was based in primary care and the other in secondary care.
Design: cluster randomised controlled trial.
Participant parameters: Aged sixty-five years or over, living in the community, two or more falls in the previous year and not presenting to an emergency department with index fall.
Setting: Mid Hampshire, UK.
Intervention: eighteen general practices were randomly allocated to one of three groups. The primary care group was assessed by nurses in the community, using a risk factor review and subsequent targeted referral to other professionals. The secondary care group received a multi-disciplinary assessment in a day hospital followed by identified appropriate interventions. The control group received usual care. Follow-up period was for 1 year.
Results: five hundred and five participants were recruited. Follow-up was completed in 83% of cases (421/505). The proportion of participants who fell again was significantly lower in the secondary care group (75%, 158/210) compared to the control group
Conclusion: a structured multi-disciplinary assessment of recurrent fallers significantly reduced the number experiencing further falls, but a community-based nurse-led assessment with targeted referral to other professionals did not.
The paper can be viewed here: Spice et al. 2009
