Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 2: Controlled trial in multiple centres

Abstract

Objectives To assess the effectiveness of trained nurses based in general practices individually prescribing a home exercise programme to reduce falls and injuries in elderly people and to estimate the cost effectiveness of the programme. Design Controlled trial with one year's follow up. Setting 32 general practices in seven southern New Zealand centres. Participants 450 women and men aged 80 years and older. Intervention 330 participants received the exercise programme (exercise centres) and 120 received usual care (control centres); 87% (371 of 426) completed the trial. Main outcome measures Number of falls, number of injuries resulting from falls, costs of implementing the programme, and hospital costs as a result of falls. Results Falls were reduced by 30% in the exercise centres (incidence rate ratio 0.70, 95% confidence interval 0.59 to 0.84). The programme was equally effective in men and women. The programme cost $NZ418 (£121) (at 1998 prices) per person to deliver for one year or $NZ1519 (£441) per fall prevented. Fewer participants had falls resulting in injuries, but there was no difference in the number who had serious injuries and no difference in hospital costs resulting from falls in exercise centres compared with control centres. Conclusions An individually tailored exercise programme, delivered by trained nurses from within general practices, was effective in reducing falls in three different centres. This strategy should be combined with other successful interventions to form part of home programmes to prevent falls in elderly people.

Analysis of Fall Injuries by Body Mass Index

“…A nine-month balance and strength-specific programme of group and home exercise in over 65 year old frequent fallers halved the rate of falls compared to controls (94,95). Even though it would be expected that home exercise alone might not be adhered to as well as group exercise, a year-long, partially supervised, home exercise programme was highly effective at reducing falls, but more costeffective in over-80s (96,97).…”

“…Costs per person for a fall prevention programme can differ greatly. Based on evidence from New Zealand and Australia, the cost per fall prevented differs widely among programmes, from €80 to €880 per fall prevented by home-based exercise (96,97) to about €2700 per fall for home modification (126). For injury reduction, costs also differ widely for home based exercise, from €208 to €3654 (127) and home…”

Reducing falls among older people in general practice: The ProAct65+ exercise intervention trial

“…The OEP was most cost effective in those aged over 80 (Robertson 2001b). The original FaME intervention is a 9 month group-based programme led by a postural stability exercise instructor.…”

“…The original OEP was a 1 year home-based falls prevention exercise programme that averaged a 35% reduction in falls in the trials conducted in community-dwelling people aged 75+ in New Zealand (Campbell 1997, Robertson 2001a, 2001b. The OEP was most cost effective in those aged over 80 (Robertson 2001b).…”

The strategic development of the NSW Health Plan for Prevention of Falls and Harm from Falls Among Older People: 2011 - 2015; translating research into policy and practice

“…30 The Centre has also funded the replication of promising interventions found to be effective internationally such as the evidencebased Otago home-based exercise program in sentinel health areas. 31 Finally, the Centre has also provided funds to the Clinical Excellence Commission to work with the Ambulance Service of NSW and researchers to better understand fall patterns and develop and test assessment and referral pathways for the management of older people attended to by the Ambulance Service of NSW following a fall but not transported to hospital. 32 …”