Multifactorial assessment and targeted intervention to reduce falls among the oldest-old: a randomized controlled trial

Abstract

BackgroundThe purpose of this study was to assess the effectiveness of a multifactorial intervention to reduce falls among the oldest-old people, including individuals with cognitive impairment or comorbidities.MethodsA randomized, single-blind, parallel-group clinical trial was conducted from January 2009 to December 2010 in seven primary health care centers in Baix Llobregat (Barcelona). Of 696 referred people who were born in 1924, 328 were randomized to an intervention group or a control group. The intervention model used an algorithm and was multifaceted for both patients and their primary care providers. Primary outcomes were risk of falling and time until falls. Data analyses were by intention-to-treat.ResultsSixty-five (39.6%) subjects in the intervention group and 48 (29.3%) in the control group fell during follow-up. The difference in the risk of falls was not significant (relative risk 1.28, 95% confidence interval [CI] 0.94–1.75). Cox regression models with time from randomization to the first fall were not significant. Cox models for recurrent falls showed that intervention had a negative effect (hazard ratio [HR] 1.46, 95% CI 1.03–2.09) and that functional impairment (HR 1.42, 95% CI 0.97–2.12), previous falls (HR 1.09, 95% CI 0.74–1.60), and cognitive impairment (HR 1.08, 95% CI 0.72–1.60) had no effect on the assessment.ConclusionThis multifactorial intervention among octogenarians, including individuals with cognitive impairment or comorbidities, did not result in a reduction in falls. A history of previous falls, disability, and cognitive impairment had no effect on the program among the community-dwelling subjects in this study.

Multimorbidity as specific disease combinations, an important predictor factor for mortality in octogenarians: the Octabaix study

“…The current data were gathered from the longitudinal data set of Octabaix study project, a 3-year randomized clinical intervention program to prevent falls and malnutrition in 328 community-dwelling inhabitants all born in the year 1924. 15 , 16 The Octabaix project is a prospective population-based study on aging with a primary purpose on falls and malnutrition assessment. All community-dwelling inhabitants born in 1924 (aged 85 years at the time of inclusion) and registered at one of seven primary health care centers in Baix Llobregat in Barcelona, Spain, were contacted.…”

A Systematic Review of the Guidelines and Delphi Study for the Multifactorial Fall Risk Assessment of Community-Dwelling Elderly

“…Approximately one-third of all people over 65 years of age experience at least one fall, and 15% fall at least twice in their lifetime. [ 1 ]. Falls are among the most common causes of injury to the elderly, and they can lead to physical disability, including fractures that result in long-term disability, and reduced exercise capacity; they can even be fatal [ 2 ].…”

A systematic review of chiropractic care for fall prevention: rationale, state of the evidence, and recommendations for future research

“…Collectively, these studies illustrate the challenges researchers face in quantifying fall frequency in the context of clinical trials. Recent trials on multifactorial fall prevention programs offer some guidance for improving the rigor associated with estimating fall frequency including combining the use of patient completed fall logs with systematic phone or in-person queries [176][177][178][179][180], or adjudicating logs with reports embedded within medical records (e.g., emergency department visits or radiographic records [181][182][183]. Other approaches that leverage emerging technologies include the use of wearable sensors or camera-based home surveillance for long-term continuous monitoring of high-risk populations [184,185].…”