Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: randomised controlled trial

Abstract

Objective To determine the effectiveness of multifactorial intervention after a fall in older patients with cognitive impairment and dementia attending the accident and emergency department. Design Randomised controlled trial. Participants 274 cognitively impaired older people (aged 65 or over) presenting to the accident and emergency department after a fall: 130 were randomised to assessment and intervention and 144 were randomised to assessment followed by conventional care (control group). Setting Two accident and emergency departments, Newcastle upon Tyne. Main outcome measures Primary outcome was number of participants who fell in year after intervention. Secondary outcomes were number of falls (corrected for diary returns), time to first fall, injury rates, fall related attendances at accident and emergency department, fall related hospital admissions, and mortality. Results Intention to treat analysis showed no significant difference between intervention and control groups in proportion of patients who fell during 1 year's follow up (74% (96/130) and 80% (115/144), relative risk ratio 0.92, 95% confidence interval 0.81 to 1.05). No significant differences were found between groups for secondary outcome measures. Conclusions Multifactorial intervention was not effective in preventing falls in older people with cognitive impairment and dementia presenting to the accident and emergency department after a fall.

A new significant and independent risk factor for falls in elderly men and women: a low creatinine clearance of less than 65�ml/min

“…These risk assessment tools help to identify several risk factors for falls and offer the possibility of multifactorial intervention. While several studies have shown that multifactorial intervention may prevent falls, other studies have shown that multifactorial interventions are not appropriate for all elderly and that they fail in preventing falls [49,50]. In general, the determination of the creatinine clearance is of great clinical utility in the identification of elderly with an increased risk for falls since its determination offers multiple advantages.…”

Effectiveness of Interventions to Prevent Falls in People With Alzheimer’s Disease and Related Dementias

“…The odds of sustaining an injury from a fall are greater among these older adults (the range is estimated to be between 3 and 8 times as likely) than among other older adults, and the differential increases with age (Allan, Ballard, Rowan, & Kenny, 2009;Finkelstein, Prabhu, & Chen, 2007;Rose & Maffulli, 1999;Shaw et al, 2003). The risk of falling for people with dementia is especially high shortly after admission and after transfer to other hospital units.…”

Assessment and prevention of falls in older people – concise guidance

“…Evidence to support the effi cacy of the recommendations in older people with cognitive impairment is lacking, 17 although this group was not excluded in several studies.…”