Screening and Intervention to Prevent Falls and Fractures in Older People

Abstract

BACKGROUNDCommunity screening and therapeutic prevention strategies may reduce the incidence of falls in older people. The effects of these measures on the incidence of fractures, the use of health resources, and health-related quality of life are unknown. METHODSIn a pragmatic, three-group, cluster-randomized, controlled trial, we estimated the effect of advice sent by mail, risk screening for falls, and targeted interventions (multifactorial fall prevention or exercise for people at increased risk for falls) as compared with advice by mail only. The primary outcome was the rate of fractures per 100 person-years over 18 months. Secondary outcomes were falls, health-related quality of life, frailty, and a parallel economic evaluation. RESULTSWe randomly selected 9803 persons 70 years of age or older from 63 general practices across England: 3223 were assigned to advice by mail alone, 3279 to falls-risk screening and targeted exercise in addition to advice by mail, and 3301 to falls-risk screening and targeted multifactorial fall prevention in addition to advice by mail. A falls-risk screening questionnaire was sent to persons assigned to the exercise and multifactorial fall-prevention groups. Completed screening questionnaires were returned by 2925 of the 3279 participants (89%) in the exercise group and by 2854 of the 3301 participants (87%) in the multifactorial fall-prevention group. Of the 5779 participants from both these groups who returned questionnaires, 2153 (37%) were considered to be at increased risk for falls and were invited to receive the intervention. Fracture data were available for 9802 of the 9803 participants. Screening and targeted intervention did not result in lower fracture rates; the rate ratio for fracture with exercise as compared with advice by mail was 1.20 (95% confidence interval [CI], 0.91 to 1.59), and the rate ratio with multifactorial fall prevention as compared with advice by mail was 1.30 (95% CI, 0.99 to 1.71). The exercise strategy was associated with small gains in health-related quality of life and the lowest overall costs. There were three adverse events (one episode of angina, one fall during a multifactorial fall-prevention assessment, and one hip fracture) during the trial period. CONCLUSIONSAdvice by mail, screening for fall risk, and a targeted exercise or multifactorial intervention to prevent falls did not result in fewer fractures than advice by mail alone.

Prevention services via public long-term care insurance can be effective among a specific group of older adults in Japan

“…Our results showed the effects of preventive services in comparison with varied age and status of disability. Globally, the prevention strategy for the risk of falls is beginning to be questioned for its effectiveness [ 28 ]. Cochrane Library or other literature reviews could show only limited effectiveness with slightly difference from control group [ 29 , 30 ].…”

Fall prevention interventions in primary care to reduce fractures and falls in people aged 70 years and over: the PreFIT three-arm cluster RCT

“…This trial is the first large-scale, pragmatic, definitive trial to investigate the clinical effectiveness and cost-effectiveness of different falls prevention interventions embedded within UK primary care services. 131 The trial was designed to reflect a significant and contemporary dilemma in UK health policy, which is whether or not to introduce systematic screening and linked interventions from primary care for falls prevention. We aimed to provide evidence to inform UK health-care practitioners about the options for preventing falls and fractures in older people.…”

Qualitative Research to Inform Economic Modelling: Older People’s Views on Implementing the Nice Falls Prevention Guideline in English Community Context.

“…• Older person's motivation to maintain health • Older person's lack of falls risk awareness [3][4][5][6][7][8][9][10][11][12][13][14][15] • Low motivation of older persons [3][4][5][6][7][8][9][10][11][12][13][14][15][16] (B) Facilitators and barriers in the community…”

“…• Community marketing [3][4] • Peer recommendations [3][4][5] • Marketing health bene ts of interventions [3][4][5][6] • Lack of information in community [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] • Barriers related to socioeconomic class [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] • Linguistic barriers to information uptake [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]…”

“…This recommends that persons aged 65 + receive falls risk screening at routine visits to health and social care professionals; those screened to be at high risk would then be referred to multidisciplinary falls risk assessment and tailored treatments, including exercise, home assessment and modi cation (HAM), medication modi cation and vision improvements (2). These treatments may also be delivered individually as singlecomponent interventions (11)(12)(13), either as substitutes for the multifactorial intervention or as nonmutually exclusive complements (14,15). These interactions between screening and treatment components, the multifactorial risk pro le of falls as a geriatric syndrome (16), and the wider environmental risk factors (17,18) introduce substantial complexity to falls prevention (19,20).…”