The design and development of a complex multifactorial falls assessment intervention for falls prevention: The Prevention of Falls Injury Trial (PreFIT)

Abstract

BackgroundThis paper describes the design and development of a complex multifactorial falls prevention (MFFP) intervention for implementation and testing within the framework of a large UK-based falls prevention randomised controlled trial (RCT).MethodsA complex intervention was developed for inclusion within the Prevention of Falls Injury Trial (PreFIT), a multicentre pragmatic RCT. PreFIT aims to compare the clinical and cost-effectiveness of three alternative primary care falls prevention interventions (advice, exercise and MFFP), on outcomes of fractures and falls. Community-dwelling adults, aged 70 years and older, were recruited from primary care in the National Health Service (NHS), England.ResultsDevelopment of the PreFIT MFFP intervention was informed by the existing evidence base and clinical guidelines for the assessment and management of falls in older adults. After piloting and modification, the final MFFP intervention includes seven falls risk factors: a detailed falls history interview with consideration of ‘red flags’; assessment of balance and gait; vision; medication screen; cardiac screen; feet and footwear screen and home environment assessment. This complex intervention has been fully manualised with clear, documented assessment and treatment pathways for each risk factor. Each risk factor is assessed in every trial participant referred for MFFP. Referral for assessment is based upon a screening survey to identify those with a history of falling or balance problems. Intervention delivery can be adapted to the local setting.ConclusionThis complex falls prevention intervention is currently being tested within the framework of a large clinical trial. This paper adheres to TIDieR and CONSORT recommendations for the comprehensive and explicit reporting of trial interventions. Results from the PreFIT study will be published in due course. The effectiveness and cost-effectiveness of the PreFIT MFFP intervention, compared to advice and exercise, on the prevention of falls and fractures, will be reported at the conclusion of the trial.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-017-0492-6) contains supplementary material, which is available to authorized users.

‘I’ve always done what I was told by the medical people’: a qualitative study of the reasons why older adults attend multifactorial falls risk assessments mapped to the Theoretical Domains Framework

“…Falls and fall-related injuries pose a major challenge for older people and our health systems 1. Falls among older adults are increasing in prevalence as a result of increasing life expectancy 2.…”

“…Falls among older adults are increasing in prevalence as a result of increasing life expectancy 2. For an older person, a fall may lead to serious physical, psychological and social consequences including pain and fractures, loss of confidence, increased dependency, social isolation and depression 1 3–5. WHO rank fall-related injuries as the third leading cause of ‘years lived with disability’4 and injurious falls are a leading cause of death in those aged 75 years and over 6.…”

“…Systematic reviews support multifactorial risk interventions as effective in reducing the rate of falls in older people 5 8. Multifactorial interventions assess an individual’s risk of falling, and then initiate treatment or arrange referrals to reduce identified risks 1. As this approach focuses on several risk factors, it can result in greater reductions in falls when compared with a single intervention 9.…”

Inertial Sensor-Based Variables Are Indicators of Frailty and Adverse Post-Operative Outcomes in Cardiovascular Disease Patients

“…Falls [ 1 ] and frailty [ 2 , 3 ] in elderly patients are multifactorial [ 4 ] and are attributed to a complex interaction of intrinsic and extrinsic risk factors superimposed on normal aging process [ 5 , 6 , 7 , 8 ]. Patients with intrinsic cardiac cause for falling have been found to have higher mortality rate than those with non-cardiovascular or unknown causes of falls [ 9 ].…”

Development and delivery of an exercise programme for falls prevention: the Prevention of Falls Injury Trial (PreFIT)

“…Therefore, using the TIDieR checklist (Appendix B) [12] , this paper describes the development and procedures for the PreFIT exercise intervention. The design of the MFFP intervention has been described elsewhere [13] .…”