Dr. Jacqueline Close MRCP, Margaret Ellis FCOT, Richard Hooper PhD, Edward Glucksman PhD, Stephen Jackson FRCP and Cameron Swift FRCP
Falls in elderly people are a common presenting complaint to accident and emergency departments. Current practice commonly focuses on the injury, with little systematic assessment of the underlying cause, functional consequences, and possibilities for future prevention. We undertook a randomised controlled study to assess the benefit of a structured inderdisciplinary assessment of people who have fallen in terms of further falls.
Eligible patients were aged 65 years and older, lived in the community, and presented to an accident and emergency department with a fall. Patients assigned to the intervention group (n=184) underwent a detailed medical and occupational-therapy assessment with referral to relevant services if indicated; those assigned to the control group (n=213) received usual care only. The analyses were by intention to treat. Follow-up data were collected every 4 months for 1 year.
At 12-month follow-up, 77% of both groups remained in the study. The total reported number of falls during this period was 183 in the intervention group compared with 510 in the control group (p=0·0002). The risk of falling was significantly reduced in the intervention group (odds ratio 0·39 [95% CI 0·23–0·66]) as was the risk of recurrent falls (0·33 [0·16–0·68]). In addition, the odds of admission to hospital were lower in the intervention group (0·61 [0·35–1·05]) whereas the decline in Barthel score with time was greater in the control group (p<0·00001).
The study shows that an interdisciplinary approach to this high-risk population can significantly decrease the risk of further falls and limit functional impairment.