Close, et al.
This intervention provided medical assessments for fall risk factors with referrals to relevant services and an occupational therapy home hazard assessment with recommendations for home modifications. After 12 months, those in the intervention group were 60 percent less likely to fall once and 67 percent less likely to fall repeatedly (at least 3 times), compared with those who did not receive the intervention.
Participants were seniors who had been treated for a fall in a hospital emergency department. All were aged 65 or older and lived in the community. Two-thirds of participants were female.
London, United Kingdom
Identify medical risk factors and home hazards, and provide referrals and/or recommendations to reduce fall risk and improve home safety.
The medical assessment took place in an outpatient hospital clinic. The occupational therapy assessment took place in participants’ homes.
The medical assessment was conducted soon after the fall that was treated in the emergency room. It included assessments of visual acuity, postural hypotension, balance, cognition, depression, and medication problems. The results were used to identify and address problems that could contribute to fall risk. Participants received referrals to relevant services, as appropriate, based on identified risk factors. The home assessment was conducted during a single visit. The occupational therapist (OT) identified environmental hazards in the home such as uneven outdoor surfaces, loose rugs, and unsuitable footwear. Based on findings, the OT provided advice and education regarding safety within the home, made safety modifications to the home with the participant’s consent, and provided minor safety equipment. The OT made social service referrals for participants who required hand rails, other technical aids, adaptive devices such as grab bars and raised toilet seats, and additional support services.
The average length of the medical assessment was 45 minutes. The average length of the home assessment was 60 minutes.
A physician specializing in geriatrics conducted the medical assessment. An OT delivered the home hazard assessment.
This program could be implemented by:
- Appropriately trained geriatricians
- General practitioners with a strong interest in older adult health
- Trained physical therapists or nurses with the support of a general practitioner in case medication modification, referrals to specialists, or other medical services were required
For medication review and modification, a medical specialist rather than a general practitioner is recommended.
- Folstein mini-mental state examination (see Supplemental articles)
- Modified Geriatric Depression Scale (see Supplemental articles)
- Snellen vision assessment chart
- Medical assessment form*—the form used in the outpatient hospital clinic setting
- Accident and emergency assessment tool*—the instrument used in the emergency department to identify people at high risk of falling and those who should be referred for a comprehensive geriatric assessment
- Environmental hazards checklist*—the checklist used to guide the home assessment
* See Appendix D-5.
Close J, Ellis M, Hooper R, Glucksman E, Jackson S, Swift C. Prevention of Falls in the Elderly Trial (PROFET): A randomised controlled trial. Lancet. 1999 Jan 9;353(9147):93-7.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research. 1975 Nov;12(3):189-98.
Sheikh J, Yesavage J. Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. Clinical Gerontology. 1986;5(1/2):165-72.
Practitioners interested in using this intervention may contact the principal investigator for more information:
Jacqueline Close, MD
Neuroscience Research Australia
Barker Street, Randwick
Sydney NSW 2031, Australia
Tel: +61 (2) 9399 1055
Fax: +61 (2) 9399 1005
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