Spice, et al.
This study evaluated the effectiveness of 2 fall interventions. The primary care intervention consisted of fall risk assessments by nurses followed by referrals to other professionals. The secondary care intervention involved multidisciplinary fall risk assessments (by a doctor, nurse, physical therapist, and occupational therapist), followed by appropriate interventions and follow-up if necessary. Only the secondary care intervention was effective in reducing falls.
Compared to the group who received usual care, participants in the secondary care multidisciplinary intervention were half as likely to fall, a third less likely to sustain a fall-related fracture, and 55 percent less likely to die in the year following the intervention.
Participants were community-dwelling adults aged 65 or older who had sustained 2 or more falls in the previous year. About threequarters were female.
Mid Hampshire, United Kingdom
Assess fall risk factors and provide individualized interventions.
Baseline assessments were conducted in a multidisciplinary clinic with referrals for interventions and follow-up if necessary.
Participants received a standardized assessment for fall risk factors that included psychoactive medications; visual impairment; neurological, musculoskeletal, and/or cardiovascular problems; poor mobility; postural hypotension; improper footwear; environmental hazards; and alcohol use.
Individualized interventions included medication changes; physical therapy interventions such as strength, balance, and gait training; occupational therapy interventions such as corrective shoes, adaptive equipment, and home visits to reduce fall hazards; nursing interventions such as monitoring postural hypotension; and social services interventions such as increasing home help.
|Assessed by a doctor:|
|General medical history and examination||Refer to appropriate specialists|
|Medications||Stop medications when possible; add medication where appropriate; make recommendations to primary care physician; reduce or stop psychoactive medications|
|Visual impairment||Recommend optician if one has not been seen in 2 years or if there is a change in vision; refer to ophthalmologist when appropriate (e.g., cataracts)|
|Alcohol use||Advise to reduce or stop|
|Assessed by a nurse:|
|Postural hypotension||Refer to primary care nurse for monitoring|
|Review of continence||Refer to community nurse|
|Assessed by a physical therapist:|
|Poor mobility||Physical therapy interventions such as strength, balance, and gait training; exercise instruction; provide mobility aids|
|Assessed by an occupational therapist:|
|Improper footwear||Information on footwear; refer for orthotics or corrective shoes|
|Environmental hazards||In-home visit; suggest adaptive equipment; recommend grab bars; refer to local organizations specializing in home safety assessments for security advice, and to install window or door locks, security lights, smoke alarms etc., if necessary|
|Personal and domestic activities of daily living||Daily living advice; refer to social services for assistance|
Fall risk assessments took about 2 hours. The amount and duration of the follow-up interventions varied by the type of interventions received.
Assessments and individualized interventions were implemented by doctors, nurses, physical therapists, and occupational therapists.
This intervention requires a variety of highly trained health care professionals. Preparation for conducting the baseline assessments requires a half-day training session.
Doctors, nurses, physical therapists, and occupational therapists used a structured in-depth assessment instrument.
Structured assessment instrument*
*See Appendix D-6.
Spice CL, Morotti W, George S, Dent THS, Rose J, Harris S, Gordon CJ. The Winchester falls project: A randomised controlled trial of secondary prevention of falls in older people. Age and Aging. 2009 Jan;38(1):33-40.
Practitioners interested in using this intervention may contact the principal investigator for more information:
Dr. Claire Spice
Department of Medicine for Older People
Portsmouth Hospitals NHS Trust
Queen Alexandra Hospital
Southwick Hill, Cosham PO6 3LY, United Kingdom
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