Multifaceted Interventions: The Winchester Falls Project

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.

Population

Participants were community-dwelling adults aged 65 or older who had sustained 2 or more falls in the previous year. About threequarters were female.

Geographic Locale

Mid Hampshire, United Kingdom

Focus

Assess fall risk factors and provide individualized interventions.

Program Setting

Baseline assessments were conducted in a multidisciplinary clinic with referrals for interventions and follow-up if necessary.

Content

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.

Risk Factor	Intervention
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

Duration

Fall risk assessments took about 2 hours. The amount and duration of the follow-up interventions varied by the type of interventions received.

Delivered by

Assessments and individualized interventions were implemented by doctors, nurses, physical therapists, and occupational therapists.

Minimum Level of Training Needed

This intervention requires a variety of highly trained health care professionals. Preparation for conducting the baseline assessments requires a half-day training session.

Key Elements

Doctors, nurses, physical therapists, and occupational therapists used a structured in-depth assessment instrument.

Available Materials

Structured assessment instrument*

*See Appendix D-6.

Study Citation

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.

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