Abstract
Falls in older people are a major public health concern in terms of morbidity, mortality and cost. Previous studies suggest that multifactorial interventions can reduce falls, and many geriatric day hospitals are now offering falls intervention programmes. However, no studies have investigated whether these programmes, based in the day hospital are effective, nor whether they can be successfully applied to high-risk older people screened in primary care.The hypothesis is that a multidisciplinary falls assessment and intervention at Day hospitals can reduce the incidence of falls in older people identified within primary care as being at high risk of falling. This will be tested by a pragmatic parallel-group randomised controlled trial in which the participants, identified as at high risk of falling, will be randomised into either the intervention Day hospital arm or to a control (current practice) arm. Those participants preferring not to enter the full randomised study will be offered the opportunity to complete brief diaries only at monthly intervals. This data will be used to validate the screening questionnaire. Three day hospitals (2 Nottingham, 1 Derby) will provide the interventions, and the University of Nottingham's Departments of Primary Care, the Division of Rehabilitation and Ageing Unit, and the Trent Institute for Health Service Research will provide the methodological and statistical expertise. Four hundred subjects will be randomised into the two arms. The primary outcome measure will be the rate of falls over one year. Secondary outcome measures will include the proportion of people experiencing at least one fall, the proportion of people experiencing recurrent falls (>1), injuries, fear of falling, quality of life, institutionalisation rates, and use of health services. Cost-effectiveness analyses will be performed to inform health commissioners about resource allocation issues. The importance of this trial is that the results may be applicable to any UK day hospital setting.SitesGeneral practices across Nottinghamshire and Derbyshire.Day hospitals:Derbyshire Royal Infirmary (Southern Derbyshire Acute Hospitals NHS Trust)Sherwood Day Service (Nottingham City Hospital Trust)Leengate Day Hospital (Queen's Medical Centre Nottingham University Hospital NHS Trust)
Highlights
Falls are a common and serious problem facing elderly people and are associated with considerable mortality and morbidity [1]
The UK PROFET study showed that in patients presenting to an Accident and Emergency department with a fall, the number of subsequent falls were reduced by half in those who had received the intervention, which constituted a thorough medical assessment and an occupational therapy home visit[11]
We do not know whether interventions provided to high risk older people identified in primary care are effective, nor whether falls programmes offered by day hospitals are sufficiently well constituted and intensive to deliver similar benefits to those studies outlined above
Summary
Falls are a common and serious problem facing elderly people and are associated with considerable mortality and morbidity [1]. We do not know whether interventions provided to high risk older people identified in primary care are effective, nor whether falls programmes offered by day hospitals are sufficiently well constituted and intensive to deliver similar benefits to those studies outlined above. The proposed multi-centre randomised controlled trial will assess whether falls can be successfully and cost-effectively reduced using day hospital facilities. In addition to assessing the effectiveness of the Day hospital as an intervention to reduce falls it is important to evaluate the intervention in terms of its cost-effectiveness. Within the context of this proposed study the economic objective is to establish whether it is efficient to allocate resources to the Day hospital, in comparison to standard care, as an intervention to reduce falls amongst elderly people.
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