Abstract
BackgroundAnnually, about 30% of the persons of 65 years and older falls at least once and 15% falls at least twice. Falls often result in serious injuries, such as fractures. Therefore, the prevention of accidental falls is necessary. The aim is to describe the design of a study that evaluates the efficacy and cost-effectiveness of a multidisciplinary assessment and treatment of multiple fall risk factors in independently living older persons with a high risk of falling.Methods/DesignThe study is designed as a randomised controlled trial (RCT) with an economic evaluation. Independently living persons of 65 years and older who recently experienced a fall are interviewed in their homes and screened for risk of recurrent falling using a validated fall risk profile. Persons at low risk of recurrent falling are excluded from the RCT. Persons who have a high risk of recurrent falling are blindly randomised into an intervention (n = 100) or usual care (n = 100) group. The intervention consists of a multidisciplinary assessment and treatment of multifactorial fall risk factors. The transmural multidisciplinary appraoch entails close cooperation between geriatrician, primary care physician, physical therapist and occupational therapist and can be extended with other specialists if relevant. A fall calendar is used to record falls during one year of follow-up. Primary outcomes are time to first and second falls. Three, six and twelve months after the home visit, questionnaires for economic evaluation are completed. After one year, during a second home visit, the secondary outcome measures are reassessed and the adherence to the interventions is evaluated. Data will be analysed according to the intention-to-treat principle and also an on-treatment analysis will be performed.DiscussionStrengths of this study are the selection of persons at high risk of recurrent falling followed by a multidisciplinary intervention, its transmural character and the evaluation of adherence. If proven effective, implementation of our multidisciplinary assessment followed by treatment of fall risk factors will reduce the incidence of falls.Trial registrationCurrent Controlled Trials ISRCTN11546541.
Highlights
About 30% of the persons of 65 years and older falls at least once and 15% falls at least twice
The intervention consists of a systematic assessment of the putative causes of falling and subsequent targeted individualised preventive measures. Unique characteristics of this trial are the evaluation of fall risk factors and subsequent treatment of persons with a high risk of recurrent falling, and the close collaboration between the hospital and primary care physician
A similar strategy has previously been investigated in the Prevention Of Falls in the Elderly Trial (PROFET) study in the UK, leading to a fall incidence reduction of 50% [13]
Summary
About 30% of the persons of 65 years and older falls at least once and 15% falls at least twice. About one in four fallers consults a hospital emergency room or primary care physician after the fall [6] These facts emphasize the necessity of measures to prevent falling in older persons. The intervention consists of a systematic assessment of the putative causes of falling and subsequent targeted individualised preventive measures Unique characteristics of this trial are the evaluation of fall risk factors and subsequent treatment of persons with a high risk of recurrent falling, and the close collaboration between the hospital and primary care physician (transmural care). Both the effectiveness and cost-effectiveness of the intervention will be assessed
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