Multifactorial Fall Prevention Program Research Articles

Pharmacist intervention is associated with fewer serious falls over 3 months among older fallers at a day hospital: A quasi-experimental study

ObjectivesSome drugs increase the risk of falls, including serious falls. The objective of this quasi-experimental study was to determine whether the intervention of a clinical pharmacist among older outpatients receiving a multifactorial fall prevention program at a geriatric day hospital dedicated to older patients with a recent history of falls was effective in preventing serious falls over a 3-month follow-up, compared with usual care. Study designQuasi-experimental study in 296 consecutive older outpatients, including 85 with pharmacist intervention (the intervention group) and 148 without (the control group). Main outcome measuresThe main outcome was the occurrence of at least one serious fall within 3 months of follow-up. Covariates included age, sex, body mass index, grip strength, history of falls, Mini-Mental State Examination score, use of ≥3 drugs associated with risk of falls, frailty, and disability. ResultsFewer participants in the intervention group experienced at least one serious fall than in the control group (5 (5.9 %) versus 23 (15.5 %), P = 0.029), which persisted after adjustment for potential confounding factors (OR = 0.30 [95CI:0.11–0.84], P = 0.022). No significant effect was found on the indicence of all falls. Pharmacist intervention allowed more frequent therapeutic optimizations of antithrombotics (OR = 3.69 [95CI: 1.66–8.20]), proton pump inhibitors (OR = 3.34 [95CI: 1.31–8.50]), benzodiazepines (OR = 3.15 [95CI: 1.06–9.36]) and antidepressants (OR = 3.87 [95CI: 1.21–12.35]). ConclusionsAmong older fallers receiving a multifactorial fall prevention program at a day hospital, a clinical pharmacist intervention was associated with fewer incident serious falls over 3 months of follow-up.

Implementation fidelity of a multifactorial in-hospital fall prevention program and its association with unit systems factors: a single center, cross-sectional study

BackgroundFalls are a common, costly global public health burden. In hospitals, multifactorial fall prevention programs have proved effective in reducing falls’ incidence; however, translating those programs accurately into daily clinical practice remains challenging. This study’s aim was to identify ward-level system factors associated with implementation fidelity to a multifactorial fall prevention program (StuPA) targeting hospitalized adult patients in an acute care setting.MethodsThis retrospective cross-sectional study used administrative data on 11,827 patients admitted between July and December 2019 to 19 acute care wards at the University Hospital Basel, Switzerland, as well as data on the StuPA implementation evaluation survey conducted in April 2019. Data were analysed using descriptive statistics, Pearson’s coefficients and linear regression modelling for variables of interest.ResultsThe patient sample had an average age of 68 years and a median length of stay of 8.4 (IQR: 2.1) days. The mean care dependency score was 35.4 points (ePA-AC scale: from 10 points (totally dependent) to 40 points (totally independent)); the mean number of transfers per patient -(e.g., change of room, admission, discharge) was 2.6 (range: 2.4– 2.8). Overall, 336 patients (2.8%) experienced at least one fall, resulting in a rate of 5.1 falls per 1’000 patient days. The median inter-ward StuPA implementation fidelity was 80.6% (range: 63.9–91.7%). We found the mean number of inpatient transfers during hospitalisation and the mean ward-level patient care dependency to be statistically significant predictors of StuPA implementation fidelity.ConclusionWards with higher care dependency and patient transfer levels showed higher implementation fidelity to the fall prevention program. Therefore, we assume that patients with the highest fall prevention needs received greater exposure to the program. For the StuPA fall prevention program, our results suggest a need for implementation strategies contextually adapted to the specific characteristics of the target wards and patients.

Analyzing a Multifactorial Fall Prevention Program Using ARIMA Models.

Preventing inpatient falls is challenging for hospitals to improve and often leads to patient injury. To describe multifactorial patient-tailored interventions and to evaluate whether they were associated with a sustained decline in total and injury falls. A multifactorial fall prevention program was instituted over the course of several years. An interrupted time series design was used to assess the effect of each intervention on total and injury fall rates. ARIMA models were built to assess the step and ramp change. Total fall rates decreased from 4.3 to 3.6 falls per 1000 patient days (16.28% decrease), and injury fall rates decreased from 1.02 to 0.8 falls per 1000 patient days (21.57% decrease). All the interventions contributed to fall reduction, with specific interventions contributing more than others. Using multiple interventions that are sustained long enough to demonstrate success reduced the total fall rate and injury fall rate.

Efficacy of a multiple-component and multifactorial personalized fall prevention program in a mixed population of community-dwelling older adults with stroke, Parkinson's Disease, or frailty compared to usual care: The PRE.C.I.S.A. randomized controlled trial.

BackgroundFall risk in the elderly is a major public health issue due to the injury-related consequences and the risk of associated long-term disability. However, delivering preventive interventions in usual clinical practice still represents a challenge.AimTo evaluate the efficacy of a multiple-component combined with a multifactorial personalized intervention in reducing fall rates in a mixed population of community-dwelling elderly compared to usual care.DesignRandomized Controlled Trial (NCT03592420, clinicalTrials.gov).SettingOutpatients in two Italian centers.Population403 community-dwelling elderly at moderate-to-high fall risk, including subjects with Parkinson's Disease and stroke.MethodsAfter the randomization, the described interventions were administered to the intervention group (n = 203). The control group (n = 200) received usual care and recommendations to minimize fall risk factors. In addition, each participant received a fall diary, followed by 12 monthly phone calls. The primary endpoint was the total number of falls in each group over 12 months, while the secondary endpoints were other fall-related indicators recorded at one year. In addition, participants' functioning was assessed at baseline (T1) and 3-month (T3).Results690 falls were reported at 12 months, 48.8% in the intervention and 51.2% in the control group, with 1.66 (± 3.5) and 1.77 (± 3.2) mean falls per subject, respectively. Subjects with ≥ 1 fall and ≥2 falls were, respectively, 236 (58.6%) and 148 (36.7%). No statistically significant differences were observed between groups regarding the number of falls, the falling probability, and the time to the first fall. According to the subgroup analysis, no significant differences were reported. However, a statistically significant difference was found for the Mini-BESTest (p = 0.004) and the Fullerton Advanced Balance Scale (p = 0.006) for the intervention group, with a small effect size (Cohen's d 0.26 and 0.32, respectively), at T1 and T3 evaluations.ConclusionsThe intervention was ineffective in reducing the number of falls, the falling probability, and the time to the first fall at 12 months in a mixed population of community-dwelling elderly. A significant improvement for two balance indicators was recorded in the intervention group. Future studies are needed to explore different effects of the proposed interventions to reduce falls and consequences.

Feasibility of a new multifactorial fall prevention assessment and personalized intervention among older people recently discharged from the emergency department

Falls among older people occur frequently and are a leading cause of Emergency department (ED) admissions, disability, death and rising health care costs. Multifactorial fall prevention programs that are aimed to target the population at risk have shown to effectively reduce the rate of falling and fall-related injuries in community-dwelling older people. However, the participation of and adherence to these programs in real life situation is generally low. To test the feasibility of a transitionally organized fall prevention assessment with accompanying personalized intervention initiated at the ED. A process evaluation, of a non-randomized controlled pilot trial for implementing a transitionally organized multifactorial fall prevention intervention, was performed using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to gain insight into the barriers and facilitators of implementation. Older fallers (>70yrs) presenting at the ED were selected based on ZIP-code and after obtaining informed consent, data for the evaluation was collected through questionnaires and interviews. Furthermore, feedback was collected from the healthcare providers. The consent was obtained by 24 (70%) of the patients approached directly at the ED and 17 (26%) of the patients approached later by phone. Adherence to the protocol by the participants, clinical assessors and family practice were all more than 90%. After three months, nine (26%) of the participants had at least one recurrent fall: three (20%) patients in the intervention group and six (32%) in the control group. ED presentation due to a fall in older persons provides a window of opportunity for optimizing adherence to a multifactorial fall prevention program as willingness to participate was higher when the patients were approached at the ED during their stay. Implementing a transitionally organized multidisciplinary fall prevention program was successful with a high protocol adherence. NTR NL8142, November 8, 2019.

"What is Effective for Fall Prevention Among Individuals Post- Stroke? A Systematic Review"

Background: Falls are a significant concern for people post-stroke. Interventions that effectively prevent or reduce the number of falls should be well documented and appraised for effectiveness. Therefore, our study aimed to identify and appraise the literature on interventions aimed at preventing or reducing falls among people post-stroke.Methods: A comprehensive literature search was conducted in five databases. Two independent reviewers screened the literature search results to include relevant studies. Subsequently, reviewers extracted the data using a standardized form, and the quality of studies was assessed using a critical appraisal tool.Results: 26 studies met the selection criteria and were included in our review. We identified eight categories for preventing and reducing falls. These categories were: electrotherapy, multifactorial fall prevention programs, educational programs, multifaceted stroke telerehabilitation, virtual reality, vitamin-D supplements, rehabilitation instruments, and physical activities.Conclusion: The evidence for these interventions varied between studies, with no single intervention superior to others. The current review findings indicate that there is limited evidence to recommend one fall intervention to be generalized among people post-stroke. Further studies involving large sample sizes and different fall outcomes are needed to make valuable recommendations for clinical practice.

Multifactorial falls prevention programme compared with usual care in UK care homes for older people: multicentre cluster randomised controlled trial with economic evaluation

ObjectivesTo determine the clinical and cost effectiveness of a multifactorial fall prevention programme compared with usual care in long term care homes.DesignMulticentre, parallel, cluster randomised controlled trial.SettingLong term care homes...

Older adults’ views on barriers and facilitators to participate in a multifactorial falls prevention program: Results from Prevquedas Brasil

ObjectivesTo understand the reasons older people engage in a multifactorial fall prevention program and, to identify the barriers and facilitators for adherence. MethodsCross-sectional study, with 218 older adults from the intervention group of a 12-week multifactorial fall prevention program (Prevquedas Brazil). We interviewed participants using a semi-structured questionnaire concerning reasons to engage in, barriers, and facilitators to participating in the program. We compared participants with low (0−5 sessions) and moderate/high (6–12 sessions) adherence regarding barriers and facilitators. ResultsPhysical and mental health problems (55 %), and competing demands (45.2 %) were the most frequent barriers reported. Pleasant environment (97.7 %), a sense of receiving proper care (96.7 %), and empathy with the team (96.7 %) were the main facilitators. Seven out of the twelve facilitators distinguished participants with high adherence from those with low adherence. Only the barriers related to the program characteristics and the lack of social support were able to identify participants with low adherence. Open-ended questions revealed that self-determination, commitment, and the desire of being physically active and fit promoted participation. Anticipated health benefits and functional gains, a need to take action due to fall consequences, and encouragement from others were among the reasons to engage in the program. ConclusionAlthough barriers should not be neglected, facilitators are critically important for adherence. Health professionals may develop skills to facilitate uptake and optimize older adults' participation. Implementing sustainable fall prevention programs in low and middle-income countries requires overcoming the fragmentation and inflexibility of healthcare services.

Effectiveness of a programme delivered in a falls clinic in preventing serious injuries in high-risk older adults: A pre- and post-intervention study

ObjectiveTo evaluate whether a multifactorial programme delivered in a real practice setting would help prevent serious fall-related injuries in high-risk older patients. DesignA 6-month pre–post intervention study in 134 fallers (81.6 ± 7.2 years) consecutively referred to a fall prevention clinic after repeated falls in the previous year or after a fall associated with balance, gait, or strength disorders. The programme was delivered by a physiotherapist, an occupational therapist, a podiatrist, and a geriatrician based on a 3-hour fall risk assessment. ResultsThe proportion of patients with serious and moderate fall-related injuries was significantly lower in the 6 months after than in the 6-months preceding clinic attendance [8 (6.1%) vs 40 (30.5%), and 11 (8.2%) vs 19 (14.2%), respectively; p < 0.0001], as were the overall proportion of fallers (32.1% vs 95.4%; p < 0.0001) and the number of falls per patient (-5.2 ± -20.4; p < 0.0001). When compared with baseline, fear of falling at 6 months was reduced (p < 0.05), mobility was maintained, and the proportion of patients with an ADL score ≤ 2 was increased (5.6% vs 9.7% respectively; p < 0.001). Adherence to the main recommendations and satisfaction with the programme were > 75% at 6 months post-clinic. ConclusionsA multifactorial fall prevention programme delivered by a multidisciplinary geriatric team in older patients at high risk of falling helps to reduce over a 6-month period the risk of serious and moderate injuries related to falls, the risk of falling, and the fear of falling, and helps to maintain mobility and improve functional status.

Effects of a fall prevention program in elderly: a pragmatic observational study in two orthopedic departments.

PurposeFalls are a common adverse event experienced by elderly in hospitals. This study assessed the effects of a fall prevention program on the rate of fallers, the patient safety culture, and patient-perceived safety.Materials and methodsTwo orthopedic departments in different towns in Norway participated in the study. A comprehensive, multifactorial fall prevention program was implemented in one of the departments, the other one was used for control. The changes in the outcomes in the two departments from before to after the intervention were compared. All patients above 64 years of age admitted to the two departments in a 1-year period before and after the intervention were included. All employees at the two departments were invited to participate in surveys measuring the patient safety culture, and a selection of the patients reported patient-perceived safety. The primary outcome was the rate of fallers. Secondary outcomes were the employees’ perceived patient safety culture (measured with the Safety Attitudes Questionnaire) and patient-perceived safety (measured with Norwegian Patient Experience Questionnaire).ResultsFalls were registered in 114 out of 3,143 patients (3.6%) with 17,006 days in the hospital. Ten patients had two falls, giving a fall rate of 7.3 falls/1,000 days in the hospital. The number of fallers before and after the intervention in the intervention department were 37/734 (5.04%) and 31/735 (4.22%), P=0.46, and in the control department, 25/811 (3.08%) and 21/863 (2.43%), P=0.46. The difference between the changes in the two departments was not statistically significant; 0.17% (95% CI: −2.49 to 2.84; P=0.90). There were also no significant differences in the changes in patient safety culture and patient-perceived safety.ConclusionThe fall prevention program revealed no significant effect on the rate of fallers, the patient safety culture, or patient-perceived safety.

Effect of a fall prevention program for elderly persons attending a rural family medicine center, Egypt

In Egypt, few studies have explored the problem of falling and interventions to prevent falls in older adults. To assess the effect of multifactorial, individualized interventions for prevention of falls among elderly persons. A quasi-experimental intervention study design with pre-post assessment was used. A sample of 100 community-dwelling persons aged 60 years or older was selected from the Fanara Family Medicine Center regestries. An evidence-based, coordinated fall prevention program was implemented. The primary outcome measure was rate of falls assessed at baseline and 12 months. The secondary outcomes were changes in home hazards, functional status, muscle strength, balance and adherence to Otago exercises. There was a statistically significant difference in rate of falls (P = 0.049) and recurrent falls (P = 0.011) among participants from baseline to 12 months post-intervention. There were statistically significant improvements from baseline to post-intervention in dynamic balance (P = 0.02), muscle strength (P < 0.001), adherence to Otago exercises (P < 0.001) and the total score of home hazards (P = 0.029). The multifactorial fall prevention program was effective in reducing the rate of falls and most home hazards and improving functional performance and balance abilities in community-dwelling older adults after 1-year follow-up.

Adherence to a multifactorial fall prevention program following paramedic care: Predictors and impact on falls and health service use. Results from an RCT a priori subgroup analysis

To identify predictors and impact of adherence to a multifactorial fall-prevention program on falls and health service utilisation. Randomised controlled trial with a priori subgroup analysis within intervention group according to adherence. Participants were community dwelling, (≥65years), not transported to hospital following fall-related paramedic care. The Attitudes to Falls-Related Interventions Scale (AFRIS) was completed at baseline, adherence levels were measured (three-point scale) at six months, and falls and health service utilisation were recorded for 12months. Multivariate logistic regression and area under the curve were calculated with 95% confidence interval (CI). Attitudes to Falls-Related Interventions Scale scores (n = 85) were independent of baseline characteristics. At six months, 39 (46%) participants reported full adherence. Independent predictors of adherence were positive AFRIS (OR 4.10, 95% CI 1.48-11.39) and receiving 3+ recommendations (OR 3.36, 95% CI 1.26-9.00). Adherers experienced fewer falls (IRR 0.53, 95% CI 0.45-0.80) and fall-related health service use (emergency department presentations IRR 0.37, 95% CI 0.17-0.82) compared to non-adherers. Older adults who adhere to recommendations benefit, regardless of fall-risk profile.

ASSOCIATION BETWEEN DEPRESSIVE SYMPTOMS, RECURRENT, AND SINGLE FALLS FROM PREVQUEDAS BRAZIL

Introduction: Depressive symptoms are associated with falls in a variety of studies in developed countries. Objectives: 1) To examine the association between abnormal 15-item GDS score, single and recurrent falls in community-dwelling older adults in a developing country. 2) To check if recurrent fallers have greater scores in 15-item GDS, examining if it has any association with age, ethnicity, genre, and numbers of medications used. Methods: Transversal data analyzed was extracted from Prevquedas Brasil, a Multicenter parallel-group randomized controlled trial that evaluates the effectiveness of a multifactorial falls prevention program in reducing the rate of falls in community-dwelling older people. Statistical Analysis: Pearson Chi-square test used to compare positive screening for depressive symptoms (GDS >5) and fall events (single or recurrent). Sociodemographic variables were analyzed by logistic regression. Stata® software was used. Results: 402 participants (mean age 73.8 ± 7.1years; 88.1% women; 59.8% white). Recurrent falls have association with GDS >5 (92 vs. 28, p=0.008). The mean GDS score is greater for recurrent fallers than to non-recurrent fallers (p<0,001). After logistic regression for sociodemographic variables and medications, elderly with GDS >5 had twice more chance to be a recurrent faller (OR 2.0, 95%IC 1.2–3.3; p=0.007), compared to GDS ≦5. Conclusions: Abnormal 15-item GDS and its greater scores are associated with recurrent fallers in elderly from a developing country.

Analysis of Fall Accidents of Dizzy Patients in a Tertiary Hospital in South Korea (2011-2015)

Background and Objectives A fall refers to a sudden fall accident resulting in injury and hurt of the human body. In the hospital, fall accidents occur mainly in dizzy patients or elderly people, but can also occur even in young people who fail to adapt to the unfamiliar hospital environment. This study analyzed the incidence of fall accidents and its pattern in dizzy patients in a tertiary hospital in South Korea. Subjects and Method This study was conducted using 477 fall accidents that occurred in a tertiary hospital in Korea from 2011 to 2015. Extensively investigated were related fall risk factors such as patient’s sex, age, medical department, diagnosis, first witness, mental status, physical activity, patient risk factors, walking aids, medication use and treatment. Results Dizziness induced falls consisted of 20.5% of the total fall accidents. Sedative medications were frequently used in patients of dizziness induced falls (42.9%). Fall acidents were mainly detected by nurses 33%. The frequente sites of fall were the bed rooms (55%), the corridor (15%) or the bath rooms (8%). Types of physical damage were no damage (47%), abrasion or bruising (20%), laceration (10%), bath rooms (8%), fracture (3%), and head trauma (1%). In 532 treatments, observation was recommended for 68%, sterilization 15.2%, suture 4.7%, cast 1%, and surgery 1%. Conclusion The study finds that the fall risk screening test and Multifactorial Fall Prevention Program should be performed for all high-risk patients of fall. About 20% of falls were associated with otologic dizziness, and otolaryngology doctors should pay attention to the fall problem and the medication related to dizziness, which may potentially increase the risk of falls. Key words: Accident prevention ㆍ Accidental falls ㆍ Dizziness ㆍ Education ㆍ Risk factors

Long-Term Effectiveness of a Multifactorial Fall and Fracture Prevention Program in Bavarian Nursing Homes: An Analysis Based on Health Insurance Claims Data

ObjectiveFemoral fractures are frequently consequences of falls in nursing homes and are associated with considerable costs and unfavorable outcomes such as immobility and mortality. The purpose of this study was to examine the long-term effectiveness of a multifactorial fall and fracture prevention program in nursing homes in terms of reducing femoral fractures. DesignRetrospective cohort study. SettingNursing homes. ParticipantsHealth insurance claims data for 2005-2013 including 85,148 insurants of a sickness fund (Allgemeine Ortskrankenkasse Bayern), aged 65 years or older and living in 802 nursing homes in Bavaria, Germany. InterventionThe fall prevention program was implemented stepwise in 4 time-lagged waves in almost 1,000 nursing homes in Bavaria, Germany, and was financially supported by a Bavarian statutory health insurance for the initial period of 3 years after implementation. The components of Bavarian Fall and Fracture Prevention Program were related to the staff (education), to the residents (progressive strength and balance training, medication, hip protectors), and suggested environmental adaptations as well as fall documentation and feedback on fall statistics. MeasurementsData were used to create an unbalanced panel data set with observations per resident and quarterly period. We designed each wave to have 9 quarters (2.25 years) before implementation and 15 quarters (3.75 years) as follow-up period, respectively. Time trend–adjusted logistic generalized estimating equations were used to examine the impact of implementation of the fall prevention program on the likelihood of femoral fractures, controlling for resident and nursing home characteristics. The analysis took into account that the fall prevention program was implemented in 4 time-lagged waves. ResultsThe implementation of the fall prevention program was not associated with a significant reduction in femoral fractures. Only a transient reduction of femoral fractures in the first wave was observed. Patient characteristics were positively associated with the likelihood of femoral fractures (P < .001); women compared to men [odds ratio (OR) = 0.877], age category 2 (OR = 1.486) and 3 (OR = 1.973) compared to category 1, care level 1 compared to 2 (OR = 0.897) and 3 (OR = 0.426), and a prior fracture (OR = 2.230) significantly increased the likelihood of a femoral fracture. ConclusionsThere was no evidence for the long-term effectiveness of the fall prevention program in nursing homes. The restriction of the transient reduction to the first implementation wave may be explainable by a higher motivation of nursing homes starting first with the fall prevention program. Efforts should be directed to further identify factors that determine the long-term effectiveness of fall prevention programs in nursing homes.

Efficacy of a Student-Led, Community-Based, Multifactorial Fall Prevention Program: Stay in Balance.

Falls are a major public health concern in older adults. Recent fall prevention guidelines recommend the use of multifactorial fall prevention programs (FPPs) that include exercise for community-dwelling older adults; however, the availability of sustainable, community-based FPPs is limited. We conducted a 24-week quasi-experimental study to evaluate the efficacy of a community-based, multifactorial FPP [Stay in Balance (SIB)] on dynamic and functional balance and muscular strength. The SIB program was delivered by allied health students and included a health education program focused on fall risk factors and a progressive exercise program emphasizing lower-extremity strength and balance. All participants initially received the 12-week SIB program, and participants were non-randomly assigned at baseline to either continue the SIB exercise program at home or as a center-based program for an additional 12 weeks. Adults aged 60 and older (n = 69) who were at-risk of falling (fall history or 2+ fall risk factors) were recruited to participate. Mixed effects repeated measures using Statistical Application Software Proc Mixed were used to examine group, time, and group-by-time effects on dynamic balance (8-Foot Up and Go), functional balance (Berg Balance Scale), and muscular strength (30 s chair stands and 30 s arm curls). Non-normally distributed outcome variables were log-transformed. After adjusting for age, gender, and body mass index, 8-Foot Up and Go scores, improved significantly over time [F(2,173) = 8.92, p = 0.0; T0 - T2 diff = 1.2 (1.0)]. Berg Balance Scores [F(2,173) = 29.0, p < 0.0001; T0 - T2 diff = 4.96 (0.72)], chair stands [F(2,171) = 10.17, p < 0.0001; T0 - T2 diff = 3.1 (0.7)], and arm curls [F(2,171) = 12.7, p < 0.02; T0 - T2 diff = 2.7 (0.6)] also all improved significantly over time. There were no significant group-by-time effects observed for any of the outcomes. The SIB program improved dynamic and functional balance and muscular strength in older adults at-risk for falling. Our findings indicate continuing home-based strength and balance exercises at home after completion of a center-based FPP program may be an effective and feasible way to maintain improvements in balance and strength parameters.

Fall Prevention in a Primary Care Setting.

Falls and fall-related injuries are common in community-dwelling elderly people. Effective multifactorial fall prevention programs in the primary care setting may be a promising approach to reduce the incidence rate of falls. In a cluster randomized trial in 33 general practices 378 people living independently and at high risk of falling (65 to 94 years old; 285 women) were allocated to either a 16 week exercise-based fall prevention program including muscle strengthening and challenging balance training exercises, combined with a 12 week home-based exercise program (222 participants), or to usual care (156 participants). The main outcome was number of falls over a period of 12 months. Secondary outcomes were the number of fall-related injuries, physical function (Timed-Up-and-Go-Test, TUG, Chair-Stand-Test, CST, modified Romberg Test), and fear of falling. In the intervention group (n=222 patients in 17 general practices) 291 falls occurred, compared to 367 falls in the usual care group (n=156 patients in 16 general practices). We observed a lower incidence rate for falls in the intervention group (incidence rate ratio/IRR: 0.54; 95% confidence interval (CI): [0.35; 0.84], p=0.007) and for fall-related injuries (IRR: 0.66; [0.42; 0.94], p=0.033). Additionally, patients in the intervention group showed significant improvements in secondary endpoints (TUG: -2.39 s, [-3.91; -0.87], p=0.014; mRomberg: 1.70 s, [0.35; 3.04], p=0.037; fear of falling: -2.28 points, [-3.87; -0.69], p=0.022) compared to usual care. A complex falls prevention program in a primary care setting was effective in reducing falls and fall-related injuries in community dwelling older adults at risk.

Prevention Program Lowered The Risk Of Falls And Decreased Claims For Long-Term Services Among Elder Participants.

The LIFT (Living Independently and Falls-free Together) Wellness Program is a multifactorial fall-prevention intervention developed for community-dwelling elders. Its effectiveness was tested in a randomized controlled trial of consenting people who were ages seventy-five and older and who held long-term care insurance policies with one of three major insurers. The study was conducted during 2008-12. In the first year following the intervention, participants in the intervention group had an 11 percent reduction in risk of falling and an 18 percent reduction in risk of injurious falls, compared to participants in the active control group. In the three years after the intervention, participants in the intervention group had a significantly (33 percent) lower incidence of claims for long-term services and supports than those in the administrative control group, for an estimated return of $1.68 on every dollar invested in program delivery. The results of this evaluation are unique in demonstrating that a multifactorial fall prevention program can do more than reduce falls in this population; they suggest that the broader availability of LIFT could benefit long-term care insurers and policyholders alike.

Effects of a multifactorial fall prevention program on balance, gait, and fear of falling in post-stroke inpatients.

[Purpose] This study investigated the effects of a multifactorial fall prevention program on balance, gait, and fear of falling in stroke patients. [Subjects] Twenty-five stroke patients were divided randomly into multifactorial fall prevention program group (n=15) and control treadmill group (n=10). [Methods] All interventions were applied for 30 min, five times per week, for five weeks. The fall prevention program included interventions based on the “Step Up to Stop Falls” initiative and educational interventions based on the Department of Health guidelines. For those in the treadmill group, the speed was increased gradually. The Korean falls efficacy scale and Korean activities-specific balance confidence scale were used to assess fear of falling. To assess balance and walking ability, the Korean performance-oriented mobility assessment scale and the 10-m and 6-minute walk tests were used. [Results] The fall prevention program interventions were found to be very effective at improving gait, balance, and fear of falling compared with the treadmill intervention and therefore seem appropriate for stroke patients. [Conclusion] A multifactorial fall prevention program is effective at improving balance, gait ability, and fear of falling. It is a more specific and broad intervention for reducing falls among inpatients in facilities and hospitals.

What factors influence community-dwelling older people's intent to undertake multifactorial fall prevention programs?

PurposeTo investigate previous, current, or planned participation in, and perceptions toward, multifactorial fall prevention programs such as those delivered through a falls clinic in the community setting, and to identify factors influencing older people’s intent to undertake these interventions.Design and methodsCommunity-dwelling people aged >70 years completed a telephone survey. Participants were randomly selected from an electronic residential telephone listing, but purposeful sampling was used to include equal numbers with and without common chronic health conditions associated with fall-related hospitalization. The survey included scenarios for fall prevention interventions, including assessment/multifactorial interventions, such as those delivered through a falls clinic. Participants were asked about previous exposure to, or intent to participate in, the interventions. A path model analysis was used to identify factors associated with intent to participate in assessment/multifactorial interventions.ResultsThirty of 376 participants (8.0%) reported exposure to a multifactorial falls clinic-type intervention in the past 5 years, and 16.0% expressed intention to undertake this intervention. Of the 132 participants who reported one or more falls in the past 12 months, over one-third were undecided or disagreed that a falls clinic type of intervention would be of benefit to them. Four elements from the theoretical model positively influenced intention to participate in the intervention: personal perception of intervention effectiveness, self-perceived risk of falls, self-perceived risk of injury, and inability to walk up/down steps without a handrail (P<0.05).ConclusionMultifactorial falls clinic-type interventions are not commonly accessed or considered as intended fall prevention approaches among community-dwelling older people, even among those with falls in the past 12 months. Factors identified as influencing intention to undertake these interventions may be useful in promoting or targeting these interventions.