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A multidisciplinary intervention to prevent subsequent falls and health service use following fall-related paramedic care: a randomised controlled trial.

Authors
  • Mikolaizak, A Stefanie1
  • Lord, Stephen R1
  • Tiedemann, Anne2
  • Simpson, Paul3
  • Caplan, Gideon A4
  • Bendall, Jason5
  • Howard, Kirsten6
  • Webster, Lyndell1
  • Payne, Narelle1
  • Hamilton, Sarah1
  • Lo, Joanne1
  • Ramsay, Elisabeth2
  • O'Rourke, Sandra1
  • Roylance, Linda1
  • Close, J C7, 8
  • 1 Falls Balance Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia. , (Australia)
  • 2 The George Institute for Global Health, Sydney, New South Wales, Australia. , (Australia)
  • 3 Western Sydney University, School of Science and Health, Campbelltown, New South Wales, Australia. , (Australia)
  • 4 Post Acute Care Services, Prince of Wales Hospital, Randwick, Sydney, New South Wales 2031, Australia. , (Australia)
  • 5 University of the Sunshine Coast, Maroochydore DC, Queensland, Australia. , (Australia)
  • 6 Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia. , (Australia)
  • 7 Neuroscience Research Australia, Randwick, New South Wales, Australia. , (Australia)
  • 8 UNSW Prince of Wales Clinical School, Randwick, New South Wales, Australia. , (Australia)
Type
Published Article
Journal
Age and Ageing
Publisher
Oxford University Press
Publication Date
Mar 01, 2017
Volume
46
Issue
2
Pages
200–207
Identifiers
DOI: 10.1093/ageing/afw190
PMID: 28399219
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

approximately 25% of older people who fall and receive paramedic care are not subsequently transported to an emergency department (ED). These people are at high risk of future falls, unplanned healthcare use and poor health outcomes. to evaluate the impact of a fall-risk assessment and tailored fall prevention interventions among older community-dwellers not transported to ED following a fall on subsequent falls and health service use. Randomised controlled trial involving 221 non-transported older fallers from Sydney, Australia. the intervention targeted identified risk factors and used existing services to implement physiotherapy, occupational therapy, geriatric assessment, optometry and medication management interventions as appropriate. The control group received individualised written fall prevention advice. primary outcome measures were rates of falls and injurious falls. Secondary outcome measures were ambulance re-attendance, ED presentation, hospitalisation and quality of life over 12 months. Analysis was by intention-to-treat and per-protocol according to self-reported adherence using negative binominal regression and multivariate analysis. ITT analysis showed no significant difference between groups in subsequent falls, injurious falls and health service use. The per-protocol analyses revealed that the intervention participants who adhered to the recommended interventions had significantly lower rates of falls compared to non-adherers (IRR: 0.53 (95% CI : 0.32-0.87)). a multidisciplinary intervention did not prevent falls in older people who received paramedic care but were not transported to ED. However the intervention was effective in those who adhered to the recommendations. the trial is registered at the Australian New Zealand Clinical Trials Registry: ACTRN 12611000503921, 13/05/2011. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: [email protected]

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