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The Winchester falls project: a randomised controlled trial of secondary prevention of falls in older people

The Winchester falls project: a randomised controlled trial of secondary prevention of falls in older people
The Winchester falls project: a randomised controlled trial of secondary prevention of falls in older people


Background: the mortality and morbidity of falls in older people is significant, with recurrent fallers being at an increased
risk. The most effective way to reduce falls in this group is not clear.

Objective: to determine the effectiveness of two interventions, one based in primary care and the other in secondary care, at
preventing further falls in recurrent fallers.

Design: cluster randomised controlled trial.

Participants: sixty-five years or over, living in the community, two or more falls in the previous year and not presenting to an
emergency department with index fall.

Setting: Mid Hampshire, UK.

Intervention: eighteen general practices were randomly allocated to one of three groups. The primary care group was assessed by nurses in the community, using a risk factor review and subsequent targeted referral to other professionals. The secondary care group received a multi-disciplinary assessment in a day hospital followed by identified appropriate interventions. The control group received usual care. Follow-up was for 1 year.

Results: five hundred and five participants were recruited. Follow-up was completed in 83% (421/505). The proportion of
participants who fell again was significantly lower in the secondary care group (75%, 158/210) compared to the control group [84%, 133/159, adjusted odds ratio (OR) 0.52 (95% CI 0.35–0.79) P = 0.002]. The primary care group showed similar results to the control group [87%, 118/136, adjusted OR 1.17 (95% CI 0.57–2.37) P = 0.673].

Conclusion: a structured multi-disciplinary assessment of recurrent fallers significantly reduced the number experiencing
further falls, but a community-based nurse-led assessment with targeted referral to other professionals did not.
elderly, older people, prevention, randomised controlled trial, recurrent falls
0002-0729
33-40
Spice, Claire L.
57e1f75d-297d-43dc-80c6-2002a045d102
Morotti, Wendy
f28a26aa-d0b3-49ac-a22d-d49862964ea4
George, Steve
bdfc752b-f67e-4490-8dc0-99bfaeb046ca
Dent, Thomas H.S.
6118f281-7ad9-480f-9187-d0b83639dbdd
Rose, Jim
890dc69d-1fdb-4a27-ac0c-7c6088e0c87c
Harris, Scott
19ea097b-df15-4f0f-be19-8ac42c190028
Gordon, Christopher J.
7cb8cb99-c0e0-4e8e-b605-420b754e0c95
Spice, Claire L.
57e1f75d-297d-43dc-80c6-2002a045d102
Morotti, Wendy
f28a26aa-d0b3-49ac-a22d-d49862964ea4
George, Steve
bdfc752b-f67e-4490-8dc0-99bfaeb046ca
Dent, Thomas H.S.
6118f281-7ad9-480f-9187-d0b83639dbdd
Rose, Jim
890dc69d-1fdb-4a27-ac0c-7c6088e0c87c
Harris, Scott
19ea097b-df15-4f0f-be19-8ac42c190028
Gordon, Christopher J.
7cb8cb99-c0e0-4e8e-b605-420b754e0c95

Spice, Claire L., Morotti, Wendy, George, Steve, Dent, Thomas H.S., Rose, Jim, Harris, Scott and Gordon, Christopher J. (2008) The Winchester falls project: a randomised controlled trial of secondary prevention of falls in older people. Age and Ageing, 38 (1), 33-40. (doi:10.1093/ageing/afn192). (PMID:18829689)

Record type: Article

Abstract



Background: the mortality and morbidity of falls in older people is significant, with recurrent fallers being at an increased
risk. The most effective way to reduce falls in this group is not clear.

Objective: to determine the effectiveness of two interventions, one based in primary care and the other in secondary care, at
preventing further falls in recurrent fallers.

Design: cluster randomised controlled trial.

Participants: sixty-five years or over, living in the community, two or more falls in the previous year and not presenting to an
emergency department with index fall.

Setting: Mid Hampshire, UK.

Intervention: eighteen general practices were randomly allocated to one of three groups. The primary care group was assessed by nurses in the community, using a risk factor review and subsequent targeted referral to other professionals. The secondary care group received a multi-disciplinary assessment in a day hospital followed by identified appropriate interventions. The control group received usual care. Follow-up was for 1 year.

Results: five hundred and five participants were recruited. Follow-up was completed in 83% (421/505). The proportion of
participants who fell again was significantly lower in the secondary care group (75%, 158/210) compared to the control group [84%, 133/159, adjusted odds ratio (OR) 0.52 (95% CI 0.35–0.79) P = 0.002]. The primary care group showed similar results to the control group [87%, 118/136, adjusted OR 1.17 (95% CI 0.57–2.37) P = 0.673].

Conclusion: a structured multi-disciplinary assessment of recurrent fallers significantly reduced the number experiencing
further falls, but a community-based nurse-led assessment with targeted referral to other professionals did not.

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More information

Published date: 2008
Keywords: elderly, older people, prevention, randomised controlled trial, recurrent falls

Identifiers

Local EPrints ID: 62142
URI: http://eprints.soton.ac.uk/id/eprint/62142
ISSN: 0002-0729
PURE UUID: ee4a2e28-befe-4d69-a346-d72532ec0527

Catalogue record

Date deposited: 08 Apr 2009
Last modified: 15 Mar 2024 11:29

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Contributors

Author: Claire L. Spice
Author: Wendy Morotti
Author: Steve George
Author: Thomas H.S. Dent
Author: Jim Rose
Author: Scott Harris
Author: Christopher J. Gordon

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