Annals of Long Term Care

CLINICAL INVESTIGATIONS
Effect of a Risk-Based Multifactorial Fall Prevention Program on the Incidence of Falls
Marika J. Salminen, PhD, Tero J. Vahlberg, MSc, Maritta T. Salonoja, MD, Pertti T.T. Aarnio, MD, PhD, and Sirkka-Liisa Kivelä, MD, PhD

OBJECTIVES: To evaluate the effects of a multifactorial fall prevention program on falls and to identify the subgroups that benefit the most.

DESIGN: Randomized controlled trial.

SETTING: Community-dwelling subjects who had fallen at least once during the previous 12 months.

PARTICIPANTS: Five hundred ninety-one subjects randomized into intervention (IG) (n=293) and control (CG) (n=298) groups.

INTERVENTION: A multifactorial 12-month fall prevention program.

MEASUREMENTS: Incidence of falls.

RESULTS: The intervention did not reduce the incidence of falls overall (incidence rate ratio (IRR) for IG vs CG=0.92, 95% confidence interval (CI)=0.72–1.19). In subgroup analyses, significant interactions between subgroups and groups (IG and CG) were found for depressive symptoms (P=.006), number of falls during the previous 12 months (P=.003), and self-perceived risk of falling (P=.045). The incidence of falls decreased in subjects with a higher number of depressive symptoms (IRR=0.50, 95% CI=0.28–0.88), whereas it increased in those with a lower number of depressive symptoms (IRR=1.20, 95% CI=0.92–1.57). The incidence of falls decreased also in those with at least three previous falls (IRR=0.59, 95% CI=0.38–0.91) compared to those with one or two previous falls (IRR=1.28, 95% CI=0.95–1.72). The intervention was also more effective in subjects with high self-perceived risk of falling (IRR=0.77, 95% CI=0.55–1.06) than in those with low self-perceived risk (IRR=1.28, 95% CI=0.88–1.86).

CONCLUSION: The program was not effective in reducing falls in the total sample of community-dwelling subjects with a history of falling, but the incidence of falls decreased in participants with a higher number of depressive symptoms and in those with at least three falls. J Am Geriatr Soc 2009;57(4):612-619.

OBJECTIVES: To study the feasibility and effectiveness of a discharge planning intervention.

DESIGN: Quasi-experimental pre–post study design.

SETTING: General medicine wards at three hospitals: an academic medical center, a community teaching hospital, and a community-based nonteaching hospital.

PARTICIPANTS: All patients aged 65 and older admitted to the hospitalist services.

INTERVENTION: The intervention toolkit had five core elements: admission form with geriatric cues, facsimile to the primary care provider, interdisciplinary worksheet to identify barriers to discharge, pharmacist–physician collaborative medication reconciliation, and predischarge planning appointments.

MEASUREMENTS: Thirty-day re-admission and return to emergency department rates and patient satisfaction with discharge. Odds ratios were determined, and site effects were examined according to interaction terms and Breslow Day statistics.

RESULTS: Two hundred thirty-seven patients were followed during the preintervention period, and 185 were exposed to the intervention. Patients characteristics were similar across the two time periods. The proportion of patients with high-quality transitions home, measured according to Coleman's Care Transition Measures, increased from 68% to 89% (odds ratio (OR)=3.49, 95% confidence interval (CI)=2.06–5.92).