title: Patients with recurrent falls attending Accident & Emergency benefit from multifactorial intervention--a randomised controlled trial.
abstract: OBJECTIVE
  To determine the effectiveness of multifactorial intervention to prevent falls in cognitively intact older persons with recurrent falls.
  
  
  METHODS
  Randomised controlled trial of multifactorial (medical, physiotherapy and occupational therapy) post-fall assessment and intervention compared with conventional care.
  
  
  METHODS
  Accident & Emergency departments in a university teaching hospital and associated district general hospital.
  
  
  METHODS
  313 cognitively intact men and women aged over 65 years presenting to Accident & Emergency with a fall or fall-related injury and at least one additional fall in the preceding year; 159 randomised to assessment and intervention and 154 to conventional care.
  
  
  METHODS
  primary outcome was the number of falls and fallers in 1 year after recruitment. Secondary outcomes included injury rates, fall-related hospital admissions, mortality and fear of falling.
  
  
  RESULTS
  There were 36% fewer falls in the intervention group (relative risk 0.64, 95% confidence interval 0.46-0.90). The proportion of subjects continuing to fall (65% (94/144) compared with 68% (102/149) relative risk 0.95, 95% confidence interval 0.81-1.12), and the number of fall-related attendances and hospital admissions was not different between groups. Duration of hospital admission was reduced (mean difference admission duration 3.6 days, 95% confidence interval 0.1-7.6) and falls efficacy was better in the intervention group (mean difference in Activities Specific Balance Confidence Score of 7.5, 95% confidence interval 0.72-14.2).
  
  
  CONCLUSIONS
  Multifactorial intervention is effective at reducing the fall burden in cognitively intact older persons with recurrent falls attending Accident & Emergency, but does not reduce the proportion of subjects still falling.
authors.affiliation: Falls and Syncope Service and Institute for Ageing and Health, Newcastle General Hospital, Newcastle upon Tyne, UK.
authors.forename: John
authors.initials: J
authors.lastname: Davison
authors.forename: John
authors.initials: J
authors.lastname: Bond
authors.forename: Pamela
authors.initials: P
authors.lastname: Dawson
authors.forename: I Nicholas
authors.initials: IN
authors.lastname: Steen
authors.forename: Rose Anne
authors.initials: RA
authors.lastname: Kenny
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D003131:Combined Modality Therapy; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006769:Hospitals, General; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D009788:Occupational Therapy; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D010359:Patient Readmission / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities; D012307:Risk Factors; D015996:Survival Rate; D014947:Wounds and Injuries / Q000517:prevention & control / Q000534:rehabilitation