title: A preliminary study of the effectiveness of an otolaryngology-based multidisciplinary falls prevention clinic.
abstract: Because the cause of falls is often multifactorial, efforts to identify risk factors and promote prevention would benefit from a multidisciplinary approach in which the contributions of a broad range of body systems are considered. We describe the practices and procedures followed at the otolaryngology-based multidisciplinary Falls Prevention Clinic at Henry Ford Hospital in Detroit. Our team is made up of an otolaryngologist, an audiologist, an internist, and a physical therapist. Our multidisciplinary approach involves evaluations of vestibular and balance function, cardiovascular function, and visual function; lower-extremity strength and sensation; cognition and mood; and medication use. We also assess a number of nonmedical risk factors. Evaluations are made over the course of two clinic visits. To assess the effectiveness of our approach, we conducted a preliminary study based on chart reviews and telephone interviews of 52 patients who had been referred to our clinic for evaluation and counseling. The basis of our study was a comparison of the number of falls that patients had experienced during the 6 months prior to their first visit to our clinic and the number of falls they experienced during the 6 months after their second visit. We found that among "true fallers" (i.e., those who had actually experienced a fall at some point during the study), 64.7% reported that they had experienced fewer falls after their clinic visits than before (p < 0.001). Also, 59.1% of patients who had been "frequent fallers" prior to their clinic evaluation (i.e., >or=3 falls during the previous 6 mo) reported that they had not fallen at all during the 6 months following their last visit. Finally, our evaluations identified a substantial number of risk factors in individual patients that had been missed previously, including many nonvestibular factors that might not have been detected without a multidisciplinary approach. We conclude that the results of this preliminary study demonstrate the potential that a comprehensive falls prevention clinic can have in reducing the number of falls among outpatients at risk, and we believe that further study is warranted.
authors.affiliation: Division of Audiology, Department of Otolaryngology, Henry Ford Hospital, 2799 W. Grand Blvd., K-8, Detroit, MI 48202, USA. lalvord1@hfhs.org
authors.forename: Lynn S
authors.initials: LS
authors.lastname: Alvord
authors.forename: Michael S
authors.initials: MS
authors.lastname: Benninger
authors.forename: Brad A
authors.initials: BA
authors.lastname: Stach
mesh_terms: D000056:Accident Prevention / Q000379:methods*; D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data*; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D010036:Otolaryngology / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration; D011322:Primary Prevention / Q000379:methods*; D011336:Probability; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D018709:Statistics, Nonparametric