title: Effectiveness of a falls-and-fracture nurse coordinator to reduce falls: a randomized, controlled trial of at-risk older adults.
abstract: OBJECTIVE
  To assess the effectiveness of a community-based falls-and-fracture nurse coordinator and multifactorial intervention in reducing falls in older people.
  
  
  METHODS
  Randomized, controlled trial.
  
  
  METHODS
  Screening for previous falls in family practice followed by community-based intervention.
  
  
  METHODS
  Three hundred twelve community-living people aged 75 and older who had fallen in the previous year.
  
  
  METHODS
  Home-based nurse assessment of falls-and-fracture risk factors and home hazards, referral to appropriate community interventions, and strength and balance exercise program. Control group received usual care and social visits.
  
  
  METHODS
  Primary outcome was rate of falls over 12 months. Secondary outcomes were muscle strength and balance, falls efficacy, activities of daily living, self-reported physical activity level, and quality of life (Medical Outcomes Study 36-item Short Form Questionnaire).
  
  
  RESULTS
  Of the 3,434 older adults screened for falls, 312 (9%) from 19 family practices were enrolled and randomized. The average age was 81+/-5, and 69% (215/312) were women. The incidence rate ratio for falls for the intervention group compared with the control group was 0.96 (95% confidence interval=0.70-1.34). There were no significant differences in secondary outcomes between the two groups.
  
  
  CONCLUSIONS
  This nurse-led intervention was not effective in reducing falls in older people who had fallen previously. Implementation and adherence to the fall-prevention measures was dependent on referral to other health professionals working in their usual clinical practice. This may have limited the effectiveness of the interventions.
authors.affiliation: Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand. c.elley@auckland.ac.nz
authors.forename: C Raina
authors.initials: CR
authors.lastname: Elley
authors.forename: M Clare
authors.initials: MC
authors.lastname: Robertson
authors.forename: Sue
authors.initials: S
authors.lastname: Garrett
authors.forename: Ngaire M
authors.initials: NM
authors.lastname: Kerse
authors.forename: Eileen
authors.initials: E
authors.lastname: McKinlay
authors.forename: Beverley
authors.initials: B
authors.lastname: Lawton
authors.forename: Helen
authors.initials: H
authors.lastname: Moriarty
authors.forename: Simon A
authors.initials: SA
authors.lastname: Moyes
authors.forename: A John
authors.initials: AJ
authors.lastname: Campbell
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003152:Community Health Nursing; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000451:nursing* / Q000517:prevention & control; D015577:Geriatric Assessment; D005851:Geriatric Nursing; D006620:Hip Fractures / Q000451:nursing / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009520:New Zealand; D009730:Nursing Assessment; D010348:Patient Care Team; D011446:Prospective Studies; D012017:Referral and Consultation; D012307:Risk Factors; D012449:Safety; D012931:Social Environment; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000451:nursing / Q000517:prevention & control