Effectiveness of a falls-and-fracture nurse coordinator to reduce falls: a randomized, controlled trial of at-risk older adults.
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.
Elley
C Raina
CR
Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand. c.elley@auckland.ac.nz
Robertson
M Clare
MC
Garrett
Sue
S
Kerse
Ngaire M
NM
McKinlay
Eileen
E
Lawton
Beverley
B
Moriarty
Helen
H
Moyes
Simon A
SA
Campbell
A John
AJ
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