title: Community-based intervention to optimise falls risk management: a randomised controlled trial.
abstract: BACKGROUND
  falls are the leading causes of accidental death and fragility fractures in older adults. Interventions that assess and reduce falls risk are underutilised.
  
  
  OBJECTIVE
  to evaluate the impact of a multifaceted community-based programme aimed at optimising evidence-based management of patients at risk for fall-related fractures.
  
  
  METHODS
  this was a randomised trial performed from 2003 to 2006.
  
  
  METHODS
  community-based intervention in Ontario, Canada.
  
  
  METHODS
  eligible patients were community-dwelling, aged > or =55 years and identified to be at risk for fall-related fractures. A total of 201 patients were allocated to the intervention group or to usual care.
  
  
  METHODS
  components of the intervention included assessment of falls risk, functional status and home environment, and patient education.
  
  
  METHODS
  primary outcome was the implementation of appropriate falls risk assessment at 6 months. Secondary outcomes included falls and fractures at 6 and 12 months.
  
  
  RESULTS
  the mean age of participants was 72 years, and 41% had fallen with injury in the previous year. Compared to usual care, the intervention increased the number of referrals made to physiotherapy [21% (21/101) vs 6.0% (6/100); relative risk (RR) 3.47, 95% confidence interval (CI) 1.46-8.22] and occupational therapy [15% (15/101) vs 0%; RR 30.7, 95% CI 1.86 to >500]. At 12 months, the number of falls in the intervention group was greater than in the usual care group [23% (23/101) vs 11% (11/100); RR 2.07, 95% CI 1.07-4.02].
  
  
  CONCLUSIONS
  compared to usual care, a multi-faceted intervention increased referrals to physiotherapy and occupational therapy but did not reduce risk of falls. Similar falls reduction interventions cannot be recommended based on the results of this study.
authors.affiliation: Algoma District Medical Group, Sault Ste. Marie, Canada.
authors.forename: P M
authors.initials: PM
authors.lastname: Ciaschini
authors.forename: S E
authors.initials: SE
authors.lastname: Straus
authors.forename: L R
authors.initials: LR
authors.lastname: Dolovich
authors.forename: R A
authors.initials: RA
authors.lastname: Goeree
authors.forename: K M
authors.initials: KM
authors.lastname: Leung
authors.forename: C R
authors.initials: CR
authors.lastname: Woods
authors.forename: G M
authors.initials: GM
authors.lastname: Zimmerman
authors.forename: S R
authors.initials: SR
authors.lastname: Majumdar
authors.forename: S
authors.initials: S
authors.lastname: Spadafora
authors.forename: L A
authors.initials: LA
authors.lastname: Fera
authors.forename: H N
authors.initials: HN
authors.lastname: Lee
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D019317:Evidence-Based Medicine; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009864:Ontario; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D012307:Risk Factors; D012308:Risk Management / Q000458:organization & administration*