title: Multifactorial fall prevention for pairs of frail community-dwelling older fallers and their informal caregivers: a dead end for complex interventions in the frailest fallers.
abstract: OBJECTIVE
  To assess whether a multifactorial fall prevention program was more effective than usual geriatric care in preventing falls and reducing fear of falling in frail community-dwelling older fallers, with and without cognitive impairment, and in alleviating subjective caregiver burden in caregivers.
  
  
  METHODS
  A randomized, 2 parallel-group, single-blind, multicenter trial conducted in 36 pairs of frail fallers, who were referred to a geriatric outpatient clinic after at least 1 fall in the past 6 months, and their informal caregivers.
  
  
  METHODS
  Groups of 5 pairs of patients and caregivers received 10 twice-weekly, 2-hour sessions with physical and psychological components and a booster session.
  
  
  METHODS
  The primary outcome was the fall rate during a 6-month follow-up. Additionally, we measured fear of falling and subjective caregiver burden. Data on the secondary outcome measures were collected at baseline, directly after, and at 3 and 6 months after the last session of the intervention.
  
  
  RESULTS
  Directly after the intervention and at the long-term evaluation, the rate of falls in the intervention group was higher than in the control group, although these differences were not statistically significant (RR = 7.97, P = .07 and RR = 2.12, P = .25, respectively). Fear of falling was higher in the intervention group, and subjective caregiver burden did not differ between groups.
  
  
  CONCLUSIONS
  Although we meticulously developed this pairwise multifactorial fall prevention program, it was not effective in reducing the fall rate or fear of falling and was not feasible for caregivers, as compared with regular geriatric care. Future research initiatives should be aimed at how to implement the evidence-based principles of geriatric fall prevention for all frail fallers rather than developing more complex interventions for the frailest.
authors: Radboud University Nijmegen Medical Centre, Department of Geriatric Medicine, Nijmegen, The Netherlands. m.faes@ger.umcn.nl
authors: Miriam C
authors: MC
authors: Faes
authors: Miriam F
authors: MF
authors: Reelick
authors: René J
authors: RJ
authors: Melis
authors: George F
authors: GF
authors: Borm
authors: Rianne A
authors: RA
authors: Esselink
authors: Marcel G Olde
authors: MG
authors: Rikkert
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D017028:Caregivers; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017063:Outcome Assessment, Health Care / Q000379:methods; D012112:Residential Facilities; D017751:Safety Management / Q000379:methods*