title: Multifactorial assessment and targeted intervention to reduce falls among the oldest-old: a randomized controlled trial.
abstract: BACKGROUND
  The purpose of this study was to assess the effectiveness of a multifactorial intervention to reduce falls among the oldest-old people, including individuals with cognitive impairment or comorbidities.
  
  
  METHODS
  A randomized, single-blind, parallel-group clinical trial was conducted from January 2009 to December 2010 in seven primary health care centers in Baix Llobregat (Barcelona). Of 696 referred people who were born in 1924, 328 were randomized to an intervention group or a control group. The intervention model used an algorithm and was multifaceted for both patients and their primary care providers. Primary outcomes were risk of falling and time until falls. Data analyses were by intention-to-treat.
  
  
  RESULTS
  Sixty-five (39.6%) subjects in the intervention group and 48 (29.3%) in the control group fell during follow-up. The difference in the risk of falls was not significant (relative risk 1.28, 95% confidence interval [CI] 0.94-1.75). Cox regression models with time from randomization to the first fall were not significant. Cox models for recurrent falls showed that intervention had a negative effect (hazard ratio [HR] 1.46, 95% CI 1.03-2.09) and that functional impairment (HR 1.42, 95% CI 0.97-2.12), previous falls (HR 1.09, 95% CI 0.74-1.60), and cognitive impairment (HR 1.08, 95% CI 0.72-1.60) had no effect on the assessment.
  
  
  CONCLUSIONS
  This multifactorial intervention among octogenarians, including individuals with cognitive impairment or comorbidities, did not result in a reduction in falls. A history of previous falls, disability, and cognitive impairment had no effect on the program among the community-dwelling subjects in this study.
authors.affiliation: Primary Healthcare Centre "El Plà" CAP-I, Sant Feliu de Llobregat, Spain.
authors.forename: Assumpta
authors.initials: A
authors.lastname: Ferrer
authors.affiliation: Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, Spain ; Bellvitge Biomedical Research Institute, IDIBELL, L'Hospitalet de Llobregat, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Formiga
authors.affiliation: Support Research Unit, Primary Health Department Costa Ponent, IDIAP Jordi Gol, Barcelona, Spain.
authors.forename: Héctor
authors.initials: H
authors.lastname: Sanz
authors.affiliation: Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Oscar J
authors.initials: OJ
authors.lastname: de Vries
authors.affiliation: Primary Healthcare Centre Martorell, Barcelona, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Badia
authors.affiliation: Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, Spain ; Bellvitge Biomedical Research Institute, IDIBELL, L'Hospitalet de Llobregat, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Pujol
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000369:Aged, 80 and over; D000465:Algorithms; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015397:Program Evaluation; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D016037:Single-Blind Method
keywords: elderly; falls; intervention