Home and Community Care Digest
Methods: In a study by Cumming et al., twenty-four hospital wards were randomized to either an intervention or a control group. For three months, the intervention group received a targeted multidisciplinary intervention to prevent falls from a nurse and physiotherapist. The study sample consisted of 3,999 elderly with a median hospital stay of seven days. The numbers of falls were compared between the two study groups after the three month study period. In the Hendriks et al. study, the costs and effects of a fall program were evaluated from a societal perspective, which took into account all relevant costs and outcomes. One hundred and sixty-six elderly were randomly allocated to one of the two study groups and were followed for 12 months. The intervention group received the interdisciplinary intervention program for approximately 3.5 months while the control group received the usual care. The costs and outcomes of the care between the two groups were then compared.
Findings: In the Cumming et al. study, the frequency of falls, injurious falls, or fractures were similar between intervention and control wards. Similarly, the Hendriks et al. study detected no difference in either costs or effects of the fall intervention between the intervention and control groups. The multidisciplinary intervention program to prevent falls was not cost-effective when compared with usual care. Health care utilization in the intervention and control groups was comparable. Furthermore, the intervention was found to have no effect on falls, daily functioning, or quality of life measures.
Conclusions: Studies undertaken in different countries offer consistent evidence that multidisciplinary fall prevention programs are not always effective and cost-effective among the elderly population. These findings offer the following messages to policy decision-makers: 1) interventions are specific to the targets and locations, e.g., interventions which work in one group may not work in another group; 2) interventions aimed at multiple disciplines do not always work; and 3) economic evaluations of an intervention are necessary to assess both the costs and effects of an intervention. This evidence should be taken into consideration when designing and approving an intervention to prevent falls among elderly.
Cumming RG, Sherrington C, Lord SR, Simpson JM, Vogler C, Cameron ID, Naganathan V. Cluster randomised trial of a targeted multifactorial intervention to prevent falls among older people in hospital. BMJ. 2008; doi:10.1136/bmj.39499.546030.BE
Hendriks M, Evers S Bleijlevens M, van Haastregt J, Crebolder H, van Eijk J. Cost-effectiveness of a multidisciplinary fall prevention program in community-dwelling elderly people: A randomized controlled trial. International Journal of Technology Assessment in Health Care. 2008; 2: 193-202.
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