Multifactorial Intervention After a Fall in Older People with Cognitive Impairment and Dementia Presenting to the Accident and Emergency Department: Randomised Controlled Trial

Overview

Journal BMJ

Specialty General Medicine

Date 2003 Jan 11

PMID 12521968

Citations 92

Authors

Fiona E Shaw

John Bond

David A Richardson

Pamela Dawson

I Nicholas Steen

Ian G McKeith

Rose Anne Kenny

Affiliations

Soon will be listed here.

Abstract

Objective: To determine the effectiveness of multifactorial intervention after a fall in older patients with cognitive impairment and dementia attending the accident and emergency department.

Design: Randomised controlled trial.

Participants: 274 cognitively impaired older people (aged 65 or over) presenting to the accident and emergency department after a fall: 130 were randomised to assessment and intervention and 144 were randomised to assessment followed by conventional care (control group).

Setting: Two accident and emergency departments, Newcastle upon Tyne.

Main Outcome Measures: Primary outcome was number of participants who fell in year after intervention. Secondary outcomes were number of falls (corrected for diary returns), time to first fall, injury rates, fall related attendances at accident and emergency department, fall related hospital admissions, and mortality.

Results: Intention to treat analysis showed no significant difference between intervention and control groups in proportion of patients who fell during 1 year's follow up (74% (96/130) and 80% (115/144), relative risk ratio 0.92, 95% confidence interval 0.81 to 1.05). No significant differences were found between groups for secondary outcome measures.

Conclusions: Multifactorial intervention was not effective in preventing falls in older people with cognitive impairment and dementia presenting to the accident and emergency department after a fall.

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References

Ballard C, Shaw F, McKeith I, Kenny R . High prevalence of neurovascular instability in neurodegenerative dementias. Neurology. 1998; 51(6):1760-2. DOI: 10.1212/wnl.51.6.1760. View

Ward C, Gray J, Gilroy J, Kenny R . Midodrine: a role in the management of neurocardiogenic syncope. Heart. 1998; 79(1):45-9. PMC: 1728578. DOI: 10.1136/hrt.79.1.45. View

Chong R, Horak F, Frank J, Kaye J . Sensory organization for balance: specific deficits in Alzheimer's but not in Parkinson's disease. J Gerontol A Biol Sci Med Sci. 1999; 54(3):M122-8. DOI: 10.1093/gerona/54.3.m122. View

Close J, Ellis M, Hooper R, Glucksman E, Jackson S, Swift C . Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. Lancet. 1999; 353(9147):93-7. DOI: 10.1016/S0140-6736(98)06119-4. View

Campbell A, Robertson M, GARDNER M, Norton R, Tilyard M, Buchner D . Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ. 1997; 315(7115):1065-9. PMC: 2127698. DOI: 10.1136/bmj.315.7115.1065. View

. Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. J Am Geriatr Soc. 2001; 49(5):664-72. View

Berghmans R, ter Meulen R . Ethical issues in research with dementia patients. Int J Geriatr Psychiatry. 1995; 10(8):647-51. DOI: 10.1002/gps.930100803. View

Folstein M, Folstein S, McHugh P . "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3):189-98. DOI: 10.1016/0022-3956(75)90026-6. View

Tinetti M . Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc. 1986; 34(2):119-26. DOI: 10.1111/j.1532-5415.1986.tb05480.x. View

10.

Tideiksaar R . Preventing falls: home hazard checklists to help older patients protect themselves. Geriatrics. 1986; 41(5):26-8. View

11.

Tinetti M, Speechley M, Ginter S . Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988; 319(26):1701-7. DOI: 10.1056/NEJM198812293192604. View

12.

Rubenstein L, Robbins A, Josephson K, SCHULMAN B, Osterweil D . The value of assessing falls in an elderly population. A randomized clinical trial. Ann Intern Med. 1990; 113(4):308-16. DOI: 10.7326/0003-4819-113-4-308. View

13.

Lauritzen J, Petersen M, Lund B . Effect of external hip protectors on hip fractures. Lancet. 1993; 341(8836):11-3. DOI: 10.1016/0140-6736(93)92480-h. View

14.

McIntosh S, Da Costa D, Kenny R . Outcome of an integrated approach to the investigation of dizziness, falls and syncope in elderly patients referred to a 'syncope' clinic. Age Ageing. 1993; 22(1):53-8. DOI: 10.1093/ageing/22.1.53. View

15.

van Dijk P, Meulenberg O, van de Sande H, Habbema J . Falls in dementia patients. Gerontologist. 1993; 33(2):200-4. DOI: 10.1093/geront/33.2.200. View

16.

Mulrow C, Gerety M, Kanten D, Cornell J, DeNino L, Chiodo L . A randomized trial of physical rehabilitation for very frail nursing home residents. JAMA. 1994; 271(7):519-24. View

17.

Koch M, Gottschalk M, Baker D, Palumbo S, Tinetti M . An impairment and disability assessment and treatment protocol for community-living elderly persons. Phys Ther. 1994; 74(4):286-94; discussion 295-8. DOI: 10.1093/ptj/74.4.286. View

18.

BURKE W, Coronado P, Schmitt C, Gillespie K, Chung H . Blood pressure regulation in Alzheimer's disease. J Auton Nerv Syst. 1994; 48(1):65-71. DOI: 10.1016/0165-1838(94)90160-0. View

19.

Tinetti M, Baker D, McAvay G, Claus E, Garrett P, Gottschalk M . A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med. 1994; 331(13):821-7. DOI: 10.1056/NEJM199409293311301. View

20.

Wolf S, Barnhart H, Kutner N, McNeely E, Coogler C, Xu T . Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. J Am Geriatr Soc. 1996; 44(5):489-97. DOI: 10.1111/j.1532-5415.1996.tb01432.x. View