BMJ 2003;326:73 ( 11 January )

Papers

Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: randomised controlled trial

Fiona E Shaw, Alzheimer's Society research fellow, ^a John Bond, professor, ^b David A Richardson, clinical research associate, ^a Pamela Dawson, senior lecturer, ^c I Nicholas Steen, statistician, ^b Ian G McKeith, professor, ^d Rose Anne Kenny, professor of cardiovascular research. ^a

^a Cardiovascular Investigation Unit, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, ^b Centre for Health Services Research, University of Newcastle upon Tyne NE2 4AA, ^c Division of Physiotherapy and Applied Life Sciences, University of Northumbria, Newcastle upon Tyne NE7 7XA, ^d Department of Old Age Psychiatry, Newcastle General Hospital, Newcastle upon Tyne NE4 6BE

Correspondence to: Dr Shaw, Newcastle General Hospital, Newcastle upon Tyne NE4 6BE fionashaw{at}aol.com

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.

What is already known on this topic Multifactorial intervention prevents falls in cognitively normal older people living in the community and in those who present to the accident and emergency department after a fall Fall prevention strategies have not been tested by controlled trials in patients with cognitive impairment and dementia who fall What this study adds No benefit was shown from multifactorial assessment and intervention after a fall in patients with cognitive impairment and dementia presenting to the accident and emergency department The intervention was less effective in these patients than in cognitively normal older people

---

© 2003 BMJ Publishing Group Ltd
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Preventing falls in elderly people living in hospitals and care homes

Ian D Cameron and Susan Kurrle
BMJ 2007 334: 53-54. [Extract] [Full Text] [PDF]

Randomised controlled trial of prevention of falls in people aged 75 with severe visual impairment: the VIP trial

A John Campbell, M Clare Robertson, Steven J La Grow, Ngaire M Kerse, Gordon F Sanderson, Robert J Jacobs, Dianne M Sharp, and Leigh A Hale
BMJ 2005 331: 817. [Abstract] [Full Text] [PDF]

Multifactorial intervention fails to prevent falls
BMJ 2003 326: 0. [Full Text] [PDF]

A doctor ponders, a journalist reveals
BMJ 2003 326: 0. [Full Text] [PDF]

This article has been cited by other articles:

• Developed in collaboration with, , European Heart Rhythm Association (EHRA), , Heart Failure Association (HFA), , and Heart Rhythm Society (HRS), , Endorsed by the following societies, , European Society of Emergency Medicine (EuSEM), , European Federation of Internal Medicine (EFIM), , European Union Geriatric Medicine Society (EUGMS), , American Geriatrics Society (AGS), , European Neurological Society (ENS), , European Federation of Autonomic Societies (EFAS), , American Autonomic Society (AAS), , Authors/Task Force Members, , Moya, A., Sutton, R., Ammirati, F., Blanc, J.-J., Brignole, M., Dahm, J. B., Deharo, J.-C., Gajek, J., Gjesdal, K., Krahn, A., Massin, M., Pepi, M., Pezawas, T., Granell, R. R., Sarasin, F., Ungar, A., van Dijk, J. G., Walma, E. P., Wieling, W., External Contributors, , Abe, H., Benditt, D. G., Decker, W. W., Grubb, B. P., Kaufmann, H., Morillo, C., Olshansky, B., Parry, S. W., Sheldon, R., Shen, W. K., ESC Committee for Practice Guidelines (CPG), , Vahanian, A., Auricchio, A., Bax, J., Ceconi, C., Dean, V., Filippatos, G., Funck-Brentano, C., Hobbs, R., Kearney, P., McDonagh, T., McGregor, K., Popescu, B. A., Reiner, Z., Sechtem, U., Sirnes, P. A., Tendera, M., Vardas, P., Widimsky, P., Document Reviewers, , Auricchio, A., Acarturk, E., Andreotti, F., Asteggiano, R., Bauersfeld, U., Bellou, A., Benetos, A., Brandt, J., Chung, M. K., Cortelli, P., Da Costa, A., Extramiana, F., Ferro, J., Gorenek, B., Hedman, A., Hirsch, R., Kaliska, G., Kenny, R. A., Kjeldsen, K. P., Lampert, R., Molgard, H., Paju, R., Puodziukynas, A., Raviele, A., Roman, P., Scherer, M., Schondorf, R., Sicari, R., Vanbrabant, P., Wolpert, C., Zamorano, J. L. (2009). Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC). Eur Heart J 30: 2631-2671 [Full text]  
• Liu-Ambrose, T. Y, Ashe, M. C, Graf, P., Beattie, B L., Khan, K. M (2008). Increased Risk of Falling in Older Community-Dwelling Women With Mild Cognitive Impairment. ptjournal 88: 1482-1491 [Abstract] [Full text]  
• Allore, H. G, Murphy, T. E (2008). Review: An examination of effect estimation in factorial and standardly-tailored designs. Clin Trials 5: 121-130 [Abstract]  
• Campbell, A. J., Robertson, M. C. (2007). Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial interventions. Age Ageing 36: 656-662 [Abstract] [Full text]  
• Sjosten, N. M., Salonoja, M., Piirtola, M., Vahlberg, T. J., Isoaho, R., Hyttinen, H. K., Aarnio, P. T., Kivela, S.-L. (2007). A multifactorial fall prevention programme in the community-dwelling aged: predictors of adherence. Eur J Public Health 17: 464-470 [Abstract] [Full text]  
• Allan, L M, Ballard, C G, Allen, J, Murray, A, Davidson, A W, McKeith, I G, Kenny, R A (2007). Autonomic dysfunction in dementia. J. Neurol. Neurosurg. Psychiatry 78: 671-677 [Abstract] [Full text]  
• Cameron, I. D, Kurrle, S. (2007). Preventing falls in elderly people living in hospitals and care homes. BMJ 334: 53-54 [Full text]  
• Yardley, L., Bishop, F. L., Beyer, N., Hauer, K., Kempen, G. I. J. M., Piot-Ziegler, C., Todd, C. J., Cuttelod, T., Horne, M., Lanta, K., Holt, A. R. (2006). Older People's Views of Falls-Prevention Interventions in Six European Countries.. Gerontologist 46: 650-660 [Abstract] [Full text]  
• Aspray, T. J., Francis, R. M. (2006). Fracture prevention in care home residents: is vitamin D supplementation enough?. Age Ageing 35: 455-456 [Full text]  
• Whitney, J. C., Lord, S. R., Close, J. C. T. (2005). Streamlining assessment and intervention in a falls clinic using the Timed Up and Go Test and Physiological Profile Assessments. Age Ageing 34: 567-571 [Abstract] [Full text]  
• Campbell, A J., Robertson, M C., La Grow, S. J, Kerse, N. M, Sanderson, G. F, Jacobs, R. J, Sharp, D. M, Hale, L. A (2005). Randomised controlled trial of prevention of falls in people aged >=75 with severe visual impairment: the VIP trial. BMJ 331: 817- [Abstract] [Full text]  
• Allore, H. G, Tinettia, M. E, Gill, T. M, Peduzzi, P. N (2005). Experimental designs for multicomponent interventions among persons with multifactorial geriatric syndromes. Clin Trials 2: 13-21 [Abstract]  
• Pearse, H., Nicholson, L., Bennett, M. (2004). Falls in hospices: a cancer network observational study of fall rates and risk factors. Palliat Med 18: 478-481 [Abstract]  
• Garelick, A., Fagin, L. (2004). Doctor to doctor: getting on with colleagues. Adv. Psychiatr. Treat. 10: 225-232 [Abstract] [Full text]  
• Chang, J. T, Morton, S. C, Rubenstein, L. Z, Mojica, W. A, Maglione, M., Suttorp, M. J, Roth, E. A, Shekelle, P. G (2004). Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. BMJ 328: 680- [Abstract] [Full text]  
• (2004). Guidelines on Management (diagnosis and treatment) of syncope - update 2004: The Task Force on Syncope, European Society of Cardiology. Europace 6: 467-537 [Full text]  
• Birks, Y. (2003). A structured education programme increased hip protector use and may reduce hip fractures in nursing homes.. Evid. Based Nurs. 6: 114-115 [Full text]  
• (2003). It's Not Easy to Prevent Falls in Demented People. JWatch Psychiatry 2003: 8-8 [Full text]  
• (2003). It's Not Easy to Prevent Falls in Demented People. JWatch General 2003: 4-4 [Full text]  

Rapid Responses:

Read all Rapid Responses

Long live Medispeak!

Alan N Conner
bmj.com, 10 Jan 2003 [Full text]

Fracture risk against fall risk

Matthew Thomas, et al.
bmj.com, 17 Jan 2003 [Full text]

Two too different calls for falls

Giovanni Gambassi, et al.
bmj.com, 25 Jan 2003 [Full text]

Preventing Falls in Cognitively Impaired Older People

Rebecca S Walton, et al.
bmj.com, 25 Feb 2003 [Full text]

Online poll

Find out more on doc2doc >>