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

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© 2003 BMJ Publishing Group Ltd
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