Research Article

Can health visitors prevent fractures in elderly people?

BMJ 1992; 304 doi: (Published 04 April 1992) Cite this as: BMJ 1992;304:888
  1. N. J. Vetter,
  2. P. A. Lewis,
  3. D. Ford
  1. University of Wales College of Medicine, Cardiff.


    OBJECTIVES--To assess whether intervention by a health visitor could reduce the number of fractures, over a four year period, in those aged 70 and over. DESIGN--Randomised, controlled trial; randomisation by household. SETTING--General practice in a market town. SUBJECTS--Of 863 patients aged 70 and over on the practice records, 674 were traced and successfully interviewed; 350 were assigned to the intervention group, 324 as controls. INTERVENTION--The people in the intervention group were allocated to the care of a health visitor. The approach was four pronged: assessment and correction of nutritional deficiencies, including reducing smoking and alcohol intake; assessment and referral of medical conditions such as heart block or inappropriate medication; assessment and correction of environmental hazards in the home such as poor lighting; assessment and improvement of fitness--for example, exercise classes for the moderately fit. The intervention continued for four years. MAIN OUTCOME MEASURE--Fracture rate over four years. RESULTS--The incidence of fractures was 5% (16/350) in the intervention group and 4% (14/324) in the control group (difference not significant). CONCLUSIONS--A health visitor visiting a group of people aged 70 and over and using simple preventive measures had no effect on the incidence of fractures.