Authors’ reply to BontenBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5116 (Published 30 September 2015) Cite this as: BMJ 2015;351:h5116
- Fabienne El-Khoury, doctoral researcher1,
- Bernard Cassou, professor of public health and geriatrician2,
- Patricia Dargent-Molina, senior researcher in epidemiology3
- 1Inserm, Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité (CRESS), U1153, F-94807, Villejuif, France
- 2Inserm, VIMA: Vieillissement et Maladies Chroniques, U1168, F-94807, Villejuif
- 3Inserm CRESS-Equipe ORCHARD, Hôpital Paul Brousse, 94807 Villejuif
Bonten’s comments and questions on how our results can be translated into clinical practice and integrated into clinical guidelines give us the opportunity to talk about the place that exercise programmes such as Ossébo may have in a comprehensive strategy of falls prevention in older people.1 2
Two approaches to falls prevention in community dwelling older people have been shown to be effective in randomised controlled trials. The first is the multifactorial and multidisciplinary approach, which involves individual clinical assessments of risk factors for falling, followed by multiple interventions targeting all remediable risk factors (normally within a specialist falls service). The second is single community based interventions targeting common risk factors (such as impaired strength and balance).
Multifactorial intervention community programmes are resource and staff intensive, and there is no evidence that they are more effective than single intervention programmes, such as balance and strength training.3 Hence, the multifactorial approach, especially if delivered by a multidisciplinary team, is generally reserved for those at high risk, such as frail …
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