We welcome the article from Close and Lord on falls prevention, as raising awareness of this common, serious and costly condition is important.
However, the evidence for systematic screening for falls risk and intervening on those at high risk is still immature. Screening and intervening may be clinically effective - for example a recent RCT demonstrated a stratum-adjusted incidence rate ratio of 0.86 (95% CI 0.73-1.01), P = 0.08, and 0.73 (95% CI 0.51-1.03), P = 0.07 when adjusted for baseline characteristics in favour of a falls prevention programme for community dwelling older people at high risk of falls (1). However, it does not appear to be cost-effective - from the same study, the estimated Incremental Cost Effectiveness Ratio was ?3,320 per fall averted (2).
It is unlikely that such an exercise is affordable on a widespread scale, especially in a cost-constrained NHS. Recommendations on screening should be more tempered until more robust evidence is available.
1. Conroy S, Masud T, Coupland C, Drummond A, Gladman J, Harwood R, et al. A multicentre RCT of a day hospital falls prevention programme for community dwelling older people. Age Ageing 2010;39(S1):i33.
2. Lisa Irvine, Simon P. Conroy, Tracey Sach, John R. F. Gladman, Rowan H. Harwood, Denise Kendrick, et al. Cost-effectiveness of a day hospital falls prevention programme for screened community-dwelling older people at high risk of falls. Age Ageing 2010;39(6):710-16.
Competing interests:
Active researcher in the field
Competing interests:
Active researcher in the field
Rapid Response:
Screening for falls
We welcome the article from Close and Lord on falls prevention, as raising awareness of this common, serious and costly condition is important.
However, the evidence for systematic screening for falls risk and intervening on those at high risk is still immature. Screening and intervening may be clinically effective - for example a recent RCT demonstrated a stratum-adjusted incidence rate ratio of 0.86 (95% CI 0.73-1.01), P = 0.08, and 0.73 (95% CI 0.51-1.03), P = 0.07 when adjusted for baseline characteristics in favour of a falls prevention programme for community dwelling older people at high risk of falls (1). However, it does not appear to be cost-effective - from the same study, the estimated Incremental Cost Effectiveness Ratio was ?3,320 per fall averted (2).
It is unlikely that such an exercise is affordable on a widespread scale, especially in a cost-constrained NHS. Recommendations on screening should be more tempered until more robust evidence is available.
1. Conroy S, Masud T, Coupland C, Drummond A, Gladman J, Harwood R, et al. A multicentre RCT of a day hospital falls prevention programme for community dwelling older people. Age Ageing 2010;39(S1):i33.
2. Lisa Irvine, Simon P. Conroy, Tracey Sach, John R. F. Gladman, Rowan H. Harwood, Denise Kendrick, et al. Cost-effectiveness of a day hospital falls prevention programme for screened community-dwelling older people at high risk of falls. Age Ageing 2010;39(6):710-16.
Competing interests: Active researcher in the field
Competing interests: Active researcher in the field