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Age and Ageing Advance Access originally published online on October 1, 2008
Age and Ageing 2009 38(1):33-40; doi:10.1093/ageing/afn192
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© The Author 2008. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

The Winchester falls project: a randomised controlled trial of secondary prevention of falls in older people*

Claire L. Spice1, Wendy Morotti2, Steve George3, Thomas H. S. Dent4, Jim Rose5, Scott Harris6 and Christopher J. Gordon7

1 Consultant, Department of Medicine for Older People, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Southwick Hill, Cosham, PO6 3LY, UK
2 Project Research Nurse, Mid Hampshire Primary Care Trust, Tidbury Farm, Bullington Cross, Sutton Scotney, Hampshire, SO21 3QQ
3 Director of University of Southampton Clinical Trials Unit MP131, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
4 Mid Hampshire Primary Care Trust, Tidbury Farm, Bullington Cross, Sutton Scotney, Hampshire, SO21 3QQ
5 GP Principal. Derrydown Clinic, St Mary Bourne, Andover, UK
6 Statistician, Public Health Sciences and Medical Statistics Group, University of Southampton School of Medicine, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
7 Consultant Physician, Medicine and Elderly Care, Royal Hampshire County Hospital, Romsey Road, Winchester SO22 5DG, UK

Address correspondence to: Claire Spice, Department Medicine for Older People, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Southwick Hill, Cosham, PO6 3LY, UK. Email: claire.spice{at}porthosp.nhs.uk

Background: the mortality and morbidity of falls in older people is significant, with recurrent fallers being at an increased risk. The most effective way to reduce falls in this group is not clear.

Objective: to determine the effectiveness of two interventions, one based in primary care and the other in secondary care, at preventing further falls in recurrent fallers.

Design: cluster randomised controlled trial.

Participants: sixty-five years or over, living in the community, two or more falls in the previous year and not presenting to an emergency department with index fall.

Setting: Mid Hampshire, UK.

Intervention: eighteen general practices were randomly allocated to one of three groups. The primary care group was assessed by nurses in the community, using a risk factor review and subsequent targeted referral to other professionals. The secondary care group received a multi-disciplinary assessment in a day hospital followed by identified appropriate interventions. The control group received usual care. Follow-up was for 1 year.

Results: five hundred and five participants were recruited. Follow-up was completed in 83% (421/505). The proportion of participants who fell again was significantly lower in the secondary care group (75%, 158/210) compared to the control group [84%, 133/159, adjusted odds ratio (OR) 0.52 (95% CI 0.35–0.79) P = 0.002]. The primary care group showed similar results to the control group [87%, 118/136, adjusted OR 1.17 (95% CI 0.57–2.37) P = 0.673].

Conclusion: a structured multi-disciplinary assessment of recurrent fallers significantly reduced the number experiencing further falls, but a community-based nurse-led assessment with targeted referral to other professionals did not.

Keywords: elderly, older people, prevention, randomised controlled trial, recurrent falls

*This study was a joint initiative between the Royal Hampshire County Hospital and Mid-Hampshire Primary Care Trust with the work being carried out within the community and at the Royal Hampshire County Hospital.

Received 9 May 2007; accepted in revised form 16 July 2008.


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