Age and Ageing Advance Access originally published online on September 19, 2009
Age and Ageing 2009 38(6):724-730; doi:10.1093/ageing/afp176
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Community-based intervention to optimise falls risk management: a randomised controlled trial
1 Algoma District Medical Group, Sault Ste. Marie, Canada
2 Department of Medicine, University of Calgary, Calgary, Canada
3 Department of Medicine, University of Toronto, Toronto, Canada
4 Department of Family Medicine, McMaster University, Hamilton, Canada
5 Centre for Evaluation of Medicines, St. Joseph's Healthcare, Hamilton, Canada
6 Program for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Hospital, Hamilton, Canada
7 Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
8 Department of Physical Therapy, Group Health Centre, Sault Ste. Marie, Canada
9 Algoma Public Health, Sault Ste. Marie, Canada
10 Department of Biology, Lake Superior State University, Sault Ste. Marie, USA
11 Department of Medicine, University of Alberta, Edmonton, Canada
12 Clinical Research Department, Group Health Centre, Sault Ste. Marie, Canada
13 Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, Ontario, Canada
Address correspondence to: S.E. Straus. Tel: (+1)416 864 3068; Fax: (+1) 416 865 5805. E-mail: sharon.straus{at}utoronto.ca
Background: falls are the leading causes of accidental death and fragility fractures in older adults. Interventions that assess and reduce falls risk are underutilised.
Objective: to evaluate the impact of a multifaceted community-based programme aimed at optimising evidence-based management of patients at risk for fall-related fractures.
Design: this was a randomised trial performed from 2003 to 2006.
Setting: community-based intervention in Ontario, Canada
Participants: eligible patients were community-dwelling, aged 
55 years and identified to be at risk for fall-related fractures. A total of 201 patients were allocated to the intervention group or to usual care.
Intervention: components of the intervention included assessment of falls risk, functional status and home environment, and patient education.
Measurements: primary outcome was the implementation of appropriate falls risk assessment at 6 months. Secondary outcomes included falls and fractures at 6 and 12 months.
Results: the mean age of participants was 72 years, and 41% had fallen with injury in the previous year. Compared to usual care, the intervention increased the number of referrals made to physiotherapy [21% (21/101) vs 6.0% (6/100); relative risk (RR) 3.47, 95% confidence interval (CI) 1.46–8.22] and occupational therapy [15% (15/101) vs 0%; RR 30.7, 95% CI 1.86 to >500]. At 12 months, the number of falls in the intervention group was greater than in the usual care group [23% (23/101) vs 11% (11/100); RR 2.07, 95% CI 1.07–4.02].
Conclusions: compared to usual care, a multi-faceted intervention increased referrals to physiotherapy and occupational therapy but did not reduce risk of falls. Similar falls reduction interventions cannot be recommended based on the results of this study.
Keywords: falls assessment and prevention, knowledge translation, elderly
Received 6 January 2009; accepted in revised form 23 July 2009.
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  S. E. Straus, J. Tetroe, I. D. Graham, M. Zwarenstein, O. Bhattacharyya, and S. Shepperd Monitoring use of knowledge and evaluating outcomes Can. Med. Assoc. J., February 9, 2010; 182(2): E94 - E98. [Full Text] [PDF]
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