Individual and community fall prevention strategies
SIR—The article by Campbell and Robertson [1] makes a very important contribution to the translation of the growing falls prevention evidence base to sensible policy decisions. The suggestion that single interventions are as effective as multifactorial interventions is intriguing and does indeed warrant close examination.Campbell and Robertson posit that interactions between interventions may actually reduce their effectiveness when combined, and cite their falls prevention trial in visually impaired older people, in which interactions were observed, as evidence in support of this explanation. However, in our multifactorial falls prevention trial among relatively healthy community dwelling older people, we found no evidence of negative interactions among the interventions [2]. One of the three tested interventions (exercise) reduced falls when delivered on its own, and there was a trend towards increased effectiveness when exercise was combined with either home hazard modifications or vision correction interventions. All three delivered together had the largest effect.
Campbell and Robertson also suggested that multiple interventions may decrease compliance. We found only slightly lower exercise attendance rates in those in the exercise-only group compared with those in the all intervention group (Table 1, chi-square 2.397, P = 0.30).
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It could be that the occurrence of interactions between falls interventions, and the acceptance of multiple interventions, may depend on the types of interventions and the specific population of older people. Therefore, the comparison of single and multiple interventions for preventing falls does not appear to be straight forward and further research is required to determine optimal intervention strategies for both general and frailer populations of older people.
1 Monash University, Melbourne, Australia
2 Prince of Wales Medical Research Institute, University of New South Wales, Sydney, Australia
* To whom correspondence should be addressed E-mail: lesley.day{at}muarc.monash.edu.au
References
- Campbell AJ, Robertson MC. Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial interventions. Age Ageing (2007) 36:656–62.
[Abstract/Free Full Text] - Day L, Fildes B, Gordon I, et al. A randomised factorial trial of falls prevention among community-dwelling older people. Br Med J (2002) 325:128.
[Abstract/Free Full Text]
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