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Preventing falls in community-dwelling frail older people using a home intervention team (HIT): results from the
Thorsten Nikolaus1, Matthias Bach
1Department of Geriatric Medicine, University of Ulm and Bethesda Geriatric Clinic, Zollernring 26, D-89073 Ulm, Germany. thorsten.nikolaus@medizin.uni-ulm.de
Objectives:
To evaluate the effect of an intervention by a multidisciplinary team to reduce falls in older people's homes.
Design:
Randomized, controlled trial with follow-up of subjects for 1 year.
Setting:
University-affiliated geriatric hospital and older patients' homes.
Participants:
Three hundred sixty subjects (mean age +/- standard deviation = 81.5 +/- 6.4) admitted from home to a geriatric hospital and showing functional decline, especially in mobility.
Intervention:
The participants were randomly assigned to receive a comprehensive geriatric assessment followed by a diagnostic home visit and home intervention or a comprehensive geriatric assessment with recommendations and usual care at home. The home intervention included a diagnostic home visit, assessing the home for environmental hazards, advice about possible changes, offer of facilities for any necessary home modifications, and training in the use of technical and mobility aids. An additional home visit was made after 3 months to reinforce the recommendations. After 12 months of follow-up, a home visit was made to all study participants.
Measurements:
Number of falls, type of recommended home modifications, and compliance with recommendations.
Results:
After 1 year, there were 163 falls in the intervention group and 204 falls in the control group. The intervention group had 31% fewer falls than the control group (incidence rate ratio (IRR) = 0.69, 95% confidence interval (CI) = 0.51-0.97). The intervention was most effective in a subgroup of participants who reported having had two or more falls during the year before recruitment into the study. In this subgroup, the proportion of frequent fallers and the rate of falls was significantly reduced for the intervention group compared with the control group (21 vs 36 subjects with recurrent falls, P =.009; IRR = 0.63, 95% CI = 0.43-0.94). The compliance rate varied with the type of change recommended from 83% to 33% after 12 months of follow-up.
Conclusion:
Home intervention based on home visits to assess the home for environmental hazards, providing information about possible changes, facilitating any necessary modifications, and training in the use of technical and mobility aids was effective in a selected group of frail older subjects with a history of recurrent falling.
