A preliminary study of the effectiveness of an otolaryngology-based multidisciplinary falls prevention clinic

Because the cause of falls is often multifactorial, efforts to identify risk factors and promote prevention would benefit from a multidisciplinary approach in which the contributions of a broad range of body systems are considered. We describe the practices and procedures followed at the otolaryngology-based multidisciplinary Falls Prevention Clinic at Henry Ford Hospital in Detroit. Our team is made up of an otolaryngologist, an audiologist, an internist, and a physical therapist. Our multidisciplinary approach involves evaluations of vestibular and balance function, cardiovascular function, and visual function; lower-extremity strength and sensation; cognition and mood; and medication use. We also assess a number of nonmedical risk factors. Evaluations are made over the course of two clinic visits. To assess the effectiveness of our approach, we conducted a preliminary study based on chart reviews and telephone interviews of 52 patients who had been referred to our clinic for evaluation and counseling. The basis of our study was a comparison of the number of falls that patients had experienced during the 6 months prior to their first visit to our clinic and the number of falls they experienced during the 6 months after their second visit. We found that among "true fallers" (i.e., those who had actually experienced a fall at some point during the study), 64.7% reported that they had experienced fewer falls after their clinic visits than before (p < 0.001). Also, 59.1% of patients who had been "frequent fallers" prior to their clinic evaluation (i.e., >or=3 falls during the previous 6 mo) reported that they had not fallen at all during the 6 months following their last visit. Finally, our evaluations identified a substantial number of risk factors in individual patients that had been missed previously, including many nonvestibular factors that might not have been detected without a multidisciplinary approach. We conclude that the results of this preliminary study demonstrate the potential that a comprehensive falls prevention clinic can have in reducing the number of falls among outpatients at risk, and we believe that further study is warranted.