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A Randomized Trial of a Multifactorial Strategy to Prevent Serious Fall Injuries.

Shalender Bhasin1, Thomas M Gill1, David B Reuben1

  • 1From the Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism (S. Bhasin, N.K.L., S. Basaria, T.W.S., T.G.T., L.G., B.F.B., R.E.), Brigham and Women's Hospital (S. Bhasin, N.K.L., S. Basaria, P.C.D., T.W.S., T.G.T., P.G., M.B.C., L.G., B.F.B., R.E.), Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School (T.G.T.), and the University of Massachusetts Boston (P.G.), Boston, and Meyers Primary Care Institute (joint endeavor of Reliant Medical Group, Fallon Health, and University of Massachusetts Medical School), Worcester (J.H.G.); the Yale Claude D. Pepper Older Americans Independence Center (T.M.G., P.C., K.A., J.M.M., E.A.S., D.B.), the Yale Center for Analytical Sciences (E.J.G., J.D., D.E., C.L., H.R., C.M., H.A., P.P.), and the Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine (T.M.G., H.A.), Yale University, New Haven, CT; the Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA (D.B.R., D.A.G.), the Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System (D.A.G.), and the UCLA Claude D. Pepper Older Americans Independence Center (D.B.R, D.A.G.), Los Angeles, and HealthCare Partners, El Segundo (J.R.) - all in California; the School of Nursing, University of Minnesota, Minneapolis (S.M.M.), and Essentia Health, Duluth (S.C.W.) - both in Minnesota; Wake Forest University, School of Medicine, Winston-Salem, NC (M.E.M., P.W.D.); the University of Miami Health System, Miami (M.F.); the Pittsburgh Claude D. Pepper Older Americans Independence Center, Division of Geriatrics and Gerontology, University of Pittsburgh, Pittsburgh (S.L.G., N.M.R.); the University of Michigan, Ann Arbor (N.A., J.W.); Icahn School of Medicine at Mount Sinai, New York (F.K., A.L.S.); the UTMB Claude D. Pepper Older Americans Independence Center, Sealy Center on Aging, University of Texas Medical Branch, Galveston (E.V.); Johns Hopkins University (A.W.W., C.B.) and the University of Maryland School of Medicine (J.M.), Baltimore, and the National Institute on Aging, Bethesda (R.C.-A.) - all in Maryland; and the University of Iowa, Iowa City (R.B.W., C.C.).

The New England Journal of Medicine
|July 9, 2020
PubMed
Summary
This summary is machine-generated.

A nurse-led intervention to prevent serious fall injuries in older adults did not significantly reduce adjudicated fall injuries. However, it did lower participant-reported fall injuries, suggesting a potential benefit in injury perception.

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Area of Science:

  • Gerontology
  • Public Health
  • Clinical Nursing

Background:

  • Falls are a leading cause of injury and death in older adults.
  • Despite known prevention strategies, fall injury rates remain high.
  • Effective interventions are crucial to improve safety and reduce healthcare burden in the elderly population.

Purpose of the Study:

  • To evaluate a multifactorial intervention for preventing serious fall injuries in community-dwelling older adults.
  • To assess the effectiveness of nurse-administered risk assessment and individualized care plans.
  • To determine if the intervention reduces the rate of first serious fall injury compared to enhanced usual care.

Main Methods:

  • A pragmatic, cluster-randomized trial involving 86 primary care practices.
  • Intervention group received nurse-led multifactorial care; control group received enhanced usual care.
  • Primary outcome: time to first serious fall injury, adjudicated using multiple data sources.

Main Results:

  • No significant difference in the rate of first adjudicated serious fall injury between groups (HR 0.92, P=0.25).
  • A significant reduction in participant-reported fall injuries was observed in the intervention group (HR 0.90, P=0.004).
  • Hospitalization or death rates were similar between the intervention and control groups.

Conclusions:

  • The nurse-led multifactorial intervention did not significantly lower the rate of adjudicated serious fall injuries.
  • The intervention showed a significant reduction in self-reported fall injuries.
  • Further research may explore the impact on injury perception and reporting in fall prevention strategies.