Elsevier

The Lancet

Volume 353, Issue 9147, 9 January 1999, Pages 93-97
The Lancet

Articles
Prevention of falls in the elderly trial (PROFET): a randomised controlled trial

https://doi.org/10.1016/S0140-6736(98)06119-4Get rights and content

Summary

Background

Falls in elderly people are a common presenting complaint to accident and emergency departments. Current practice commonly focuses on the injury, with little systematic assessment of the underlying cause, functional consequences, and possibilities for future prevention. We undertook a randomised controlled study to assess the benefit of a structured inderdisciplinary assessment of people who have fallen in terms of further falls.

Methods

Eligible patients were aged 65 years and older, lived in the community, and presented to an accident and emergency department with a fall. Patients assigned to the intervention group (n=184) underwent a detailed medical and occupational-therapy assessment with referral to relevant services if indicated; those assigned to the control group (n=213) received usual care only. The analyses were by intention to treat. Follow-up data were collected every 4 months for 1 year.

Findings

At 12-month follow-up, 77% of both groups remained in the study. The total reported number of falls during this period was 183 in the intervention group compared with 510 in the control group (p=0·0002). The risk of falling was significantly reduced in the intervention group (odds ratio 0·39 [95% CI 0·23–0·66]) as was the risk of recurrent falls (0·33 [0·16–0·68]). In addition, the odds of admission to hospital were lower in the intervention group (0·61 [0·35–1·05]) whereas the decline in Barthel score with time was greater in the control group (p<0·00001).

Interpretation

The study shows that an interdisciplinary approach to this high-risk population can significantly decrease the risk of further falls and limit functional impairment.

Introduction

There is a need for strategies to prevent falls in older people.1, 2 The cost of falling is high both to the individual in terms of physical3, 4 and psychological trauma,5 loss of independence,6, 7 or even death,8, 9 and to health and allied services8, 10, 11 in terms of resources and bed occupancy.

There is still no agreed approach to the management of elderly people who fall, and previous studies have produced conflicting results12, 13, 14, 15, 16, 17, 18, 19, 20 Direct comparison between studies is hampered by differences in methods, lack of clarity in definition, and differences in study populations and intervention strategies.

8% of people aged 70 years and above seek care in accident and emergency departments each year for fall-related injuries,7 and of these, 30–40% are admitted to hospital.21 About 50% of elderly patients discharged from accident and emergency departments show an increase in dependency,6, 22 in many cases related to trauma; yet the emergency department records make little reference to functional ability and support services are underused6 Although accident and emergency departments are a prime location for identification of functional problems and referral of patients, previous studies have shown important underdiagnosis of remediable problems in older people.23

We did a randomised controlled study to ascertain whether a structured bidisciplinary assessment of elderly people, who live in the community and attend an accident and emergency department with a primary diagnosis of a fall, could alter outcome and decrease the rate of further falls during the 12-month follow-up period. Secondary endpoints were death, major injury, moves to institutional care, functional status, and use of health care.

Section snippets

Participants

We recruited patients between December, 1995, and the end of June, 1996. All patients aged 65 years and above, who lived in the local community and attended the accident and emergency department with a primary diagnosis of a fall were potentially eligible. Formal ethics committee approval was obtained for the study. We excluded patients with cognitive impairment defined as a score on the abbreviated mental test (AMT)24 of less than 7 and with no regular carer because of difficulties with

Demography

1031 consecutive patients aged 65 years or older attended the accident and emergency department with a primary diagnosis of a fall during the recruitment period (figure 1). This total represents 20% of all attendees and 14% of emergency admissions for this age-group. The ultimately randomised number of patients was 397 (39%). The commonest reason for not proceeding to randomisation was inabilty to contact patients after the attendance at the accident and emergency department. Table 1 summarises

Discussion

This controlled study has shown the efficacy of a structured interdisciplinary approach to the management and prevention of falls in older people in a routine service setting. The numbers of subsequent falls and people with recurrent falls were significantly and substantially reduced. The multifactorial approach is consistent with the prospective identification of risk factors used previously in institutional and community settings.12, 13 We applied our strategy in a more routine, and

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