Targeting doctors reduces falls among the elderly

Medical Tribune October 2008 P11
David Brill

Fall-related injuries among
the elderly can be reduced
through a scheme to educate
doctors, researchers from the
Yale School of Medicine, US, have
shown.
The study found that injury
rates among over-70s were reduced
by 9 percent in a region where a
clinician-targeted strategy was implemented,
as compared to an area
with no such intervention.
Fall-related use of medical
services also decreased by 11 percent
– equivalent to some 1,800
fewer hospital visits and savings
of around US$21 million in healthcare
costs.
The project, run by the Connecticut
Collaboration for Fall
Prevention (CCFP), promoted evidence
from previous clinical trials
and encouraged clinicians to incorporate
the findings into practice.
[N Engl J Med 2008;359:252-6]
Specific recommendations included
managing patients’ visual
problems, reducing their medications
and working on balance,
gait and strength training. The
information was disseminated
through various methods, including
recruiting opinion leaders
to influence colleagues, and
performing outreach visits and
demonstrations at the participating
facilities.
Dr. Noor Hafizah Ismail, a
Singapore-based falls prevention
expert, said that the CCFP strategy
would be considered should
an intervention to reduce falls in
the community be undertaken in
future, but added that the data
would need to be carefully assessed
first.
“The results do suggest there is
some benefit in introducing practice
changes in primary healthcare
givers, but it is hard to prove that
there is cause and effect as there
was no direct follow-up of patients
who had the intervention,” she
said, noting that patient outcomes
in the study were assessed indirectly
using a statewide hospital
database.
The Falls and Balance Clinic
at Tan Tock Seng Hospital, where
Ismail is a senior consultant, currently
adopts an approach similar
to recommendations in the American
Geriatric Society guidelines,
she said.
The CCFP intervention was
introduced (in a nonrandomized
fashion) to a single region of Connecticut
between 2001 and 2004.
Clinicians from a range of disciplines
– including primary care,
emergency departments, outpatient
rehabilitation and home care
– were invited to participate.
The rate of serious fall-related
injuries in the intervention region
dropped from 31.9 per 1,000 person-
years prior to the intervention
(1999 to 2001) to 28.6 afterwards
(2004 to 2006). In a region where
the strategy was not implemented,
the comparable injury rates were
31.2 and 31.4.
Fall-related use of medical services
in the intervention region increased
from 70.7 to 74.2 per 1,000
person-years over this period,
whereas in the usual-care region
the rate rose much more sharply,
from 68.1 to 83.3.
The effects of the CCFP strategy
on both injury rates and medical
service usage persisted for a
further year after conclusion of the
evaluation period.
Fall-related injuries are a common
cause of morbidity among the
elderly and are estimated to account
for some 10 percent of emergency
department visits in those
over 65.
“Doctors need to be vigilant in
identifying patients at risk of falls,”
said Ismail, adding that “the strongest
predictor of future falls is a
previous fall history.”