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Abstract
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Provenance: Invited. Not peer reviewed.
Summary of: Lamb SE, Bruce J, Hossain A, Ji C, Longo R, Lall R, et al for the Prevention of Fall Injury Trial Study Group. Screening and intervention to prevent falls and fractures in older people. N Engl J Med 2020;383:1848-1859.
Question: Does fall-risk screening followed by targeted exercise or multifactorial fall prevention reduce fracture rate over 18 months in older adults at higher risk of falls? Design: Pragmatic, three-group, cluster-randomised controlled trial with general practice centres randomly assigned to one of three interventions. Setting: Sixty-three general practices in seven rural and urban regions in England. Participants: Community-dwelling adults aged ≥ 70 years randomly selected from patient registries. Individuals residing in assisted-living facilities, with terminal illnesses or with life expectancy < 6 months were excluded. Randomisation of 63 general medical practices assigned 21 practices to advice-by-mail; 21 practices to advice-by-mail, screening and targeted exercise; and 21 practices to advice-by-mail, screening and targeted multifactorial fall prevention. Interventions: Participants completed a screening questionnaire to determine fall risk. Interventions were offered only to individuals whose screening responses indicated high fall risk. All groups received a fall prevention advice booklet: Age U.K. Staying Steady. In addition, the exercise group completed the Otago Exercise Program, involving home exercises for strength and balance at least twice weekly, a recreational walking program and at least seven sessions with a physiotherapist over 6 months. The multifactorial intervention was individualised based on comprehensive assessments conducted by nurses, general practitioners and geriatricians, and could include the same exercise program, medication review, home modifications, and/or referral to opticians, medical specialists and podiatrists. Outcome measures: The primary outcome was rate of fractures per 100 person-years over 18 months. Secondary outcomes included health service utilisation and falls over 18 months, as well as health-related quality of life, frailty and a cost-utility analysis.
RESULTS: A total of 8,301 participants completed the study at 18 months. Of those assigned to exercise or multifactorial intervention, 37% of screening questionnaire respondents were considered high fall risk and offered the randomised intervention. There was no difference in fracture rate between the exercise group and the advice-only group (adjusted rate ratio for fracture: 1.20, 95% CI 0.91 to 1.59) or between the multifactorial intervention group and the advice-only group (adjusted rate ratio for fracture: 1.30, 95% CI 0.99 to 1.71). There were no between-group differences in secondary outcomes except that the exercise group had slightly lower costs and small gains in quality-adjusted life years compared with the other groups.
CONCLUSION: Offering targeted exercise or multifactorial fall prevention to older adults at an increased risk of falls, determined by mail screening, did not reduce fracture rate more than advice alone via mail.
Language: en |