A multifactorial intervention reduced the mean number of falls bul not the proportion who fell in older people with recurrent falls

摘要

A high quality systematic review suggests that multifactorial interventions reduce the proportion of people who fall, whereas the study by Davison et al found only a reduction in the number of falls per year. Several points might explain this finding. Firstly, the mean age of patients was 77 years. Similar studies have reported mean ages >=80 years. As well, the proportion of frail older adults was unknown. It is possible that the sample in the study by Davison ef al included a lower proportion of frail older adults than previous studies. Secondly, 20% of the conventional care group visited a falls clinic and received some of the same treatment as the intervention group, which may have masked any beneficial effect of the intervention. Patients who received treatment from the falls clinic were likely those assessed as potentially benefiting most from intervention. Thirdly, the multidisciplinary team did not include nurses, whereas many previous studies did. Nevertheless, the findings of Davison ef al have implications for nurses. Despite its differences from previous studies, this research confirms the benefits of multifactorial interventions in reducing the number of subsequent falls. It also reminds us that the assessment of people who fall is complex. A fall may indicate presentation of a new illness or worsening of a chronic illness. With these points in mind, discharge planning from the ED should include occupational therapy and physiotherapy assessments and assistance with personal care if function has been lost because of injury.