A multidisciplinary intervention to reduce subsequent falls and health service use in older fallers who are not transported to hospital following ambulance care

摘要

Many older people who fall require ambulance attendance, however around 25% are not subsequently transported to emergency departments (ED). This population is at high risk of future falls and unplanned health care use, and non-transported fallers have poorer health outcomes than their transported counterparts, potentially due to a lack of appropriate referral pathways and follow-up care.This randomised controlled trial investigated the effect of a multidisciplinary, individualised fall prevention program offered to older non-transported fallers. It aimed to reduce subsequent falls and health service use by addressing identified risk factors, linking participants into existing services and providing proactive assistance to implement physiotherapy, occupational therapy, geriatric assessment, optometry review and/ or medication management as appropriate. The control group received written fall prevention advice. Uptake and adherence, as well as benefits beyond fall prevention, were also assessed.Intention-to-treat analysis showed no significant difference between groups in regard to subsequent falls and health service use after 12 months’ follow-up. Within-group analysis revealed that control group participants had significantly worse depressive symptomatology, lower quality of life and increased fear of falling six months post index fall, while this deterioration was not evident within the intervention group.Adherence data revealed around half of intervention group participants did not complete the recommendations as intended. Analysis based on adherence to treatment protocol showed that there was a significant difference in fall rates and health service use, in favour of the “adherers” at 12 months compared to those who did not adhere to recommendations. Baseline attitudes towards falls-prevention interventions were predictive of adherence rates recorded during the reassessment.This study found that the multidisciplinary intervention did not prevent falls in older people who have received ambulance care. However, this model of care may have the potential to significantly reduce falls and fall-related health service use. When targeted at individuals intending to adhere to the tailored recommendations, there is significant benefit for participants, regardless of their medical history and fall risk factors.