LETTERS TO THE EDITOR RESEARCH EFFECTIVENESS OF AN EVIDENCE-BASED MULTIDISCIPLINARY FALLS PREVENTION PROGRAM IN REDUCING FALLS IN HIGH-RISK OLDER PEOPLE To the Editor: The prevalence of falls in older people resulting in morbidity or death is continually increasing. Population studies have identified that approximately 20% of falls in adults aged 65 and older cause injury requiring medical treatment1 and that approximately 5% result in fracture injury.2 Intervention strategies have been shown to reduce the prevalence of falls significantly in older people in a community setting.3 Several factors have been shown to increase the risk of falling in older people, including impaired vision, peripheral sensation, muscle strength, reaction time, and balance.4 Pros and cons of single-intervention and multidisciplinary falls programs have been extensively discussed, highlighting that both types of programs are successful in falls prevention.5 Multifactorial fall interventions adopt a holistic approach involving functional, medical, and social aspects of assessing falls risk factors and devising an appropriate falls prevention plan and are therefore well suited to integration into existing and developing structures of coordinated care.6 The current study used a multidisciplinary falls prevention program to measure the effectiveness of reducing the number of falls and injuries in a high-risk population. The program was conducted by allied health practitioners with input from a geriatrician during the case conference where individualized management plans were generated. The initial consultation required participants to undergo a multidisciplinary falls risk assessment, including the Malnutrition Screening Tool (MST), a step test (worst leg), walking speed, the Modified Falls Efficacy Scale, the Physiological Profile Assessment (PPA), lying and standing blood pressures, and number of prescribed medications.3,4 Postassessment recommendations were provided to individuals based on the outcome measures

and specialist observations. These recommendations for intervention included medical, environmental, exercise, community, and other. All participants underwent a bone health history for osteoporosis, and if they were not taking osteoporosis medication, a formal bone health assessment was recommended. After each participant received recommendations from the specialist panel, a repeat-measure 6-month follow-up visit was conducted. Initially, 86 participants entered the study and 51 participants (aged 77.5  8.8, 65% female) completed both the initial and 6-month assessments. The Queensland Health human research ethics committee approved procedures within this protocol before data collection. One-way analysis of variance testing was used to compare the initial and 6-month review data using SPSS (SPSS, Inc., Chicago, IL). Nonparametric chi-square testing was conducted to determine whether there was a reduction in reported medical attention between the initial assessment and the 6-month follow-up visit (Table 1). There was a significant (P = .04) reduction in the need for reported medical attention between the initial assessment and the 6-month follow-up consultation (Table 1). The fracture rates before and after the interventions were 19% to 3%. This multidisciplinary program to reduce falls, injuries, and the need for medical attention in older adults was successful, as a significant reduction in reported falls (66%), injuries (75%) and medical attention (77%) evidenced. The severity of the injuries was considerably less after the intervention, with a reduction in the number of reported fractures. These reductions could be a result of numerous contributing factors, including medication, environmental awareness, and improvement in physical fitness. Previous researchers have shown that reduction in psychotropic medication was positively associated with prevalence of falls in older adults.7 The current study demonstrated a 9% reduction of the number of prescribed medications. The findings provided additional evidence that a multidisciplinary falls clinic assessment and management program

Table 1. Initial and 6-Month Review Scores on the Fall Assessment Results. Baseline Factor

Falls Injuries Malnutrition Screening Tool Step test Gait velocity Number of medications Modified Falls Efficacy Scale Physiological Profile Assessment

Six-Month Review

Mean (95% Confidence Interval)

3.53 2.55 1.31 8.39 31.42 7.23 7.03 2.05

(2.53–4.53) (1.54–3.55) (0.85–1.78) (7.30–9.49) (28.14–34.71) (6.17–8.30) (6.45–7.62) (1.73–2.38)

JAGS 778–793, 2014 © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society

1.27 0.74 0.57 8.53 31.64 6.57 7.27 2.20

(0.69–1.86) (0.20–1.29) (0.24–0.89) (7.35–9.70) (28.90–34.38) (5.72–7.72) (6.77–7.77) (1.87–2.53)

P-Value

Change, %