Screening and intervention to prevent falls and fractures in older people

Abstract

Background: Community screening and therapeutic prevention strategies may reduce falls. Effects on fractures, health resource use and health-related quality of life are unknown. Methods: In a pragmatic, three-arm, cluster randomized controlled trial we estimated the effect of advice-by-mail, falls risk screening and targeted interventions (multi-factorial fall prevention (MFFP) or exercise for people at increased falls risk) in comparison to advice-by-mail only. The primary outcome was fracture rate over 18 months. Secondary outcomes were falls, health related quality of life, frailty and a parallel economic evaluation. Results: We randomized 9803 people aged 70 years and older from 63 general practices across England. Completed falls risk screening questionnaires were returned by 2925/3279 (89%) people randomized to the exercise strategy, and 2854/3301 (87%) for MFFP. Of these, 37% (2153/5779) were considered at increased risk and invited for intervention. Fracture data were available for 9802/9803 participants. Screening and targeted intervention did not reduce fracture rates (exercise versus advice-by-mail rate ratio (RaR) 1.20 (95% CI 0.91 to 1.59, favoring advice) and MFFP versus advice-by-mail RaR 1.30 (95% CI 0.99 to 1.71, favoring advice). The exercise strategy had a short-term reduction in falls rate, small gains in health-related quality of life and lowest overall costs. There were three adverse events, one of which was serious. Conclusion: Advice-by-mail, screening for fall risk and targeted exercise or MFFP interventions did not prevent fractures compared to advice-by-mail alone.