Kate Robertson

Community falls prevention for people who call an emergency ambulance after a fall: randomised controlled trial

Objective To evaluate whether a service to prevent falls in the community would help reduce the rate of falls in older people who call an emergency ambulance when they fall but are not taken to hospital. Design Randomised controlled trial. Setting Community covered by four primary care trusts, England. Participants 204 adults aged more than 60 living at home or in residential care who had fallen and called an emergency ambulance but were not taken to hospital. Interventions Referral to community fall prevention services or standard medical and social care. Main outcome measures The primary outcome was the rate of falls over 12 months, ascertained from monthly diaries. Secondary outcomes were scores on the Barthel index, Nottingham extended activities of daily living scale, and falls efficacy scale at baseline and by postal questionnaire at 12 months. Analysis was by intention to treat. Results 102 people were allocated to each group. 99 (97%) participants in the intervention group received the intervention. Falls diaries were analysed for 88.6 person years in the intervention group and 84.5 person years in the control group. The incidence rates of falls per year were 3.46 in the intervention group and 7.68 in the control group (incidence rate ratio 0.45, 95% confidence interval 0.35 to 0.58, P<0.001). The intervention group achieved higher scores on the Barthel index and Nottingham extended activities of daily living and lower scores on the falls efficacy scale (all P<0.05) at the 12 month follow-up. The number of times an emergency ambulance was called because of a fall was significantly different during follow-up (incidence rate ratio 0.60, 95% confidence interval 0.40 to 0.92, P=0.018). Conclusion A service to prevent falls in the community reduced the fall rate and improved clinical outcome in the high risk group of older people who call an emergency ambulance after a fall but are not taken to hospital. Trial registration Current Controlled Trials ISRCTN67535605.

Community falls prevention for people who call an emergency ambulance after a fall: an economic evaluation alongside a randomised controlled trial

OBJECTIVE we estimated the cost-effectiveness of a community falls prevention service compared with usual care from a National Health Service and personal social services perspective over the 12 month trial period. DESIGN a cost-effectiveness and cost utility analysis alongside a randomised controlled trial SETTING community. PARTICIPANTS people over 60 years of age living at home or in residential care who had fallen and called an emergency ambulance but were not taken to hospital. INTERVENTIONS referral to community fall prevention services or usual health and social care. MEASUREMENTS incremental cost per fall prevented and incremental cost per Quality-Adjusted Life Years (QALYs) RESULTS a total of 157 participants (82 interventions and 75 controls) were used to perform the economic evaluation. The mean difference in NHS and personal social service costs between the groups was £-1,551 per patient over 1 year (95% CI: £-5,932 to £2,829) comparing the intervention and control groups. The intervention patients experienced on average 5.34 fewer falls over 12 months (95% CI: -7.06 to -3.62). The mean difference in QALYs was 0.070 (95% CI: -0.010 to 0.150) in favour of the intervention group. CONCLUSION the community falls prevention service was estimated to be cost-effective in this high-risk group. Current Controlled Trials ISRCTN67535605. (controlled-trials.com).

The Falls In Care Home study: a feasibility randomized controlled trial of the use of a risk assessment and decision support tool to prevent falls in care homes

Objective: To explore the feasibility of implementing and evaluating the Guide to Action Care Home fall prevention intervention. Design: Two-centre, cluster feasibility randomized controlled trial and process evaluation. Setting: Purposive sample of six diverse old age/learning disability, long stay care homes in Nottinghamshire, UK. Subjects: Residents aged over 50 years, who had fallen at least once in the past year, not bed-bound, hoist-dependent or terminally ill. Interventions: Intervention homes (n = 3) received Guide to Action Care Home fall prevention intervention training and support. Control homes (n = 3) received usual care. Outcomes: Recruitment, attrition, baseline and six-month outcome completion, contamination and intervention fidelity, compliance, tolerability, acceptance and impact. Results: A total of 81 of 145 (56%) care homes expressed participatory interest. Six of 22 letter respondent homes (27%) participated. The expected resident recruitment target was achieved by 76% (52/68). Ten (19%) residents did not complete follow-up (seven died, three moved). In intervention homes 36/114 (32%) staff attended training. Two of three (75%) care homes received protocol compliant training. Staff valued the training, but advised greater management involvement to improve intervention implementation. Fall risks were assessed, actioned and recorded in care records. Of 115 recorded falls, 533/570 (93%) of details were complete. Six-month resident fall rates were 1.9 and 4.0 per year for intervention and control homes, respectively. Conclusions: The Guide to Action Care Home is implementable under trial conditions. Recruitment and follow-up rates indicate that a definitive trial can be completed. Falls (primary outcome) can be ascertained reliably from care records.

An Investigation of the Number and Cost of Assistive Devices Used by Older People Who Had Fallen and Called a 999 Ambulance

Some assistive devices, such as walking frames and bath boards, are provided by health and social services, but some are bought by people through shops, the internet and magazines or second hand. Using a face-to-face interview, the number and cost of assistive devices bought by people who had fallen and called a 999 ambulance were investigated. Two hundred and four older people (mean age 83 years, 72/35% men) who had fallen and called an emergency ambulance were interviewed at home by a research occupational therapist. A structured questionnaire about the cost and use of assistive devices was completed. Functional ability was measured using the Barthel Index and the Nottingham Extended Activities of Daily Living Scale. One hundred and ten people (54%) had bought their own devices, spending a median of £700 each. People with multiple sclerosis, cancer, heart conditions and Parkinsons disease had spent over twice as much as those with osteoarthritis, stroke, diabetes and dementia. Many older people buy their own assistive devices at a considerable cost to themselves. As social services direct payments allow people to manage their own care packages, more people will be buying direct and may be looking for advice.

Promoting activity, independence and stability in early dementia and mild cognitive impairment (PrAISED): development of an intervention for people with mild cognitive impairment and dementia:

This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless, they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is an understanding of how to develop an intervention for people with mild cognitive impairment and dementia to promote their independence, stability, and physical activity. Introduction: Older adults with dementia are at a high risk of falls. Standard interventions have not been shown to be effective in this patient population potentially due to poor consideration of dementia-specific risk factors. An intervention is required that addresses the particular needs of older people with dementia in a community setting. Methods: We followed guidelines for the development of an intervention, which recommend a structured approach considering theory, evidence and practical issues. The process used 15 information sources. Data from literature reviews, clinician workshops, expert opinion meetings, patient-relative interviews, focus groups with people with dementia and clinicians, a cross-sectional survey of risk factors, a pre-post intervention study and case studies were included. Data were synthesized using triangulation to produce an intervention suitable for feasibility testing. Practical consideration of how an intervention could be delivered and implemented were considered from the outset. Results: Elements of the intervention included individually tailored, dementia-appropriate, balance, strength and dual-task exercises, functional training, and activities aimed at improving environmental access, delivered using a motivational approach to support adherence and long-term continuation of activity. We focussed on promoting safe activity rather than risk or prevention of falls. Conclusion: We used a systematic process to develop a dementia-specific intervention to promote activity and independence while reducing falls risk in older adults with mild dementia.

An evaluation of the staff training within the trauma and self injury (TASI) programme in the National High Secure Healthcare Service for Women (NHSHSW)

Purpose – Patients in the National High Secure Healthcare Service for Women have a high prevalence of trauma and self injury. This highlights the need for specialised training of staff dealing with such women. The aim of this study was to evaluate the trauma and self injury (TASI) training programme on staff knowledge and skills.Design/methodology/approach – A total of 135 nurses and nursing assistants participated in the TASI two‐day training course. Questionnaires allowing for quantitative and qualitative data collection were completed before and after the training. Training and confidence levels in dealing with women who self‐harm prior to the training were identified and the impact of the programme was assessed.Findings – The majority of staff had not received any previous training on trauma and self injury. There was an increased level of confidence in working with trauma and self injury following training and staff reported an increased ability to ask for support. Self‐perceived competence improved ...