Effect of Dissemination of Evidence in Reducing Injuries from Falls

Effective strategies to prevent falls among elderly persons have been identified but are underutilized. In this comparison of a region of Connecticut in which persons were exposed to interventions to prevent falls and a region without such exposure, the interventions were associated with a 9% reduct...

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Published in:	The New England journal of medicine Vol. 359; no. 3; pp. 252 - 261
Main Authors:	Tinetti, Mary E, Baker, Dorothy I, King, Mary, Gottschalk, Margaret, Murphy, Terrence E, Acampora, Denise, Carlin, Bradley P, Leo-Summers, Linda, Allore, Heather G
Format:	Journal Article
Language:	English
Published:	Boston, MA Massachusetts Medical Society 17.07.2008
Subjects:	Accident Prevention - methods Accidental Falls - prevention & control Accidental Falls - statistics & numerical data Aged Biological and medical sciences Connecticut - epidemiology Craniocerebral Trauma - epidemiology Craniocerebral Trauma - prevention & control Education, Medical, Continuing Female Fractures, Bone - epidemiology Fractures, Bone - prevention & control General aspects Health Services - statistics & numerical data Hospitals Humans Information Dissemination Joint Dislocations - epidemiology Joint Dislocations - prevention & control Male Medical sciences Medicare Older people Primary care Risk Assessment Connecticut United States > US Medicine Fall Lesion Trauma Dissemination
ISSN:	0028-4793, 1533-4406, 1533-4406
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Abstract	Effective strategies to prevent falls among elderly persons have been identified but are underutilized. In this comparison of a region of Connecticut in which persons were exposed to interventions to prevent falls and a region without such exposure, the interventions were associated with a 9% reduction in serious injuries from falls. These findings suggest that the dissemination of information about fall prevention may reduce numbers of falls and serious injuries. In this comparison of a region of Connecticut in which persons were exposed to interventions to prevent falls and a region without such exposure, the interventions were associated with a 9% reduction in serious injuries from falls. Fall-related injuries are among the most common, morbid, and expensive health conditions involving older adults. 1 – 5 Falls account for 10% of emergency department visits and 6% of hospitalizations among persons over the age of 65 years and are major determinants of functional decline, nursing-home placement, and restricted activity. 6 – 9 The rate of falling rises after the age of 70 years. 1 , 2 , 4 Several factors — such as postural hypotension, the use of multiple medications, and impairments in cognition, vision, balance, gait, and strength — increase the risk of falling and fall injuries. 1 , 2 , 4 , 5 Risk increases as the number . . .
AbstractList	Background Falling is a common and morbid condition among elderly persons. Effective strategies to prevent falls have been identified but are underutilized. Methods Using a nonrandomized design, we compared rates of injuries from falls in a region of Connecticut where clinicians had been exposed to interventions to change clinical practice (intervention region) and in a region where clinicians had not been exposed to such interventions (usual-care region). The interventions encouraged primary care clinicians and staff members involved in home care, outpatient rehabilitation, and senior centers to adopt effective risk assessments and strategies for the prevention of falls (e.g., medication reduction and balance and gait training). The outcomes were rates of serious fall-related injuries (hip and other fractures, head injuries, and joint dislocations) and fall-related use of medical services per 1000 person-years among persons who were 70 years of age or older. The interventions occurred from 2001 to 2004, and the evaluations took place from 2004 to 2006. Results Before the interventions, the adjusted rates of serious fall-related injuries (per 1000 person-years) were 31.2 in the usual-care region and 31.9 in the intervention region. During the evaluation period, the adjusted rates were 31.4 and 28.6, respectively (adjusted rate ratio, 0.91; 95% Bayesian credibility interval, 0.88 to 0.94). Between the preintervention period and the evaluation period, the rate of fall-related use of medical services increased from 68.1 to 83.3 per 1000 person-years in the usual-care region and from 70.7 to 74.2 in the intervention region (adjusted rate ratio, 0.89; 95% credibility interval, 0.86 to 0.92). The percentages of clinicians who received intervention visits ranged from 62% (131 of 212 primary care offices) to 100% (26 of 26 home care agencies). Conclusions Dissemination of evidence about fall prevention, coupled with interventions to change clinical practice, may reduce fall-related injuries in elderly persons. Falling is a common and morbid condition among elderly persons. Effective strategies to prevent falls have been identified but are underutilized.BACKGROUNDFalling is a common and morbid condition among elderly persons. Effective strategies to prevent falls have been identified but are underutilized.Using a nonrandomized design, we compared rates of injuries from falls in a region of Connecticut where clinicians had been exposed to interventions to change clinical practice (intervention region) and in a region where clinicians had not been exposed to such interventions (usual-care region). The interventions encouraged primary care clinicians and staff members involved in home care, outpatient rehabilitation, and senior centers to adopt effective risk assessments and strategies for the prevention of falls (e.g., medication reduction and balance and gait training). The outcomes were rates of serious fall-related injuries (hip and other fractures, head injuries, and joint dislocations) and fall-related use of medical services per 1000 person-years among persons who were 70 years of age or older. The interventions occurred from 2001 to 2004, and the evaluations took place from 2004 to 2006.METHODSUsing a nonrandomized design, we compared rates of injuries from falls in a region of Connecticut where clinicians had been exposed to interventions to change clinical practice (intervention region) and in a region where clinicians had not been exposed to such interventions (usual-care region). The interventions encouraged primary care clinicians and staff members involved in home care, outpatient rehabilitation, and senior centers to adopt effective risk assessments and strategies for the prevention of falls (e.g., medication reduction and balance and gait training). The outcomes were rates of serious fall-related injuries (hip and other fractures, head injuries, and joint dislocations) and fall-related use of medical services per 1000 person-years among persons who were 70 years of age or older. The interventions occurred from 2001 to 2004, and the evaluations took place from 2004 to 2006.Before the interventions, the adjusted rates of serious fall-related injuries (per 1000 person-years) were 31.2 in the usual-care region and 31.9 in the intervention region. During the evaluation period, the adjusted rates were 31.4 and 28.6, respectively (adjusted rate ratio, 0.91; 95% Bayesian credibility interval, 0.88 to 0.94). Between the preintervention period and the evaluation period, the rate of fall-related use of medical services increased from 68.1 to 83.3 per 1000 person-years in the usual-care region and from 70.7 to 74.2 in the intervention region (adjusted rate ratio, 0.89; 95% credibility interval, 0.86 to 0.92). The percentages of clinicians who received intervention visits ranged from 62% (131 of 212 primary care offices) to 100% (26 of 26 home care agencies).RESULTSBefore the interventions, the adjusted rates of serious fall-related injuries (per 1000 person-years) were 31.2 in the usual-care region and 31.9 in the intervention region. During the evaluation period, the adjusted rates were 31.4 and 28.6, respectively (adjusted rate ratio, 0.91; 95% Bayesian credibility interval, 0.88 to 0.94). Between the preintervention period and the evaluation period, the rate of fall-related use of medical services increased from 68.1 to 83.3 per 1000 person-years in the usual-care region and from 70.7 to 74.2 in the intervention region (adjusted rate ratio, 0.89; 95% credibility interval, 0.86 to 0.92). The percentages of clinicians who received intervention visits ranged from 62% (131 of 212 primary care offices) to 100% (26 of 26 home care agencies).Dissemination of evidence about fall prevention, coupled with interventions to change clinical practice, may reduce fall-related injuries in elderly persons.CONCLUSIONSDissemination of evidence about fall prevention, coupled with interventions to change clinical practice, may reduce fall-related injuries in elderly persons. Effective strategies to prevent falls among elderly persons have been identified but are underutilized. In this comparison of a region of Connecticut in which persons were exposed to interventions to prevent falls and a region without such exposure, the interventions were associated with a 9% reduction in serious injuries from falls. These findings suggest that the dissemination of information about fall prevention may reduce numbers of falls and serious injuries. In this comparison of a region of Connecticut in which persons were exposed to interventions to prevent falls and a region without such exposure, the interventions were associated with a 9% reduction in serious injuries from falls. Fall-related injuries are among the most common, morbid, and expensive health conditions involving older adults. 1 – 5 Falls account for 10% of emergency department visits and 6% of hospitalizations among persons over the age of 65 years and are major determinants of functional decline, nursing-home placement, and restricted activity. 6 – 9 The rate of falling rises after the age of 70 years. 1 , 2 , 4 Several factors — such as postural hypotension, the use of multiple medications, and impairments in cognition, vision, balance, gait, and strength — increase the risk of falling and fall injuries. 1 , 2 , 4 , 5 Risk increases as the number . . . Falling is a common and morbid condition among elderly persons. Effective strategies to prevent falls have been identified but are underutilized. Using a nonrandomized design, we compared rates of injuries from falls in a region of Connecticut where clinicians had been exposed to interventions to change clinical practice (intervention region) and in a region where clinicians had not been exposed to such interventions (usual-care region). The interventions encouraged primary care clinicians and staff members involved in home care, outpatient rehabilitation, and senior centers to adopt effective risk assessments and strategies for the prevention of falls (e.g., medication reduction and balance and gait training). The outcomes were rates of serious fall-related injuries (hip and other fractures, head injuries, and joint dislocations) and fall-related use of medical services per 1000 person-years among persons who were 70 years of age or older. The interventions occurred from 2001 to 2004, and the evaluations took place from 2004 to 2006. Before the interventions, the adjusted rates of serious fall-related injuries (per 1000 person-years) were 31.2 in the usual-care region and 31.9 in the intervention region. During the evaluation period, the adjusted rates were 31.4 and 28.6, respectively (adjusted rate ratio, 0.91; 95% Bayesian credibility interval, 0.88 to 0.94). Between the preintervention period and the evaluation period, the rate of fall-related use of medical services increased from 68.1 to 83.3 per 1000 person-years in the usual-care region and from 70.7 to 74.2 in the intervention region (adjusted rate ratio, 0.89; 95% credibility interval, 0.86 to 0.92). The percentages of clinicians who received intervention visits ranged from 62% (131 of 212 primary care offices) to 100% (26 of 26 home care agencies). Dissemination of evidence about fall prevention, coupled with interventions to change clinical practice, may reduce fall-related injuries in elderly persons.
Author	Tinetti, Mary E Carlin, Bradley P King, Mary Murphy, Terrence E Baker, Dorothy I Leo-Summers, Linda Allore, Heather G Gottschalk, Margaret Acampora, Denise
Author_xml	– sequence: 1 givenname: Mary E surname: Tinetti fullname: Tinetti, Mary E – sequence: 2 givenname: Dorothy I surname: Baker fullname: Baker, Dorothy I – sequence: 3 givenname: Mary surname: King fullname: King, Mary – sequence: 4 givenname: Margaret surname: Gottschalk fullname: Gottschalk, Margaret – sequence: 5 givenname: Terrence E surname: Murphy fullname: Murphy, Terrence E – sequence: 6 givenname: Denise surname: Acampora fullname: Acampora, Denise – sequence: 7 givenname: Bradley P surname: Carlin fullname: Carlin, Bradley P – sequence: 8 givenname: Linda surname: Leo-Summers fullname: Leo-Summers, Linda – sequence: 9 givenname: Heather G surname: Allore fullname: Allore, Heather G
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Copyright	Copyright © 2008 Massachusetts Medical Society. All rights reserved. 2008 INIST-CNRS 2008 Massachusetts Medical Society 2008 Massachusetts Medical Society. 2008
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DOI	10.1056/NEJMoa0801748
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Snippet	Effective strategies to prevent falls among elderly persons have been identified but are underutilized. In this comparison of a region of Connecticut in which... Falling is a common and morbid condition among elderly persons. Effective strategies to prevent falls have been identified but are underutilized. Using a... Background Falling is a common and morbid condition among elderly persons. Effective strategies to prevent falls have been identified but are underutilized.... Falling is a common and morbid condition among elderly persons. Effective strategies to prevent falls have been identified but are...
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SubjectTerms	Accident Prevention - methods Accidental Falls - prevention & control Accidental Falls - statistics & numerical data Aged Biological and medical sciences Connecticut - epidemiology Craniocerebral Trauma - epidemiology Craniocerebral Trauma - prevention & control Education, Medical, Continuing Female Fractures, Bone - epidemiology Fractures, Bone - prevention & control General aspects Health Services - statistics & numerical data Hospitals Humans Information Dissemination Joint Dislocations - epidemiology Joint Dislocations - prevention & control Male Medical sciences Medicare Older people Primary care Risk Assessment
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Title	Effect of Dissemination of Evidence in Reducing Injuries from Falls
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