A Randomized Trial of a Multifactorial Strategy to Prevent Serious Fall Injuries
| Autor: | Thomas M. Gill, Peter Peduzzi, Rich Eder, Denise Esserman, Susan L. Greenspan, Heather G. Allore, Lori Goehring, Dorothy I. Baker, Robert B. Wallace, David A. Ganz, Thomas G. Travison, Martha B. Carnie, Jerry H. Gurwitz, Neil B. Alexander, Siobhan K McMahon, Charles Lu, David B. Reuben, Can Meng, Joanne M. McGloin, Fred C. Ko, Patricia C. Dykes, Katy L. B. Araujo, Michael E. Miller, Carri Casteel, Peter Charpentier, Jay Magaziner, Albert L. Siu, Erich J. Greene, Eleni A. Skokos, Thomas W. Storer, James Dziura, Priscilla K. Gazarian, Nancy K. Latham, Stephen C. Waring, Albert W. Wu, Rosaly Correa-de-Araujo, Jeremy N. Rich, Shalender Bhasin, Shehzad Basaria, Chad Boult, Neil M. Resnick, Elena Volpi, Brooke Brawley, Haseena Rajeevan, Jocelyn Wiggins, Maureen Fagan, Pamela W. Duncan |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Aging Comparative Effectiveness Research STRIDE Trial Investigators Poison control 030204 cardiovascular system & hematology Suicide prevention Medical and Health Sciences Occupational safety and health law.invention 0302 clinical medicine Randomized controlled trial law Risk Factors 80 and over 030212 general & internal medicine Precision Medicine Aged 80 and over Accidental Injuries Incidence food and beverages Human factors and ergonomics Injuries and accidents General Medicine Health Services fractures mobility Hospitalization Female Patient Safety Independent Living Risk assessment medicine.medical_specialty Physical Injury - Accidents and Adverse Effects Clinical Trials and Supportive Activities frailty Risk Assessment Article 03 medical and health sciences Clinical Research General & Internal Medicine Injury prevention medicine Humans Intensive care medicine Aged business.industry Prevention fungi aging Patient Care Management Good Health and Well Being Multicenter study Accidental Falls business |
| Zdroj: | The New England journal of medicine, vol 383, iss 2 Advances in geriatric medicine and research |
| Popis: | BackgroundInjuries from falls are major contributors to complications and death in older adults. Despite evidence from efficacy trials that many falls can be prevented, rates of falls resulting in injury have not declined.MethodsWe conducted a pragmatic, cluster-randomized trial to evaluate the effectiveness of a multifactorial intervention that included risk assessment and individualized plans, administered by specially trained nurses, to prevent fall injuries. A total of 86 primary care practices across 10 health care systems were randomly assigned to the intervention or to enhanced usual care (the control) (43 practices each). The participants were community-dwelling adults, 70 years of age or older, who were at increased risk for fall injuries. The primary outcome, assessed in a time-to-event analysis, was the first serious fall injury, adjudicated with the use of participant report, electronic health records, and claims data. We hypothesized that the event rate would be lower by 20% in the intervention group than in the control group.ResultsThe demographic and baseline characteristics of the participants were similar in the intervention group (2802 participants) and the control group (2649 participants); the mean age was 80 years, and 62.0% of the participants were women. The rate of a first adjudicated serious fall injury did not differ significantly between the groups, as assessed in a time-to-first-event analysis (events per 100 person-years of follow-up, 4.9 in the intervention group and 5.3 in the control group; hazard ratio, 0.92; 95% confidence interval [CI], 0.80 to 1.06; P = 0.25). The rate of a first participant-reported fall injury was 25.6 events per 100 person-years of follow-up in the intervention group and 28.6 events per 100 person-years of follow-up in the control group (hazard ratio, 0.90; 95% CI, 0.83 to 0.99; P = 0.004). The rates of hospitalization or death were similar in the two groups.ConclusionsA multifactorial intervention, administered by nurses, did not result in a significantly lower rate of a first adjudicated serious fall injury than enhanced usual care. (Funded by the Patient-Centered Outcomes Research Institute and others; STRIDE ClinicalTrials.gov number, NCT02475850.). |
| Databáze: | OpenAIRE |
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