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- Title
The value of assessing falls in an elderly population. A randomized clinical trial.
- Authors
Rubenstein LZ; Robbins AS; Josephson KR; Schulman BL; Osterweil D; Rubenstein, L Z; Robbins, A S; Josephson, K R; Schulman, B L; Osterweil, D
- Abstract
<bold>Objective: </bold>To measure the effects of a specialized postfall assessment intended to detect causes and underlying risk factors for falls, and to recommend preventive and therapeutic interventions.<bold>Design: </bold>Randomized, controlled trial.<bold>Setting: </bold>A long-term residential care facility for elderly persons.<bold>Subjects: </bold>Within 7 days of a fall, 160 ambulatory subjects (mean age, 87 years) were randomly assigned to receive either a comprehensive postfall assessment (intervention group, n = 79) or usual care (control group, n = 81).<bold>Intervention: </bold>The postfall assessment included a detailed physical examination and environmental assessment by a nurse practitioner; laboratory tests; electrocardiogram; and 24-hour Holter monitoring. Probable cause or causes for the fall, identified risk factors, and therapeutic recommendations were given to the patient's primary physician.<bold>Measurements and Main Results: </bold>Through use of the assessment, many remediable problems (for example, weakness, environmental hazards, orthostatic hypotension, drug side effects, gait dysfunction) were detected. At the end of the 2-year follow-up period, the intervention group had 26% fewer hospitalizations (P less than 0.05) and a 52% reduction in hospital days (P less than 0.01) compared with controls. Patients in the intervention group had 9% fewer falls and 17% fewer deaths than controls by 2 years, but these trends were not statistically significant.<bold>Conclusions: </bold>Our study suggests that falls are a marker of underlying disorders easily identifiable by a careful postfall assessment, which in turn can reduce disability and costs.
- Publication
Annals of Internal Medicine, 1990, Vol 113, Issue 4, p308
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/0003-4819-113-4-308