Evaluation of a nurse-led falls prevention programme versus usual care

a randomized controlled trial

LIGHTBODY, ELIZABETH
WATKINS, CAROLINE
LEATHLEY, MICHAEL
SHARMA, ANIL
LYE, MICHAEL

¹Department of Medicine for the Elderly, University Hospital Aintree, Liverpool, UK
²Department of Nursing, University of Central Lancashire, Preston PR1 2HE, UK
³University Clinical Departments, The Duncan Building, Liverpool, UK

Address correspondence to: E. Lightbody. Fax: (+44) 1772 894968. Email: [email protected]

Received 13 May 2001; accepted in revised form 23 January 2002

Age and Ageing 31(3):p 203-210, May 2002.

Objective

to evaluate a nurse-led management plan and care pathway for older people discharged from an Accident and Emergency Department after a fall.

Design

randomized controlled trial.

Setting

a large teaching hospital.

Subjects

348 consecutive patients aged 65 or over attending the Accident and Emergency Department with a fall.

Interventions

we randomized patients to falls nurse intervention or usual care. Within 4 weeks, the intervention group received a home assessment to address easily modifiable risk factors for falls. This included assessments of medication, ECG, blood pressure, cognition, visual acuity, hearing, vestibular dysfunction, balance, mobility, feet and footwear. All patients were given advice and education about general safety in the home.

Main outcome measures

Further falls, functional ability, re-attendance at the Accident and Emergency Department and admission to hospital.

Results

at 6 months post-Index fall, 36 patients in the intervention group and 39 patients in the control group had had 89 and 145 falls respectively. Although the intervention group had less falls, this was not significant (P >0.05). Similarly, the intervention group had fewer fall-related admissions and bed days (8 and 69 respectively) than the control group (10 and 233 respectively). The intervention group scored significantly higher in indicators of function (P <0.05) and mobility within the community (P <0.02).

Conclusions

although the differences were not significant, patients in the intervention group had fewer falls, less hospital attendances and spent less time in hospital. Moreover, patients in the intervention group were more functionally independent at 6 months post-Index fall.