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      Effectiveness of preventive home visits in reducing the risk of falls in old age: a randomized controlled trial

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          Abstract

          Background

          Falls in older people are a major public health issue, but the underlying causes are complex. We sought to evaluate the effectiveness of preventive home visits as a multifactorial, individualized strategy to reduce falls in community-dwelling older people.

          Methods

          Data were derived from a prospective randomized controlled trial with follow-up examination after 18 months. Two hundred and thirty participants (≥80 years of age) with functional impairment were randomized to intervention and control groups. The intervention group received up to three preventive home visits including risk assessment, home counseling intervention, and a booster session. The control group received no preventive home visits. Structured interviews at baseline and follow-up provided information concerning falls in both study groups. Random-effects Poisson regression evaluated the effect of preventive home visits on the number of falls controlling for covariates.

          Results

          Random-effects Poisson regression showed a significant increase in the number of falls between baseline and follow-up in the control group (incidence rate ratio 1.96) and a significant decrease in the intervention group (incidence rate ratio 0.63) controlling for age, sex, family status, level of care, and impairment in activities of daily living.

          Conclusion

          Our results indicate that a preventive home visiting program can be effective in reducing falls in community-dwelling older people.

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          Most cited references 8

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          Growing old at home – A randomized controlled trial to investigate the effectiveness and cost-effectiveness of preventive home visits to reduce nursing home admissions: study protocol [NCT00644826]

          Background Regarding demographic changes in Germany it can be assumed that the number of elderly and the resulting need for long term care is increasing in the near future. It is not only an individual's interest but also of public concern to avoid a nursing home admission. Current evidence indicates that preventive home visits can be an effective way to reduce the admission rate in this way making it possible for elderly people to stay longer at home than without home visits. As the effectiveness and cost-effectiveness of preventive home visits strongly depends on existing services in the social and health system existing international results cannot be merely transferred to Germany. Therefore it is necessary to investigate the effectiveness and cost-effectiveness of such an intervention in Germany by a randomized controlled trial. Methods The trial is designed as a prospective multi-center randomized controlled trial in the cities of Halle and Leipzig. The trial includes an intervention and a control group. The control group receives usual care. The intervention group receives three additional home visits by non-physician health professionals (1) geriatric assessment, (2) consultation, (3) booster session. The nursing home admission rate after 18 months will be defined as the primary outcome. An absolute risk reduction from a 20% in the control-group to a 7% admission rate in the intervention group including an assumed drop out rate of 30% resulted in a required sample size of N = 320 (n = 160 vs. n = 160). Parallel to the clinical outcome measurement the intervention will be evaluated economically. The economic evaluation will be performed from a society perspective. Discussion To the authors' knowledge for the first time a trial will investigate the effectiveness and cost-effectiveness of preventive home visits for people aged 80 and over in Germany using the design of a randomized controlled trial. Thus, the trial will contribute to the existing evidence on preventive home visits especially in Germany.
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            Community-based health efforts for the prevention of falls in the elderly

            Falls are a major public health problem in the elderly population. The associated health care cost is great. It has therefore become an important public health matter to evaluate those interventions that might be effective in reducing the risk of falls. Risk factors that predict an increased risk of falling are described. We discuss interventions that can be employed in the community to reduce the risk of falls and associated injuries by discipline, including physiotherapy, occupational therapy, and physician-led interventions. We also discuss the cost-effectiveness of such interventions.
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              Prevention of falls--a time to translate evidence into practice.

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                Author and article information

                Journal
                Clin Interv Aging
                Clin Interv Aging
                Clinical Interventions in Aging
                Dove Medical Press
                1176-9092
                1178-1998
                2013
                2013
                12 June 2013
                : 8
                : 697-702
                Affiliations
                [1 ]Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
                [2 ]Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
                [3 ]Technical University Dresden, Dresden, Germany
                [4 ]Institute of Nursing and Health Science, Martin-Luther-University Halle-Wittenberg, Halle, Germany
                [5 ]Faculty of Health, Witten/Herdecke University, Witten, Germany
                [6 ]Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
                Author notes

                *These authors contributed equally to this work

                Correspondence: Tobias Luck University of Leipzig, Institute of Social Medicine, Occupational Health and Public Health, Public Health Research Unit, Philipp-Rosenthal-Strasse 55, Leipzig D-04103, Germany, Tel +49 341 972 4568,Fax +49 341 972 4569, Email tobias.luck@ 123456medizin.uni-leipzig.de
                cia-8-697
                10.2147/CIA.S43284
                3684143
                23788832
                © 2013 Luck et al, publisher and licensee Dove Medical Press Ltd

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                Categories
                Original Research

                Health & Social care

                evaluation, prevention, home visits, randomized controlled trial, falls

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