Evaluation of a nurse-led falls prevention programme versus usual care: a randomized controlled trial

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.