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The Value of Assessing Falls in an Elderly Population: A Randomized Clinical Trial

Laurence Z. Rubenstein, MD, MPH; Alan S. Robbins, MD; Karen R. Josephson, MPH; Barbara L. Schulman, RN, GNP; and Dan Osterweil, MD
[+] Article, Author, and Disclosure Information

Presented in part at the National Meeting of the American Federation for Clinical Research, Washington, DC, May 1989.

Grant Support: By the Health Services Research and Development Services of the Department of Veterans Affairs (project 84-141).

Requests for Reprints: Laurence Z. Rubenstein, MD, Veterans Affairs Medical Center (HE), 16111 Plummer Street, Sepulveda, CA 91343.

Current Author Addresses: Drs. Rubenstein, Robbins, Ms. Josephson, and Ms. Schulman: Veterans Affairs Medical Center (HE), 16111 Plummer Street, Sepulveda, CA 91343.

Dr. Osterweil: Jewish Homes for the Aging of Greater Los Angeles, 7150 Tampa Avenue, Reseda, CA 91335-3798.

Ann Intern Med. 1990;113(4):308-316. doi:10.7326/0003-4819-113-4-308
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Objective: 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.

Design: Randomized, controlled trial.

Setting: A long-term residential care facility for elderly persons.

Subjects: 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).

Intervention: 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.

Measurements and Main Results: 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 < 0.05) and a 52% reduction in hospital days (P < 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.

Conclusions: 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.







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