Community-based fall assessment compared with hospital-based assessment in community-dwelling older people over 65 at high risk of falling: a randomized study

Abstract

Background and aims: The effectiveness of community-based fall assessment programs in older people is unclear. In this study, we examined the effectiveness of community-based fall assessment compared with hospital-based assessment. Methods: A randomized un-blind study was conducted in 369 older adults aged 65 years and over at high risk of falling. Participants were drawn from a larger cohort of community-dwelling older people. Eligible participants were identified by means of a simple five-item screening tool. A randomly chosen subset population of people at high risk of falling was then randomized into two arms, community-based and hospital-based fall assessments. The total number of falls in both groups was recorded by following up subjects’ diaries and telephone interviews at 3, 6 and 12 months. Incidence Rate Ratios (IRR) for the rate of falls at 12 months between community- and hospital-based assessments were analysed as primary outcome, by intention-to-treat analysis. Results: A total of 349 participants completed the study. Attendance to community-based assessment was significantly higher compared with hospital-based assessment in this older population (p=0.012). There were no statistically significant differences between the two groups in total number of falls at the 12 month follow-up. According to Negative Binomial regression, the adjusted IRR of falls in the communitybased arm was not significantly different from the hospital-based one (IRR 0.95; 95% CI 0.58–1.45, p=0.83). Conclusion: This study showed the increased risk of falling according to community-based fall assessment program with respect to a traditional hospital-based one in community-dwelling older adults at high risk of falling.