The Winchester Falls Project: A Cluster Randomised Community Intervention Trial of Secondary Prevention of Falls in Community-Dwelling Older People

BACKGROUND INFORMATION

At least one in three people aged sixty five and over are reported to fall in the community each year and in the very elderly this figure is nearer 40 % (1,2). The morbidity and mortality resulting from falls in the elderly is substantial and the costs associated with such falls are likely to rise with the predicted growth in the elderly population. The Health of the Nation document recognises that falls are an important cause of disability and use of the health service in older people (3). More than 50% of accidental deaths in those aged sixty five years and over are due to falls, and survivors of falls have a tow-fold increased chance of being hospitalised (4). The target of the Health of the Nation is to reduce the death rate for accidents among people aged sixty five and over by at least 33% by the year 2005 (3). Prevention of falls and fall-related injuries will be a major factor in achieving such targets. It is therefore wise that approaches which are appropriate and likely to be effective are adequately researched and implemented if indicated. There have been a number of approaches to studying the prevention of falls, and their sequelae, in the elderly and these are explored in the accompanying literature review.

AIM

To determine whether multidisciplinary assessment of community-based patients, who have had at least one previous fall, reduces the rate of further falls and fall-related problems. The study also aims to determine whether such an intervention, if effective, is best carried out in a primary or secondary care setting.

STUDY DESIGN