Decreased falls through multifactorial intervention in frail older adults

Frail elders have higher risk of falls, with associated morbidity and mortality. Our objective was to reduce the percentage of falls in frail elders after a multifactorial and systemic intervention. Design: before-after quasi-experimental study, with own individual as control. Scope: patient’s living place, in the metropolitan area of ​​Buenos Aires city. Recruitment period: 01/10/2017-31/04/2018. Baseline assessment and 3-month follow-up. Inclusion criteria: ≥65 years with criteria of frailty according to the treating physician. Exclusion criteria: rejection of intervention or dying patient. Intervention: a health and social-care assistant systematically evaluated different dimensions for falls prevention and intervened according to need in each case in: environmental safety, prescription and training in the use of walking aids, strengthening exercises, improvement of the patient’s network of care, and medication reconciliation. The change in the percentage of people with falls in the last month (McNemar) was analyzed by intention to treat. We included 108 people. Average age was 85.2 years (SD 6.2). Women: 79.6%. Average Barthel: 50.5 (SD 35.9). Severe or total dependence: 56.8%; dementia: 29.6%; institutionalized: 30.5%; polypharmacy: 82.4%. High risk of falls: 79.6% (95% CI 71.1-86.1). In the initial evaluation, 33.3% had fallen in the last month (95% CI 25.2-42.7). After the intervention, 13.9% (95% CI 8.6-18.6), p <0.001. Previous falls rate: 50/100 people (SD 87); posterior: 11/100 people (SD 34), p <0.001. In conclusion, this multifactorial and systemic intervention in frail elders showed a reduction of people with falls of 41.7%, and a reduction of falls rate of 78%.