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Evid Based Nurs 6:114 doi:10.1136/ebn.6.4.114
  • Treatment

A multifactorial intervention after a fall did not prevent falls in elderly patients with cognitive impairment and dementia


 
 QUESTION: In elderly patients with cognitive impairment and dementia, is multifactorial assessment and intervention as effective as conventional care for preventing falls?

Design

Randomised (allocation concealed), blinded {data collectors}*, controlled trial with 1 year of follow up.

Setting

2 inner city accident and emergency (AE) departments in Newcastle upon Tyne, UK.

Patients

308 patients ≥65 years of age with cognitive impairment and dementia (Mini-Mental State Examination [MMSE] score <24), who presented to the AE department after a fall (defined as an event reported by the patient or witness of an unintentional coming to rest on the ground or at another lower level with or without loss of consciousness or injury). Exclusion criteria were inability to walk, a medical diagnosis that likely caused the index fall, unfitness for investigation within 4 months, inability to communicate for reasons other than dementia, residence outside the recruitment area, or ≤2 contacts per week with a visitor. 89% of patients were included in the analysis (mean age 84 y, 80% women).

Intervention

Patients were stratified by MMSE score (20–23 [mild cognitive impairment], 12–19 [moderate], 4–11 [severe], and 0–3 [very severe]). 150 patients were allocated to a multifactorial assessment and intervention protocol, which comprised assessment, risk factor identification, and interventions, each in 4 areas of care (medical, cardiovascular, physiotherapy, and occupational therapy). 158 patients were allocated to conventional care from …

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