Falls risk in frail seniors : clinical and methodological studies

Introduction. Falls in older adults are a significant cause of morbidity. Thirty percent of women and 25% of men aged 65 years and older fall at least once per year and 1% of falls result in hip fracture. The effectiveness of current falls prevention guidelines has not been tested. One intervention to prevent falls is strength and balance retraining. Aims. (1) to determine whether older women who present to the emergency department with a fall receive referrals consistent with published guidelines; (2) to determine whether a home-based strength and balance retraining program reduces fall risk as measured by a standardized physiological profile; (3) to undertake a review of falls prevention literature to assess the appropriateness of statistical methods; (4) to explore the use of the mean cumulative function to compare fall events between groups. Methods. (1) Telephone administered survey; (2) a randomized controlled trial (RCT) of the Otago Exercise Program versus standard care; (3) a systematic review of RCTs; (4) a simulation study of the mean cumulative function. Results. Thirty-two percent of women (95% confidence interval 21% to 43%) who fell reported a visit with their family physician and 24% (95% confidence interval, 14% to 34%) reported referral and care with a physiotherapist. The incidence rate ratio for falls for Exercise Program participants compared to standard care was 0.44 (95% CI 0.23-0.84). Among 84 published RCTs reviewed fewer than one third utilized statistical methods for recurrent events. The mean cumulative function is useful for graphically summarizing fall events over time. Summary. Presentation to an emergency department after a fall is not currently associated with care consistent with published guidelines. Strength and balance retraining shows promise of reducing falls risk and further studies with larger samples are warranted. The analysis of falls could be improved by employing appropriate recurrent events models and informative graphical summaries.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat