Predictors and effect of adherence to a multifactorial fall prevention program following paramedic care

Aim: To understand determinants of adherence to a multifactorial fall prevention program, and the program's effect on falls and health service utilisation. Methods: Randomised, single-blind, controlled trial with a priori subgroup analysis according to adherence levels within the intervention group (IG). Participants were community-dwelling adults (≥65 years), not transported to hospital following fall-related paramedic care. Fall risk assessment identified relevant fall-prevention recommendations. IG received assistance to implement. The Attitudes to Falls-Related Interventions Scale (AFRIS) was completed at baseline, adherence levels measured at 6 months, falls and health service utilisation recorded for 12-months. Multivariate logistic regression and AUC calculated with 95% CI. Results: AFRIS scores within IG (n = 85) were independent of participant characteristics; 48 (56%) participants showed positive intention towards their recommendations. At 6 months, 39 (46%) participants reported adhering to all recommendations. Significant predictors of adherence were positive AFRIS (OR 3.66, 95% CI 1.35–9.92), taking 8 + medications (OR 2.78, 95% CI 1.02–7.56) and receiving 3 + recommendations (OR 2.90, 95% CI 1.07–7.90). The AUC (3-variable model) was 0.77 (95% CI 0.66–0.87), significantly outperforming individual variables. Adhering IG participants experienced significantly fewer falls (IRR 0.53, 95% CI 0.45–0.80) fall-related paramedic attendances (IRR 0.51, 95% CI 0.30–0.88), ED presentations (fall-related: IRR 0.37, 95% CI 0.17–0.82; fall-unrelated: IRR 0.51, 95% CI 0.28–0.94) and fall-related hospitalisations (IRR 0.37, 95% CI 0.16–0.89) compared to non-adhering participants. Conclusions: Older adults who commit to adhering to individualised recommendations can significantly benefit, regardless of their fall risk factors and medical history. Information on intention to engage in intervention programs provides a mechanism for more efficient use of limited health resources