Journal article
A Randomized Trial of a Multifactorial Strategy to Prevent Serious Fall Injuries
The New England journal of medicine, Vol.383(2), pp.129-140
07/09/2020
DOI: 10.1056/NEJMoa2002183
PMCID: PMC7421468
PMID: 32640131
Abstract
BackgroundInjuries from falls are major contributors to complications and death in older adults. Despite evidence from efficacy trials that many falls can be prevented, rates of falls resulting in injury have not declined.
MethodsWe conducted a pragmatic, cluster-randomized trial to evaluate the effectiveness of a multifactorial intervention that included risk assessment and individualized plans, administered by specially trained nurses, to prevent fall injuries. A total of 86 primary care practices across 10 health care systems were randomly assigned to the intervention or to enhanced usual care (the control) (43 practices each). The participants were community-dwelling adults, 70 years of age or older, who were at increased risk for fall injuries. The primary outcome, assessed in a time-to-event analysis, was the first serious fall injury, adjudicated with the use of participant report, electronic health records, and claims data. We hypothesized that the event rate would be lower by 20% in the intervention group than in the control group.
ResultsThe demographic and baseline characteristics of the participants were similar in the intervention group (2802 participants) and the control group (2649 participants); the mean age was 80 years, and 62.0% of the participants were women. The rate of a first adjudicated serious fall injury did not differ significantly between the groups, as assessed in a time-to-first-event analysis (events per 100 person-years of follow-up, 4.9 in the intervention group and 5.3 in the control group; hazard ratio, 0.92; 95% confidence interval [CI], 0.80 to 1.06; P=0.25). The rate of a first participant-reported fall injury was 25.6 events per 100 person-years of follow-up in the intervention group and 28.6 events per 100 person-years of follow-up in the control group (hazard ratio, 0.90; 95% CI, 0.83 to 0.99; P=0.004). The rates of hospitalization or death were similar in the two groups.
ConclusionsA multifactorial intervention, administered by nurses, did not result in a significantly lower rate of a first adjudicated serious fall injury than enhanced usual care. (Funded by the Patient-Centered Outcomes Research Institute and others; STRIDE ClinicalTrials.gov number, NCT02475850.)
Injuries from falls are major contributors to death and complications in older adults. In this pragmatic, cluster-randomized trial, a multifactorial intervention that was administered by nurses did not result in a significantly lower rate of first adjudicated serious fall injury than enhanced usual care.
Details
- Title: Subtitle
- A Randomized Trial of a Multifactorial Strategy to Prevent Serious Fall Injuries
- Creators
- Shalender Bhasin - Harvard UniversityThomas M. Gill - Yale UniversityDavid B. Reuben - University of California, Los AngelesNancy K. Latham - Harvard UniversityDavid A. Ganz - University of California, Los AngelesErich J. Greene - Yale UniversityJames Dziura - Yale UniversityShehzad Basaria - Harvard UniversityJerry H. Gurwitz - University of Massachusetts Chan Medical SchoolPatricia C. Dykes - Harvard UniversitySiobhan McMahon - University of MinnesotaThomas W. Storer - Harvard UniversityPriscilla Gazarian - University of Massachusetts BostonMichael E. Miller - Wake Forest UniversityThomas G. Travison - Harvard UniversityDenise Esserman - Yale UniversityMartha B. Carnie - Harvard UniversityLori Goehring - Harvard UniversityMaureen Fagan - University of MiamiSusan L. Greenspan - University of PittsburghNeil Alexander - University of MichiganJocelyn Wiggins - University of MichiganFred Ko - Icahn School of Medicine at Mount SinaiAlbert L. Siu - Icahn School of Medicine at Mount SinaiElena Volpi - The University of Texas Medical Branch at GalvestonAlbert W. Wu - Johns Hopkins UniversityJeremy Rich - Mass General BrighamStephen C. Waring - Essentia HealthRobert B. Wallace - University of IowaCarri Casteel - University of IowaNeil M. Resnick - University of PittsburghJay Magaziner - University of Maryland, BaltimorePeter Charpentier - Yale UniversityCharles Lu - Yale UniversityKaty Araujo - Yale UniversityHaseena Rajeevan - Yale UniversityCan Meng - Yale UniversityHeather Allore - Yale UniversityBrooke F. Brawley - Harvard UniversityRich Eder - Harvard UniversityJoanne M. McGloin - Yale UniversityEleni A. Skokos - Yale UniversityPamela W. Duncan - Wake Forest UniversityDorothy Baker - Yale UniversityChad Boult - Johns Hopkins UniversityRosaly Correa-de-Araujo - National Institute on AgingPeter Peduzzi - Yale UniversitySTRIDE Trial Investigators
- Resource Type
- Journal article
- Publication Details
- The New England journal of medicine, Vol.383(2), pp.129-140
- DOI
- 10.1056/NEJMoa2002183
- PMID
- 32640131
- PMCID
- PMC7421468
- NLM abbreviation
- N Engl J Med
- ISSN
- 0028-4793
- eISSN
- 1533-4406
- Publisher
- Massachusetts Medical Soc
- Number of pages
- 12
- Grant note
- Patient-Centered Outcomes Research Institute; Patient-Centered Outcomes Research Institute - PCORI P30AG028748 / Claude D. Pepper Older Americans Independence Centers at the University of California, Los Angeles Harvard University New York Academy of Medicine P30AG2874106 / Mount Sinai Medical Center P30AG024832 / University of Texas Medical Branch Michigan Medicine, its academic health care system 5U01AG048270 / National Institute on Aging of the National Institutes of Health (NIH); United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Aging (NIA) UL1TR001102 / Harvard Catalyst, the Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, NIH) UL1TR000142 / Clinical and Translational Science Awards program of the National Center for Advancing Translational Sciences of the NIH P30AG021332 / Wake Forest University School of Medicine P30AG021342 / Yale University P30AG024824 / University of Michigan; University of Michigan System K07AG043587 / National Institute on Aging; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Aging (NIA) P30AG013679 / Boston Claude D. Pepper Older Americans Independence Center at Brigham and Women's Hospital P30AG024827 / University of Pittsburgh University of Pittsburgh Medical Center, its academic health care system KL2TR000113; UL1TR000114 / University of Minnesota Clinical and Translational Science Institute - National Center for Advancing Translational Sciences of the NIH U24AG059624 / Older Americans Independence Center National Coordinating Center
- Language
- English
- Date published
- 07/09/2020
- Academic Unit
- Occupational and Environmental Health; Epidemiology; Injury Prevention Research Center; Internal Medicine
- Record Identifier
- 9984363572402771
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