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Researchers at the University of Warwick and the University of Exeter found that two commonly prescribed population and treatment programs to prevent the elderly fall from falling did not help reduce fractures.
In the UK’s largest clinical trial of its kind, funded by the National Institute for Health Research, the team looked at two approaches to preventing falls in the elderly to see if they also resulted in fewer fractures. Their results, published today (Nov. 4) in the New England Journal of Medicine, indicated that using a population screening approach, these programs are ineffective in reducing fractures in the elderly.
Up to one in 20 elderly people with a history of falls will suffer a fracture annually, with some being hospitalized or moving to a nursing home. One in three people with a hip fracture dies within a year. Hip fractures alone cost over £ 2 billion a year in the UK. Strategies to prevent fall-related fractures are urgently needed.
The study looked at two screening and treatment programs: multifactorial fall prevention (MFFP) and exercise for people at increased risk of falls. People living in the community were screened for risk of falling and invited to participate in the programs. Both interventions are widely used in health care internationally and are regularly prescribed to the elderly.
Multifactorial fall prevention included a one-hour assessment by a trained physician for eight risk factors for falls. Participants would then either receive specific advice, contact their GP for a detailed medication review, or be referred to a physical therapy-led exercise. The exercise program lasted six months, during which they were seen by a physical therapist and trained at home.
The study recruited 9,803 people aged 70 and over – the oldest was 101 – and who lived in the community (i.e. not in a nursing home). They were asked to fill out a short questionnaire to determine their individual risk of falls, and those with a higher risk of falls were given a booklet of advice on fall prevention, which was randomly selected to take part in the 6-month exercise program, multifactorial fall prevention program or no more Intervention beyond the advice booklet. By taking a population-based screening approach rather than a targeted approach that focuses solely on those already receiving treatment for falls, researchers could create a realistic picture of the broader impact of these programs on all older people.
The researchers then used data from NHS Digital, combined with general practice records and reports from the participants themselves, to determine how often they went to hospital or attended an accident and emergency with a fracture over an 18 month period. When comparing the fracture rates from the Screen and Treat programs with those who received only the counseling brochure, they found no reduction in fracture rates between them.
Lead author Professor Sallie Lamb of the University of Exeter, who started the research at the University of Warwick, said, “While this is a disappointing result, it shows that we need to continue investing in research and development to fix fractures in the elderly reduce people. We need to think about the more general causes of fractures and also better understand what happens to cause falls. “
Co-author Professor Martin Underwood of the Warwick Department of Clinical Trials at the University of Warwick said, “Exercise programs and multifactorial fall prevention are often recommended to elderly people at risk of falling based on evidence that they reduce falls but so far there is no evidence. ” I have shown beyond any doubt that these interventions are ineffective in reducing fractures. “
Co-author Professor Julie Bruce of the Warwick Clinical Trials Unit at the University of Warwick said, “We have seen benefits to the overall health of people who exercise and a short-term reduction in the number of falls after exercise. who completed the 6 month exercise regimen got stronger and balance improved, but this did not translate into a reduction in fractures over the long term. The takeaway message is that we older people are encouraging physical activity and staying mobile for the health benefits . ”
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Screening and Intervention to Prevent Falls and Fractures in the Elderly, New England Journal of Medicine (2020). DOI: 10.1056 / NEJMoa2001500 Provided by the University of Warwick
Quote: No Reduction in Fractures in Elderly Fall Prevention Programs (2020, November 4), accessed November 4, 2020 at https://medicalxpress.com/news/2020-11-reduction-fractures-falls-programmes-older.html
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