A Randomized Trial of a Multifactorial Strategy to Prevent Serious Fall Injuries.
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
09 07 2020
09 07 2020
Historique:
entrez:
9
7
2020
pubmed:
9
7
2020
medline:
28
7
2020
Statut:
ppublish
Résumé
Injuries 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. We 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. The 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. A 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.).
Sections du résumé
BACKGROUND
Injuries 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.
METHODS
We 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.
RESULTS
The 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.
CONCLUSIONS
A 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.).
Identifiants
pubmed: 32640131
doi: 10.1056/NEJMoa2002183
pmc: PMC7421468
mid: NIHMS1610774
doi:
Banques de données
ClinicalTrials.gov
['NCT02475850']
Types de publication
Journal Article
Multicenter Study
Pragmatic Clinical Trial
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
129-140Subventions
Organisme : Patient-Centered Outcomes Research Institute
ID : 5U01AG048270
Pays : United States
Organisme : NIA NIH HHS
ID : K08 AG050808
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG028747
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG024824
Pays : United States
Organisme : NIA NIH HHS
ID : U24 AG059624
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG021342
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG028748
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000142
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG028741
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001102
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG024832
Pays : United States
Organisme : NIA NIH HHS
ID : 5U01AG048270
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG021332
Pays : United States
Organisme : NIA NIH HHS
ID : K07 AG043587
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG024827
Pays : United States
Organisme : NIA NIH HHS
ID : U01 AG048270
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG031679
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000114
Pays : United States
Organisme : NCATS NIH HHS
ID : KL2 TR000113
Pays : United States
Investigateurs
Shalender Bhasin
(S)
Thomas M Gill
(TM)
David B Reuben
(DB)
Nancy K Latham
(NK)
Shehzadsaria Shehzadsaria
(S)
Thomas W Storer
(TW)
Brooke F Brawley
(BF)
Richard Eder
(R)
Amy Larson
(A)
Lori Goehring
(L)
Molly Lukas
(M)
Scott Margolis
(S)
Martha B Carnie
(MB)
Priscilla Gazarian
(P)
Maureen Fagan
(M)
Lisa M Quintiliani
(LM)
Peter Peduzzi
(P)
James Dziura
(J)
Denise Esserman
(D)
Erich J Greene
(EJ)
Can Meng
(C)
Heather Allore
(H)
Charles Lu
(C)
Haseena Rajeevan
(H)
Liliya Katsovich
(L)
Rixin Wang
(R)
Brian Funaro
(B)
Nancy Lorenze
(N)
Margaret Doyle
(M)
Bridget Mignosa
(B)
Geraldine Hawthorne-Jones
(G)
Sui Tsang
(S)
Michael E Miller
(ME)
Thomas G Travison
(TG)
Peter Charpentier
(P)
Katy Araujo
(K)
Joanne M McGloin
(JM)
Amy Shelton
(A)
Eleni A Skokos
(EA)
Mara Abella
(M)
Luann M Bianco
(LM)
Rina Castro
(R)
Sabina Rubeck
(S)
Karen Wu
(K)
David Nock
(D)
Crysta Collins
(C)
Kenneth Rando
(K)
Eloisa Martinez
(E)
Siobhan McMahon
(S)
Stephen C Waring
(SC)
Erica Chopskie
(E)
Heather Larsen
(H)
Allise Taran
(A)
Joseph Bianco
(J)
Margaret Hoberg
(M)
Hillary Henzler-Buckingham
(H)
Austin Land
(A)
Jeremy Rich
(J)
Vivian Chavez
(V)
Christine Moore
(C)
Janelle Howe
(J)
Rosario Garcia
(R)
Samuel Ho
(S)
Yan Chen
(Y)
Albert W Wu
(AW)
Jeremy D Walston
(JD)
Yuri Agrawal
(Y)
Patti Ephraim
(P)
Tiffany Campbell
(T)
Steven J Kravet
(SJ)
Michael Albert Bimalhar
(MA)
Bernhard Birnbaum
(B)
Sajida Chaudry
(S)
LaToya Edwards
(L)
Scott Feeser
(S)
Naaz A Hussain
(NA)
Amrish Joseph
(A)
Alice Lee
(A)
Tara Scheck
(T)
Robert B Wallace
(RB)
Carri Casteel
(C)
Angela Shanahan
(A)
Julie Weldon
(J)
Anita Leveke
(A)
Charles F Keller
(CF)
Jeffrey C Reist
(JC)
David Swieskowski
(D)
Neil Alexander
(N)
Jocelyn Wiggins
(J)
Karen Burek
(K)
Tina Ledesma
(T)
Linda V Nyquist
(LV)
Nancy Gallagher
(N)
Catherine Hanson
(C)
Fred Ko
(F)
Albert L Siu
(AL)
Rosanne M Leipzig
(RM)
Christian Espino
(C)
Ravishankar Ramaswamy
(R)
Deborah West
(D)
Deborah Matza
(D)
Patricia C Dykes
(PC)
Hilary Stenvig
(H)
Kety FlorGomes
(K)
Taylor Christiansen
(T)
Alejandra Salazar
(A)
Laura Frain
(L)
Ariela Orkaby
(A)
Jonathan Bean
(J)
Yvette Wells
(Y)
Cathy Foskett
(C)
Jerry H Gurwitz
(JH)
Peggy Preusse
(P)
Anne McDonald
(A)
Lawrence Garber
(L)
Allison Richards
(A)
Azraa Amroze
(A)
Mary Ellen Stansky
(ME)
Susan L Greenspan
(SL)
Mary Anne Ferchak
(MA)
Madeline Rigatti
(M)
Neil M Resnick
(NM)
Elena Volpi
(E)
Summer R Chapman
(SR)
Roxana Hirst
(R)
Mukaila Raji
(M)
Megan A Berman
(MA)
Michael P Binder
(MP)
Cindy Chan
(C)
Matthew J Hay
(MJ)
Elizabeth A Jaramillo
(EA)
Michael T Nguyen
(MT)
Angela J Shepherd
(AJ)
Lindsay K Sonstein
(LK)
Julie S Bortolotti
(JS)
Amber M Zulfiqar
(AM)
Jay Magaziner
(J)
David A Ganz
(DA)
Joanne M McGloin
(JM)
Shehzad Basaria
(S)
Pamela W Duncan
(PW)
Chad Boult
(C)
James S Goodwin
(JS)
Todd M Manini
(TM)
Kevin P High
(KP)
Lea N Harvin
(LN)
Cynthia L Stowe
(CL)
Sergei Romashkan
(S)
Rosaly Correa-de-Araujo
(R)
Lyndon Joseph
(L)
Marcel E Salive
(ME)
Evan C Hadley
(EC)
Steven B Clauser
(SB)
David M Buchner
(DM)
Terry Fulmer
(T)
Susan S Ellenberg
(SS)
Bonita Lynn Beattie
(BL)
Abby C King
(AC)
Cynthia J Brown
(CJ)
Laurence Rubenstein
(L)
MaryAnne Sterling
(M)
Thomas R Prohaska
(TR)
Lawrence Friedman
(L)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2020 Massachusetts Medical Society.
Références
N Engl J Med. 2008 Jul 17;359(3):252-61
pubmed: 18635430
MMWR Morb Mortal Wkly Rep. 2016 Sep 23;65(37):993-998
pubmed: 27656914
BMC Geriatr. 2019 Nov 11;19(1):303
pubmed: 31711437
JAMA. 1993 Jan 6;269(1):65-70
pubmed: 8416408
JAMA. 2017 Nov 7;318(17):1687-1699
pubmed: 29114830
J Am Geriatr Soc. 2005 Sep;53(9):1618-22
pubmed: 16137297
Osteoporos Int. 2016 Feb;27(2):569-76
pubmed: 26194490
J Gerontol A Biol Sci Med Sci. 2018 Jul 9;73(8):1053-1061
pubmed: 29045582
JAMA. 2018 Apr 24;319(16):1696-1704
pubmed: 29710141
PLoS One. 2016 Mar 15;11(3):e0150939
pubmed: 26977599
Stat Med. 2007 May 20;26(11):2389-430
pubmed: 17031868
JAMA Intern Med. 2019 Mar 1;179(3):394-405
pubmed: 30592475
JAMA. 2018 Apr 24;319(16):1705-1716
pubmed: 29710140
J Am Geriatr Soc. 2015 Jan;63(1):63-70
pubmed: 25597558
J Stat Softw. 2017 Apr;77(CS1):
pubmed: 28649186
N Engl J Med. 1994 Sep 29;331(13):821-7
pubmed: 8078528
Osteoporos Int. 2014 Oct;25(10):2359-81
pubmed: 25182228
J Am Geriatr Soc. 2020 Jun;68(6):1242-1249
pubmed: 32212395
Cochrane Database Syst Rev. 2019 Jan 31;1:CD012424
pubmed: 30703272
MMWR Morb Mortal Wkly Rep. 2018 May 11;67(18):509-514
pubmed: 29746456
Cochrane Database Syst Rev. 2018 Jul 23;7:CD012221
pubmed: 30035305
J Gerontol A Biol Sci Med Sci. 2018 Oct 8;73(11):1495-1501
pubmed: 30020415
Cochrane Database Syst Rev. 2012 Sep 12;(9):CD007146
pubmed: 22972103
N Engl J Med. 2020 Feb 20;382(8):734-743
pubmed: 32074420
J Am Geriatr Soc. 2017 Dec;65(12):2733-2739
pubmed: 29044479
Med Care. 2002 Sep;40(9):771-81
pubmed: 12218768
Inj Epidemiol. 2019 Apr 15;6:14
pubmed: 31245263
J Am Geriatr Soc. 2011 Jan;59(1):148-57
pubmed: 21226685
J Safety Res. 2011 Dec;42(6):419-22
pubmed: 22152258