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Multifactorial and Exercise-Based Interventions Didn't Prevent Falls in Elders

Allan S. Brett, MD reviewing Lamb SE et al. N Engl J Med 2020 Nov 5

Fall-related injuries occurred with similar frequencies in intervention recipients and controls.

In a recent U.S. trial, a multifactorial intervention to prevent falls in older community-dwelling people failed to lower the incidence of serious injuries (NEJM JW Gen Med Aug 1 2020 and N Engl J Med 2020; 383:129). Now, U.K. researchers have conducted a somewhat similar trial in which 63 primary care practices recruited nearly 10,000 community-dwelling participants (age, >70). The practices were randomized into three groups: One group's patients received home-based exercise programs that were individually tailored by physical therapists; the second group's patients received a multifactorial fall prevention intervention in which clinicians addressed relevant medical disorders, medications, balance and gait, footwear, vision, and home environment; the third group's patients (controls) received only fall-prevention advice by mail.

During 18 months of follow-up, no significant differences were noted between the multifactorial, exercise, and control groups in the incidence of fractures (about 3 fractures per 100 person-years in each group) or falls (about 110 per 100 person-years in each group). In a subgroup of about 4000 participants considered to be at high risk for falls, results were similar: Neither intervention lowered the incidence of falls or fractures.

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