Fall prevention's place in primary care
Falls become more common in people after age 70 because of multiple medication use, postural hypotension, and impaired vision, gait, balance, and strength. However, “Despite evidence and mandates, falls remain largely ignored in clinical practice,” states lead investigator Mary E. Tinetti, MD, of Yale School of Medicine in New Haven (N Engl J Med. 2008;359:252-261).
Practice-changing interventions were set up in 212 primary-care offices. The offices were staffed by family practice physicians, internists, physician assistants, and advanced-practice nurses. Outpatient rehabilitation offices, senior centers, and home care agencies were also included in the study.
Intervention involved a number of components, including Web sites (www.fallprevention.org), patient-education materials, brochures, and outreach visits in which experts explained evidence-based fall-related strategies and advised clinicians on how to incorporate fall prevention into their practices.
In another region of the state, the primary-care clinicians practiced usual care, offering no such interventions.
Pre-intervention fall-related injury data were gathered for two years, intervention efforts took place for three years, and post-intervention evaluation took another two years. Although pre-intervention rates of serious fall-related injuries among persons aged 70 years and older were similar in both regions, during and beyond evaluation the adjusted rate of serious fall-related injuries was 9% lower in the intervention region than in the usual-care region. The adjusted rate of fall-related use of medical services was 11% lower in the intervention region.