• C Raina Elley, M Clare Robertson, Sue Garrett, Ngaire M Kerse, Eileen McKinlay, Beverley Lawton, Helen Moriarty, Simon A Moyes, and A John Campbell.
• Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand. c.elley@auckland.ac.nz
• J Am Geriatr Soc. 2008 Aug 1; 56 (8): 1383-9.

ObjectivesTo assess the effectiveness of a community-based falls-and-fracture nurse coordinator and multifactorial intervention in reducing falls in older people.DesignRandomized, controlled trial.SettingScreening for previous falls in family practice followed by community-based intervention.ParticipantsThree hundred twelve community-living people aged 75 and older who had fallen in the previous year.InterventionHome-based nurse assessment of falls-and-fracture risk factors and home hazards, referral to appropriate community interventions, and strength and balance exercise program. Control group received usual care and social visits.MeasurementsPrimary outcome was rate of falls over 12 months. Secondary outcomes were muscle strength and balance, falls efficacy, activities of daily living, self-reported physical activity level, and quality of life (Medical Outcomes Study 36-item Short Form Questionnaire).ResultsOf the 3,434 older adults screened for falls, 312 (9%) from 19 family practices were enrolled and randomized. The average age was 81+/-5, and 69% (215/312) were women. The incidence rate ratio for falls for the intervention group compared with the control group was 0.96 (95% confidence interval=0.70-1.34). There were no significant differences in secondary outcomes between the two groups.ConclusionThis nurse-led intervention was not effective in reducing falls in older people who had fallen previously. Implementation and adherence to the fall-prevention measures was dependent on referral to other health professionals working in their usual clinical practice. This may have limited the effectiveness of the interventions.

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