Screening, Intervention Do Not Cut Falls, Fractures in Seniors

THURSDAY, Nov. 5, 2020 — Compared with advice by mail alone, the addition of screening for fall risk and targeted exercise, with or without a multifactorial intervention to prevent falls, does not result in fewer fractures in older adults, according to a study published in the Nov. 5 issue of the New England Journal of Medicine.

Sarah E. Lamb, D.Phil., from the University of Exeter in the United Kingdom, and colleagues randomly assigned 9,803 persons aged 70 years and older to advice by mail only (3,223 individuals), falls-risk screening and targeted exercise in addition to advice by mail (3,279 individuals), and falls-risk screening, exercise, and targeted multifactorial fall prevention in addition to advice by mail (3,301 individuals).

The researchers found that 89 percent of the exercise group and 87 percent of the multifactorial fall-prevention group returned completed fall-risk screening questionnaires. Of these, 37 percent were considered to be at increased fall risk and were invited to receive the intervention. The rates of fracture were not lower with screening and targeted intervention: The rate ratios for fracture with exercise and with multifactorial fall prevention as compared with advice by mail were 1.20 (95 percent confidence interval, 0.91 to 1.59) and 1.30 (95 percent confidence interval, 0.99 to 1.71), respectively. Small gains in health-related quality of life and the lowest overall costs were seen in association with the exercise strategy.

“Some possible benefits were associated with screening and a targeted offer of exercise, including small enhancements of quality of life and reduced health care costs,” the authors write.

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