Reducing Fall Risk for Frail Older Home-Care Clients Using a Multifactorial and Interdisciplinary Team Approach: Design of a Randomized Controlled Trial
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Objectives: This article describes the background and design of a study that is currently in progress. The objective of the study is to evaluate the 6-month effects and costs of a multifactorial and interdisciplinary team approach to fall prevention compared with usual home care for frail older people at risk for falls. The barriers and facilitators to implementing an interdisciplinary team approach in home care will also be discussed. Methods: Two-armed, single-blind randomized controlled trial of older people 75 years or older, newly referred to and eligible for personal support services through a home-care program in Ontario, Canada, and identified as being at risk for falls. Subjects were randomly allocated to either the usual home care (control) or the interdisciplinary team (experimental) group. In addition to usual home care, the interdisciplinary team provided a comprehensive and coordinated approach to fall prevention through regular home visits, evidence-based assessment and management of modifiable risk factors, weekly case conferencing, and a single accessible fall prevention plan. Results: Enrollment is currently in progress, and the study will be completed by December 2007. Outcomes include the incidence of falls, health-related quality of life, gait and balance, depression, cognitive functioning, confidence in performing activities of daily living, and costs of all types of health services. Implications: Home care occupies a strategic position in the prevention of falls among frail older people. A multifactorial and interdisciplinary team intervention, proactively provided to frail older people at risk for falls, is needed to deliver high-quality, cost-effective care.
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