Multifactorial interventions to prevent falls in older adults

BACKGROUND: Falls are one of the most common syndromes in old age. An estimated 646,000 deaths from falls occur each year worldwide. Moreover, most fatal falls occur in people over 65 years of age. Most falls are the result of the interaction of several factors.

AIMS: To examine the long-term effectiveness of multifactorial interventions in preventing falls in elderly and senile patients.

MATERIALS AND METHODS: A sample of patients territorially attached to the Family Medicine Center of the North-Western State Medical University named after I.I. Mechnikov was established four years ago. Individual fall prevention programs were developed for all study participants (n = 260) because they had different falls risk factors. Patient follow-up was continued for 12 months. The results of the multifactorial intervention were evaluated after 12 months and after 3 years, 2 times in total, the last study in a random subsample of patients (n = 84). Aging asthenia screening, questionnaires, assessment of emotional status, and presence of sleep disturbances were performed to assess the risk of falls. The effectiveness of multifactorial interventions was assessed based on repeated assessment of risk factors for falls.

RESULTS: Participants with a history of falls were significantly more likely to have symptoms of depression, anxiety, symptoms of frailty, visual and hearing impairment (p < 0.05). On average, each participant in the group with falls had 6.1 ± 2.1 risk factors for falls and 3.8 ± 2.3 in the group without falls (p = 0.000). During the follow-up period after the interventions, the incidence of falls decreased 9-fold after one year (from 28.5% to 3.1%) and then increased to 23.8%. All patients who fell after the multifactorial intervention had a history of cognitive impairment and falls. In addition, in the group of patients with falls, fall risk factors such as low levels of physical activity, hearing impairment, and the presence of a traumatic environment at home were not eliminated. As a result of the interventions, fear of falls disappeared in 9 patients, 95% CI (2.35-65.89), p = 0.039.

CONCLUSIONS: The study demonstrated a decrease in the effectiveness of multifactorial interventions to prevent falls at three years. A less persistent effect was seen in patients with a history of falls. A history of falls, symptoms of frailty, complaints of fear of falls, sleep disturbances, and anxiety symptoms were factors that increased the risk of falls. Individualized fall prevention programs resulted in decreased fear of falls.