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No reduction in fractures seen in falls prevention programmes prescribed to older people

 

Two ‘screen and treat’ programmes designed to prevent older people falling do not reduce fractures, an NIHR funded trial has revealed.

Up to one in 20 older people with a history of falling sustains a fracture annually, with some being admitted to hospital, or needing to move to a care home. One in three people with a hip fracture dies within one year. Hip fractures alone cost the UK over £2 billion per year. 

As part of the largest clinical trial of its kind in the UK, researchers from the University of Warwick and University of Exeter examined two approaches to preventing falls in older people to find out if they also resulted in fewer fractures. Their results now published in the New England Journal of Medicine, showed that these programmes are ineffective, when using a population screening approach, in reducing fractures in older people. 

The study examined two programmes: multi-factorial fall prevention (MFFP), and exercise for people at increased falls risk. People living in the community (not in care homes) were screened for falls risk and invited to attend the programmes.  Both interventions are widely used in health services internationally, and prescribed regularly for older people.

Multi-factorial fall prevention involved a one-hour assessment with a trained health professional for eight risk factors for falls. Following this, participants would either be given specific advice, see their GP for a detailed medication review, or be referred for physiotherapy-led exercise. The exercise programme ran for six months during which they were seen by a physiotherapist and exercised at home. 

Researchers recruited 9,803 people aged over 70 - with the eldest being 101 years old  who completed a short questionnaire to determine their individual risk of experiencing a fall. Those at higher risk were provided with a falls prevention advice booklet, then randomly assigned to take part in either the 6-month exercise programme, the multi-factorial fall prevention programme, or no further intervention beyond the advice booklet. By taking a population-based screening approach, rather than targeted approach focusing solely on those already being treated for falls, the researchers could build a realistic picture of the broader impact of these programmes on all older people.

Experts then used data from NHS Digital, combined with general practice records and reports from the participants, to determine how many times they attended hospital or Accident and Emergency with fractures within 18 months. When they compared fracture rates from both ‘screen and treat’ programmes to those only receiving the advice booklet, they found no reduction in fracture rates between them.

Lead author Professor Sallie Lamb of the University of Exeter, who began the research while working at the University of Warwick, said: “Whilst this is a disappointing result, it shows that we must continue to invest in research and development to reduce fractures in older people. We need to think about the broader causes of fractures, and also understand more about what happens to cause falls.”

Co-author Professor Julie Bruce from Warwick Clinical Trials Unit at the University of Warwick said: “We saw benefits to the general health of people doing exercise and a short-term reduction in the number of falls after exercise. People completing the 6-month exercise programme became stronger and their balance improved but that did not translate into a reduction in fractures in the long term. The take home message is that we would encourage older people to do physical activity and keep mobile because of the health benefits.”

The trial was funded by the NIHR’s Health Technology Assessment (HTA) Programme. 

More information about the study is available on the NIHR Funding and Awards website.