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Comparison of different strategies of referral to a fall clinic: How to achieve an optimal casemix?

  • Comparison of Different Strategies of Referral to a Fall Clinic
  • Published:
The journal of nutrition, health & aging

Abstract

Objective

To study the potential differences in patient characteristics between two referral methods to a fall clinic, specifically: case-finding of patients admitted to an emergency department because of a fall, compared to direct referral to the fall clinic via the general practitioner.

Design

Cross-sectional study.

Setting

Fall clinics in two university teaching hospitals in the Netherlands.

Participants

Three hundred community-dwelling older people aged 65 years or over currently attending the fall clinics in Nijmegen (Group 1, n=154) and in Amsterdam (Group 2, n=146).

Measurements

Patients were referred by a general practitioner (Group 1) or were selected using the Carefall Triage Instrument (CTI) after visiting the emergency department (Group 2). In all patients, modifiable risk factors for recurrent falls were assessed.

Results

Group 1 had less modifiable risk factors for falling (a mean of 4 (SD 1.6) vs. a mean of 5 (SD 1.5) in Group 2, p<0.001). Compared to Group 2, Group 1 had more prevalent ‘recurrent falling (≥2 falls)’ (p=0.001) and ‘assisted living in homes for the aged’ (p=0.037). ‘Fear of falling’, ‘mobility and balance problems’, ‘home hazards’ and ‘osteoporosis’ were significantly less prevalent in Group 1.

Conclusion

This study suggests that patients referred to a multidisciplinary fall prevention clinic by their general practitioner have a different risk profile than those selected by case finding using the CTI. These differences have consequences for the reach of secondary care for fall-preventive interventions and will probably influence the effectiveness and efficiency of a fall prevention program.

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References

  1. Hausdorff JM, Rios DA, Edelberg HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil 2001;82:1050–1056.

    Article  PubMed  CAS  Google Scholar 

  2. Shumway-Cook A, Ciol MA, Hoffman J, Dudgeon BJ, Yorkston K, Chan L. Falls in the Medicare population: incidence, associated factors, and impact on health care. Phys Ther 2009;89:324–332.

    Article  PubMed  Google Scholar 

  3. Gribbin J, Hubbard R, Smith C, Gladman J, Lewis S. Incidence and mortality of falls amongst older people in primary care in the United Kingdom. QJM 2009;102:477–483.

    Article  PubMed  CAS  Google Scholar 

  4. Letsel Informatie Systeem 2002–2006. Den Haag: Consument en Veiligheid, 2008 (online) Available at: http://www.veiligheid.nl/csi/veiligheid.nsf/wwwVwContent/valongevallen55.html. Accessed June 12,2009.

  5. Campbell AJ, Borrie MJ, Spears G. Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol 1989;44:M112–117.

    PubMed  CAS  Google Scholar 

  6. Graafmans WC, Ooms ME, Hofstee HMA, Bezemer PD, Bouter LM, Lips P. Falls in the elderly: a prospective study of risk factors and risk profiles. Am J Epidemiol 1996;143:1129–1136.

    PubMed  CAS  Google Scholar 

  7. Tinetti ME, Doucette J, Claus E, Marottoli R. Risk factors for serious injury during falls by older persons in the community. JAGS 1995;43:1214–1221.

    CAS  Google Scholar 

  8. American Geriatrics Society, British Geriatrics Society and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. Guidelines for the prevention of falls in older persons. JAGS 2001;49:664–672.

    Article  Google Scholar 

  9. Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P, Gottschalk M, Koch ML, Trainor K, Horwitz RI. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Eng J Med 1994;331:821–827.

    Article  CAS  Google Scholar 

  10. Chang JT, Morton SC, Rubenstein LZ, Mojica WA, Maglione M, Suttorp MJ, Roth EA, Shekelle PG. Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. BMJ 2004;328:680.

    Article  PubMed  Google Scholar 

  11. Close J, Ellis M, Hooper, Glucksman E, Jackson S, Swift C. Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. Lancet 1999;353:93–97.

    Article  PubMed  CAS  Google Scholar 

  12. Hogan DB, MacDonald FA, Betts J, Bricker S, Ebly EM, Delarue B, Fung TS, Harbidge C, Hunter M, Maxwell CJ, Metcalf B. A randomized controlled trial of a community-based consultation service to prevent falls. CMAJ 2001;165:537–543.

    PubMed  CAS  Google Scholar 

  13. Davison J, Bond J, Dawson P, Steen IN, Kenny RA. Patients with recurrent falls attending Accident & Emergency benefit from multifactorial intervention—a randomised controlled trial. Age Ageing 2005;34:162–168.

    Article  PubMed  Google Scholar 

  14. Hendriks MR, Bleijlevens MH, van Haastregt JC, Crebolder HF, Diederiks JP, Evers SM, Mulder WJ, Kempen GI, van Rossum E, Ruijgrok JM, Stalenhoef PA, van Eijk JT. Lack of effectiveness of a multidisciplinary fall-prevention program in elderly people at risk: a randomized, controlled trial. J Am Geriatr Soc 2008;56:1390–1397.

    Article  PubMed  Google Scholar 

  15. Gates S, Fisher JD, Cooke MW, Carter YH, Lamb SE. Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: systematic review and meta-analysis. BMJ 2008;336:130–133.

    Article  PubMed  CAS  Google Scholar 

  16. Lamb SE, Fisher JD, Gates S, Potter R, Cooke M, Carter YH. A national survey of services for the prevention and management of falls in the UK. BMC Health Serv Res 2008;8:233.

    Article  PubMed  Google Scholar 

  17. Tinetti ME. Multifactorial fall-prevention strategies: time to retreat or advance. J Am Geriatr Soc 2008;56:1563–1565.

    Article  PubMed  Google Scholar 

  18. Campbell AJ, Robertson MC. Not a retreat, but advancing on numerous fronts. J Am Geriatr Soc 2009;57:565–566.

    Article  PubMed  Google Scholar 

  19. Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2009;CD007146.

  20. Li F, Harmer P, Fisher KJ, McAuley E, Chaumeton N, Eckstrom E, Wilson NL. Tai Chi and fall reductions in older adults: a randomized controlled trial. J Gerontol A Biol Sci Med Sci 2005;60:187–194.

    PubMed  Google Scholar 

  21. Boele van Hensbroek P, van Dijk N, van Breda GF, Scheffer AC, van der Cammen TJ, Lips P, Goslings JC, de Rooij SE; Combined Amsterdam and Rotterdam Evaluation of FALLs (CAREFALL) study group. The CAREFALL Triage Instrument identifying risk factors for recurrent falls in elderly patients. Am J Emerg Med 2009;27:23–36.

    Article  PubMed  Google Scholar 

  22. Shaw FE. Prevention of falls in older people with dementia. J Neural Transm 2007;114:1259–1264.

    Article  PubMed  CAS  Google Scholar 

  23. Kempen GI, Miedema I, Ormel J, Molenaar W. The assessment of disability with the Groningen Activity Restriction Scale. Conceptual framework and psychometric properties. Soc Sci Med 1996;43:1601–1610.

    Article  PubMed  CAS  Google Scholar 

  24. Statistics Netherlands 2009 (online) Available at: www.cbs.nl/nl-NL/menu/home/default.htm. Accessed February 8, 2009.

  25. Elley CR, Robertson MC, Kerse NM, Garrett S, McKinlay E, Lawton B, Moriarty H, Campbell AJ. Falls Assessment Clinical Trial (FACT): design, interventions, recruitment strategies and participants characteristics. BMC Public Health 2007;7:185.

    Article  PubMed  Google Scholar 

  26. Vassallo M, Poynter L, Sharma JC, Kwan J, Allen SC. Fall risk-assessment tools compared with clinical judgment: an evaluation in a rehabilitation ward. Age Ageing 2008;37:277–281.

    Article  PubMed  Google Scholar 

  27. Shandro JR, Spain DA and Dicker RA. Recruitment strategies for a fall prevention program: if we build it, will they really come? J Trauma 2007;63:142–146.

    Article  PubMed  Google Scholar 

  28. Hauer K, Pfisterer M, Schuler M, Bärtsch P, Oster P. Two years later: a prospective long-term follow-up of a training intervention in geriatric patients with a history of severe falls. Arch Phys Med Rehabil 2003;84:1426–1432.

    Article  PubMed  Google Scholar 

  29. Faber MJ, Bosscher RJ, Chin A Paw MJ, van Wieringen PC. Effects of exercise programs on falls and mobility in frail and pre-frail older adults: A multicenter randomized controlled trial. Arch Phys Med Rehabil 2006;87:885–896.

    Article  PubMed  Google Scholar 

  30. Russell MA, Hill KD, Blackberry I, Day LL, Dharmage SC. Falls risk and functional decline in older fallers discharged directly from emergency departments. J Gerontol A Biol Sci Med Sci 2006;61:1090–1095.

    PubMed  Google Scholar 

  31. Tinetti ME, Williams CS. The effect of falls and fall injuries on functioning in community-dwelling older persons. J Gerontol A Biol Sci Med Sci 1998;53:M112–119.

    PubMed  CAS  Google Scholar 

  32. Russell MA, Hill KD, Blackberry I, Day LM, Dharmage SC. The reliability and predictive accuracy of the falls risk for older people in the community assessment (FROP-Com) tool. Age Ageing 2008;37:634–639.

    Article  PubMed  Google Scholar 

  33. Scott V, Votova K, Scanlan A, Close J. Multifactorial and functional mobility assessment tools for fall risk among older adults in community, home-support, long-term and acute care settings. Age Ageing 2007;36:130–139.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Geriatric Medicine, Radboud University Nijmegen Medical Center, Radboud, the Netherlands

    Y. Schoon, M. E. Hoogsteen-Ossewaarde, A. C. Scheffer, M. G. M. Olde Rikkert & S. E. De Rooij

  2. Department of Internal Medicine, Section of Geriatrics, Academic Medical Center Amsterdam, Amsterdam, the Netherlands

    F. J. M. Van Rooij

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  1. Y. Schoon
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  2. M. E. Hoogsteen-Ossewaarde
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  3. A. C. Scheffer
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  4. F. J. M. Van Rooij
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  5. M. G. M. Olde Rikkert
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  6. S. E. De Rooij
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Schoon, Y., Hoogsteen-Ossewaarde, M.E., Scheffer, A.C. et al. Comparison of different strategies of referral to a fall clinic: How to achieve an optimal casemix?. J Nutr Health Aging 15, 140–145 (2011). https://doi.org/10.1007/s12603-011-0027-3

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  • DOI: https://doi.org/10.1007/s12603-011-0027-3

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