Multifactorial falls prevention compared with usual care in long-term care homes for older people: a multi-centre cluster randomised controlled trial with economic evaluation

2021 
Objectives To determine the clinical and cost effectiveness of a multifactorial fall prevention programme in care homes compared to usual care Design Multi-centre, parallel, 1:1 cluster randomised controlled trial Setting UK long-term care homes with registration for old age or dementia. Participants Consenting residents of participating care homes. Interventions The Guide to Action for Care Homes (GtACH): a multifactorial fall prevention programme. Main outcome measures Primary outcome measure was fall rate between 91 and 180 days after randomisation. The economic evaluation measured health-related quality of life using quality adjusted life years (QALYs) derived from the five-domain five-level version of the EuroQoL index or proxy version (EQ-5D-5L-P) and the Dementia Quality of Life measure (DEMQOL-P-U) which were completed by the resident if able to do so, and for all residents by a care home staff member proxy until 12 months after randomisation. Secondary outcome measures were: falls 1-90, 181-270 and 271-360 days after randomisation; and Barthel Index; and the Physical Activity Measure – Residential Care Homes (PAM-RC) at 91, 180, 270 and 360 post-randomisation. Results 84 care homes were randomised (39 GtACH, 45 usual care). 1657 residents consented and provided baseline measures, mean age 85 years, 32% men. GtACH training was delivered to 1051/1480 staff (71%). Primary RCT outcome data were available for 630 GtACH participants and 712 usual care participants. The unadjusted Incidence Rate Ratio for falls between 91-180 days was 0.57 (95% CI 0.45 to 0.71, p≤0.001) in favour of the GtACH programme (GtACH: 6 falls/1000 residents versus 10.4/1000 in usual care). Barthel ADL Indices and PAM-RC scores were similar between groups at all-time points. The incremental cost was £108 (95% CI -271.06 to 487.58), incremental QALYs gained were 0.024 (95% CI 0.004 to 0.044) and 0.005 (95% CI -0.019 to 0.03) for EQ-5D-5L-P and DEMQOL-P-U respectively. The incremental costs per EQ-5D-5L-P and DEMQOL-P-U based QALY were £4,544 and £20,889 respectively. Conclusions The GtACH programme reduced the fall rate and was cost-effective, without reducing activity or increasing dependency.
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