• Sarah E Lamb, Julie Bruce, Anower Hossain, Chen Ji, Roberta Longo, Ranjit Lall, Chris Bojke, Claire Hulme, Emma Withers, Susanne Finnegan, Ray Sheridan, Keith Willett, Martin Underwood, and Prevention of Fall Injury Trial Study Group.
• From the Institute of Health Research, University of Exeter (S.E.L., C.H., R.S.), and Royal Devon and Exeter Hospital (R.S.), Exeter, the Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick (J.B., C.J., R. Lall, E.W., S.F., M.U.), and University Hospitals Coventry and Warwickshire (M.U.), Coventry, Leeds Institute of Health Sciences, University of Leeds, Leeds (R. Longo, C.B.), and the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford (K.W.) - all in the United Kingdom, and the Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh (A.H.).
• N. Engl. J. Med. 2020 Nov 5; 383 (19): 1848-1859.

BackgroundCommunity screening and therapeutic prevention strategies may reduce the incidence of falls in older people. The effects of these measures on the incidence of fractures, the use of health resources, and health-related quality of life are unknown.MethodsIn a pragmatic, three-group, cluster-randomized, controlled trial, we estimated the effect of advice sent by mail, risk screening for falls, and targeted interventions (multifactorial fall prevention or exercise for people at increased risk for falls) as compared with advice by mail only. The primary outcome was the rate of fractures per 100 person-years over 18 months. Secondary outcomes were falls, health-related quality of life, frailty, and a parallel economic evaluation.ResultsWe randomly selected 9803 persons 70 years of age or older from 63 general practices across England: 3223 were assigned to advice by mail alone, 3279 to falls-risk screening and targeted exercise in addition to advice by mail, and 3301 to falls-risk screening and targeted multifactorial fall prevention in addition to advice by mail. A falls-risk screening questionnaire was sent to persons assigned to the exercise and multifactorial fall-prevention groups. Completed screening questionnaires were returned by 2925 of the 3279 participants (89%) in the exercise group and by 2854 of the 3301 participants (87%) in the multifactorial fall-prevention group. Of the 5779 participants from both these groups who returned questionnaires, 2153 (37%) were considered to be at increased risk for falls and were invited to receive the intervention. Fracture data were available for 9802 of the 9803 participants. Screening and targeted intervention did not result in lower fracture rates; the rate ratio for fracture with exercise as compared with advice by mail was 1.20 (95% confidence interval [CI], 0.91 to 1.59), and the rate ratio with multifactorial fall prevention as compared with advice by mail was 1.30 (95% CI, 0.99 to 1.71). The exercise strategy was associated with small gains in health-related quality of life and the lowest overall costs. There were three adverse events (one episode of angina, one fall during a multifactorial fall-prevention assessment, and one hip fracture) during the trial period.ConclusionsAdvice by mail, screening for fall risk, and a targeted exercise or multifactorial intervention to prevent falls did not result in fewer fractures than advice by mail alone. (Funded by the National Institute of Health Research; ISRCTN number, ISRCTN71002650.).Copyright © 2020 Massachusetts Medical Society.

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