• Pey June Tan, Ee Ming Khoo, Karuthan Chinna, Nor I'zzati Saedon, Mohd Idzwan Zakaria, Ahmad Zulkarnain Ahmad Zahedi, Norlina Ramli, Nurliza Khalidin, Mazlina Mazlan, Kok Han Chee, Imran Zainal Abidin, Nemala Nalathamby, Sumaiyah Mat, Mohamad Hasif Jaafar, Hui Min Khor, Norfazilah Mohamad Khannas, Lokman Abdul Majid, Kit Mun Tan, Ai-Vyrn Chin, Shahrul Bahyah Kamaruzzaman, Philip Poi, Karen Morgan, Keith D Hill, Lynette MacKenzie, and Maw Pin Tan.
• Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia.
• Plos One. 2018 Jan 1; 13 (8): e0199219.

ObjectiveTo determine the effectiveness of an individually-tailored multifactorial intervention in reducing falls among at risk older adult fallers in a multi-ethnic, middle-income nation in South-East Asia.DesignPragmatic, randomized-controlled trial.SettingEmergency room, medical outpatient and primary care clinic in a teaching hospital in Kuala Lumpur, Malaysia.ParticipantsIndividuals aged 65 years and above with two or more falls or one injurious fall in the past 12 months.InterventionIndividually-tailored interventions, included a modified Otago exercise programme, HOMEFAST home hazards modification, visual intervention, cardiovascular intervention, medication review and falls education, was compared against a control group involving conventional treatment.Primary And Secondary Outcome MeasuresThe primary outcome was any fall recurrence at 12-month follow-up. Secondary outcomes were rate of fall and time to first fall.ResultsTwo hundred and sixty-eight participants (mean age 75.3 ±7.2 SD years, 67% women) were randomized to multifactorial intervention (n = 134) or convention treatment (n = 134). All participants in the intervention group received medication review and falls education, 92 (68%) were prescribed Otago exercises, 86 (64%) visual intervention, 64 (47%) home hazards modification and 51 (38%) cardiovascular intervention. Fall recurrence did not differ between intervention and control groups at 12-months [Risk Ratio, RR = 1.037 (95% CI 0.613-1.753)]. Rate of fall [RR = 1.155 (95% CI 0.846-1.576], time to first fall [Hazard Ratio, HR = 0.948 (95% CI 0.782-1.522)] and mortality rate [RR = 0.896 (95% CI 0.335-2.400)] did not differ between groups.ConclusionIndividually-tailored multifactorial intervention was ineffective as a strategy to reduce falls. Future research efforts are now required to develop culturally-appropriate and affordable methods of addressing this increasingly prominent public health issue in middle-income nations.Trial RegistrationISRCTN Registry no. ISRCTN11674947.

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