Effectiveness of a falls-and-fracture nurse coordinator to reduce falls: a randomized, controlled trial of at-risk older adults

J Am Geriatr Soc. 2008 Aug;56(8):1383-9. doi: 10.1111/j.1532-5415.2008.01802.x.


Objectives: To assess the effectiveness of a community-based falls-and-fracture nurse coordinator and multifactorial intervention in reducing falls in older people.

Design: Randomized, controlled trial.

Setting: Screening for previous falls in family practice followed by community-based intervention.

Participants: Three hundred twelve community-living people aged 75 and older who had fallen in the previous year.

Intervention: Home-based nurse assessment of falls-and-fracture risk factors and home hazards, referral to appropriate community interventions, and strength and balance exercise program. Control group received usual care and social visits.

Measurements: Primary outcome was rate of falls over 12 months. Secondary outcomes were muscle strength and balance, falls efficacy, activities of daily living, self-reported physical activity level, and quality of life (Medical Outcomes Study 36-item Short Form Questionnaire).

Results: Of the 3,434 older adults screened for falls, 312 (9%) from 19 family practices were enrolled and randomized. The average age was 81+/-5, and 69% (215/312) were women. The incidence rate ratio for falls for the intervention group compared with the control group was 0.96 (95% confidence interval=0.70-1.34). There were no significant differences in secondary outcomes between the two groups.

Conclusion: This nurse-led intervention was not effective in reducing falls in older people who had fallen previously. Implementation and adherence to the fall-prevention measures was dependent on referral to other health professionals working in their usual clinical practice. This may have limited the effectiveness of the interventions.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidental Falls / prevention & control*
  • Aged
  • Aged, 80 and over
  • Algorithms
  • Community Health Nursing*
  • Exercise
  • Female
  • Follow-Up Studies
  • Fractures, Bone / nursing*
  • Fractures, Bone / prevention & control
  • Geriatric Assessment
  • Geriatric Nursing*
  • Hip Fractures / nursing
  • Hip Fractures / prevention & control
  • Humans
  • Male
  • Middle Aged
  • Mobility Limitation
  • New Zealand
  • Nursing Assessment*
  • Patient Care Team
  • Prospective Studies
  • Referral and Consultation
  • Risk Factors
  • Safety
  • Social Environment
  • Treatment Outcome
  • Wounds and Injuries / nursing
  • Wounds and Injuries / prevention & control