Individually-tailored multifactorial intervention to reduce falls in the Malaysian Falls Assessment and Intervention Trial (MyFAIT): A randomized controlled trial
Document Type
Article
Publication Date
1-1-2018
Abstract
Objective To 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. Design Pragmatic, randomized-controlled trial. Setting Emergency room, medical outpatient and primary care clinic in a teaching hospital in Kuala Lumpur, Malaysia. Participants Individuals aged 65 years and above with two or more falls or one injurious fall in the past 12 months. Intervention Individually-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 measures The primary outcome was any fall recurrence at 12-month follow-up. Secondary outcomes were rate of fall and time to first fall. Results Two 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. Conclusion Individually-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.
Keywords
Accidental Falls, Accidents, Home, Aged, Aged, 80 and over, Cardiovascular Diseases, Emergency Service, Hospital, Environment Design, Exercise Therapy, Female, Humans, Malaysia, Male, Patient Admission, Precision Medicine, Primary Prevention, Vision Disorders
Divisions
fac_med
Funders
University Malaya Research Grant (grant number UMRG-RP-010-2012),University of Malaya Postgraduate Research Fund (grant number PPP-2015B-4805,Ministry of Science and Technology Science Fund (grant number SF017-2013),University of Malaya Grand Challenge fund (grant number GC002-14HTM)
Publication Title
PLoS ONE
Volume
13
Issue
8
Publisher
Public Library of Science