Multifactorial falls prevention programme compared with usual care in UK care homes for older people: multicentre cluster randomised controlled trial with economic evaluation.

OBJECTIVES: To determine the clinical and cost effectiveness of a multifactorial fall prevention programme compared with usual care in long term care homes. DESIGN: Multicentre, parallel, cluster randomised controlled trial. SETTING: Long term care homes in the UK, registered to care for older people or those with dementia. PARTICIPANTS: 1657 consenting residents and 84 care homes. 39 were randomised to the intervention group and 45 were randomised to usual care. INTERVENTIONS: Guide to Action for Care Homes (GtACH): a multifactorial fall prevention programme or usual care. MAIN OUTCOME MEASURES: Primary outcome measure was fall rate at 91-180 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 (EQ-5D-5L) or proxy version (EQ-5D-5L-P) and the Dementia Quality of Life utility measure (DEMQOL-U), which were self-completed by competent residents and by a care home staff member proxy (DEMQOL-P-U) for all residents (in case the ability to complete changed during the study) until 12 months after randomisation. Secondary outcome measures were falls at 1-90, 181-270, and 271-360 days after randomisation, Barthel index score, and the Physical Activity Measure-Residential Care Homes (PAM-RC) score at 91, 180, 270, and 360 days after randomisation. RESULTS: Mean age of residents was 85 years. 32% were men. GtACH training was delivered to 1051/1480 staff (71%). Primary outcome data were available for 630 participants in the GtACH group and 712 in the usual care group. The unadjusted incidence rate ratio for falls between 91 and 180 days was 0.57 (95% confidence interval 0.45 to 0.71, P<0.001) in favour of the GtACH programme (GtACH: six falls/1000 residents v usual care: 10 falls/1000). Barthel activities of daily living indices and PAM-RC scores were similar between groups at all time points. The incremental cost was £108 (95% confidence interval -£271.06 to 487.58), incremental QALYs gained for EQ-5D-5L-P was 0.024 (95% confidence interval 0.004 to 0.044) and for DEMQOL-P-U was 0.005 (-0.019 to 0.03). The incremental costs per EQ-5D-5L-P and DEMQOL-P-U based QALY were £4544 and £20 889, respectively. CONCLUSIONS: The GtACH programme was associated with a reduction in fall rate and cost effectiveness, without a decrease in activity or increase in dependency. TRIAL REGISTRATION: ISRCTN34353836.

Reduced hearing, ownership, and use of hearing aids in elderly people in the UK--the MRC Trial of the Assessment and Management of Older People in the Community: a cross-sectional survey.

BACKGROUND: Reduced hearing in elderly people is important because it is disabling and potentially treatable. We aimed to assess the prevalence of reduced hearing in elderly people and levels of ownership of hearing aids and use. METHODS: We have done a cross-sectional survey of people aged at least 75 years in 106 family practices in the UK. We obtained self-reported data on hearing difficulties for 32,656 people and gave 14,877 a whispered voice test (response rate 78%). FINDINGS: 2537 (8%) of 32,656 participants reported a lot of difficulty hearing and 13,630 (42%) a little or a lot of difficulty. 3795 (26%) of 14877 participants who completed the whispered voice test (95% CI 23-29) failed the test, the proportion rising sharply with age. Following wax removal, 343 passed a retest, leaving 3452 (23%, 20-26) who failed the test, even after wax removal if present. 998 (46%) of 2180 people wearing a hearing aid at the time of testing failed the whispered voice test. More than half the people who failed the test did not own a hearing aid. 2200 (60%) of 3846 people who owned a hearing aid said they used it regularly. Level of use was strongly related to perceived benefit. INTERPRETATION: Reduced hearing is common and provision of hearing aids inadequate in elderly people. Many people who own a hearing aid do not use it regularly, and even when wearing their aid many still have socially disabling levels of hearing loss. A major source of morbidity in elderly people could be alleviated by improvements in detection and management of reduced hearing.