A single home visit by an occupational therapist reduces the risk of falling after hip fracture in elderly women: a quasi-randomized controlled trial.

OBJECTIVE: To assess the effectiveness of a single home visit by an occupational therapist in the reduction of fall risk after hip fracture in elderly women. DESIGN: Quasi-randomized controlled trial. PARTICIPANTS: Ninety-five women aged 60 years or older, living in the community, who sustained a fall-related hip fracture. METHODS: The women were allocated alternately to intervention or control groups. All the women underwent a multidisciplinary programme targeted at fall prevention during in-patient rehabilitation. Additionally, the intervention group received a home visit by an occupational therapist a median of 20 days after discharge. Falls were recorded at a 6-month follow-up. RESULTS: Thirteen of the 50 women in the control group sustained 20 falls during 9231 days, whereas 6 of the 45 women in the intervention group sustained 9 falls during 8970 days. After adjustment for observation periods, Barthel Index scores, and body height, a significantly lower proportion of fallers was found in the intervention group: the odds ratio was 0.275 (95% confidence interval 0.081-0.937, p=0.039). CONCLUSION: A single home visit by an occupational therapist after discharge from a rehabilitation hospital significantly reduced the risk of falling in a sample of elderly women following hip fracture.

Incident falls impair ability to function in hip-fracture survivors: a prospective study of 95 elderly women.

The present study focused on home-dwelling women successfully discharged back to the community after a fall-related fracture of the hip. We investigated the role of incident falls in affecting ability to function in activities of daily living. Ninety-five of 103 consecutive women without cognitive impairment were recruited during in-patient rehabilitation following their first hip fracture. Functional independence in activities of daily living was assessed by using the Barthel Index (BI) score at discharge from in-patient rehabilitation and at a 6-month follow-up. Nineteen of the 95 women sustained one or more falls during a median observation time of 187 days. At a Mann-Whitney test, both BI scores assessed at the 6-month follow-up and gains in BI scores during the follow-up were significantly lower in the 19 fallers than in the 76 non-fallers (p=0.021 and p=0.030, respectively), whereas no significant differences were found in baseline BI scores between the two groups. At linear multiple regression, we found a negative association between incident falls and both functional scores (p=0.01) and their gains (p=0.006) after adjustment for several confounders. We conclude that incident falls were significantly associated with a worse functional score in our sample of hip-fracture women.