PLoS ONE (Jan 2018)

Individually-tailored multifactorial intervention to reduce falls in the Malaysian Falls Assessment and Intervention Trial (MyFAIT): A randomized controlled trial.

  • 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,
  • Maw Pin Tan

DOI
https://doi.org/10.1371/journal.pone.0199219
Journal volume & issue
Vol. 13, no. 8
p. e0199219

Abstract

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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. TRIAL REGISTRATION:ISRCTN Registry no. ISRCTN11674947.