BMJ · 2001 · 542 citations · 26 references
To evaluate whether a trained district nurse could reduce falls and injuries in older adults and determine the programme’s cost‑effectiveness, the study aimed to assess the impact of a nurse‑prescribed home exercise programme. A one‑year randomised controlled trial enrolled 240 adults aged 75 years and older in a New Zealand community health service, assigning 121 to the exercise programme and 119 to usual care, and measured falls, injuries, programme implementation costs, and hospital costs. The programme lowered falls by 46 % (IRR 0.54, 95 % CI 0.32–0.90), eliminated all fall‑related hospital admissions, and cost $NZ1,803 per fall prevented (or $NZ155 when hospital costs are included), demonstrating cost‑effectiveness particularly for participants aged 80 years and older.
To assess the effectiveness of a trained district nurse individually prescribing a home based exercise programme to reduce falls and injuries in elderly people and to estimate the cost effectiveness of the programme.Randomised controlled trial with one year's follow up.Community health service at a New Zealand hospital.240 women and men aged 75 years and older.121 participants received the exercise programme (exercise group) and 119 received usual care (control group); 90% (211 of 233) completed the trial.Number of falls, number of injuries resulting from falls, costs of implementing the programme, and hospital costs as a result of falls.Falls were reduced by 46% (incidence rate ratio 0.54, 95% confidence interval 0.32 to 0.90). Five hospital admissions were due to injuries caused by falls in the control group and none in the exercise group. The programme cost $NZ1803 (523 pound sterling) (at 1998 prices) per fall prevented for delivering the programme and $NZ155 per fall prevented when hospital costs averted were considered.A home exercise programme, previously shown to be successful when delivered by a physiotherapist, was also effective in reducing falls when delivered by a trained nurse from within a home health service. Serious injuries and hospital admissions due to falls were also reduced. The programme was cost effective in participants aged 80 years and older compared with younger participants.
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