Effects of the falls and fractures clinic as an integrated multidisciplinary model of care in Australia: a pre–post study. Issue 7 (29th July 2019)

• Record Type: Journal Article
• Authors: Gomez, Fernando; Curcio, Carmen Lucia; Brennan-Olsen, Sharon Lee; Boersma, Derek; Phu, Steven; Vogrin, Sara; Suriyaarachchi, Pushpa; Duque, Gustavo
• Is Part Of: BMJ open. Volume 9:Issue 7(2019)
• Publication Date: 2019-07-29
• Subjects: falls -- fractures -- osteoporosis -- falls and fractures clinic -- osteosarcopenia; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2018-027013
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objectives: Traditionally, the approach to fracture prevention has focused on increasing bone mineral density while typically lacking a combined clinical approach to falls prevention and vice versa. To resolve this gap, we implemented and evaluated a novel combined model of care to the assessment and prevention of osteoporosis and falls in the outpatients setting. Setting: Falls and Fractures Clinic (FFC) at Nepean Hospital (Penrith, NSW, Australia). Participants: Pre-effects and posteffects assessment of 106 community-dwelling older patients referred from the community. Primary and secondary outcome measures: Previous falls and fractures were recorded. Clinical, functional and paraclinical evaluations were performed. A comprehensive multidisciplinary care plan was then tailored based on the presence of risk factors. Six-month follow-ups were performed assessing the incidence of falls and fractures, change in risk factors for falls and level of risk, with the recommended plan. Results: We report that 97% of patients had a fall in the preceding 6 months, 47.6% of whom experienced a fracture from the fall. Furthermore, 64% of patients had a marked risk for falling by Physiological Profile Assessment (PPA), 90% had intermediate–high 10-year probability of fracture according to FRAX and 78% had sarcopenia. At 6-month follow-up, we observed more than an 80% reduction in falls and recurrent falls, and 50% reduction in fractures. In addition, 65% of patients had reduced PPA and a 57% reduction in 10-year fracture probability. Conclusions: In conclusion, we suggest that a multidisciplinary FFC can provide substantial reductions in falls and fractures for high-risk older people, even over a relatively short 6-month time period. The current model of service provision via traditional falls clinics could be significantly improved by encompassing fracture prevention within the multifactorial approach to interventions.