Community falls prevention for people who call an emergency ambulance after a fall: an economic evaluation alongside a randomised controlled trial

OBJECTIVE

we estimated the cost-effectiveness of a community falls prevention service compared with usual care from a National Health Service and personal social services perspective over the 12 month trial period.

DESIGN

a cost-effectiveness and cost utility analysis alongside a randomised controlled trial

SETTING

community.

PARTICIPANTS

people over 60 years of age living at home or in residential care who had fallen and called an emergency ambulance but were not taken to hospital.

INTERVENTIONS

referral to community fall prevention services or usual health and social care.

MEASUREMENTS

incremental cost per fall prevented and incremental cost per Quality-Adjusted Life Years (QALYs)

RESULTS

a total of 157 participants (82 interventions and 75 controls) were used to perform the economic evaluation. The mean difference in NHS and personal social service costs between the groups was £-1,551 per patient over 1 year (95% CI: £-5,932 to £2,829) comparing the intervention and control groups. The intervention patients experienced on average 5.34 fewer falls over 12 months (95% CI: -7.06 to -3.62). The mean difference in QALYs was 0.070 (95% CI: -0.010 to 0.150) in favour of the intervention group.

CONCLUSION

the community falls prevention service was estimated to be cost-effective in this high-risk group. Current Controlled Trials ISRCTN67535605. (controlled-trials.com).

Use of personal call alarms among community-dwelling older people

Having a fall and then lying on the floor for an hour or more is known as a ‘long lie’, which is associated with serious injury and an elevated risk of admission to hospital, long-term care and death. Personal call alarms are designed to prevent long lies, although little is known about their use. Using cross-sectional data from the English Longitudinal Study on Ageing, this study investigated the proportion of self-reported users of personal call alarms among 3,091 community-dwelling adults aged 65+ who reported difficulties of mobility or activities of daily living. The characteristics of users were then explored through logistic regressions comparing those living alone with those living with others. One hundred and eighty people self-reported using a personal call alarm (6%). Multivariate regression found the following to significantly predict personal call alarm use among both those living alone and with others: greater difficulty with activities/instrumental activities of daily living, older age, and for those living with others only: lower score on the quality of life subscale for control. Personal call alarm use may be markedly lower than the 30 per cent annual incidence of falls among community-dwelling older people. Better understanding is needed of the reasons for low usage, even amongst those at highest falls risk for whom such alarms are most likely to be beneficial.