Multifactorial day hospital intervention to reduce falls in high risk older people in primary care: a multi-centre randomised controlled trial [ISRCTN46584556]

Falls in older people are a major public health concern in terms of morbidity, mortality and cost. Previous studies suggest that multifactorial interventions can reduce falls, and many geriatric day hospitals are now offering falls intervention programmes. However, no studies have investigated whether these programmes, based in the day hospital are effective, nor whether they can be successfully applied to high-risk older people screened in primary care. The hypothesis is that a multidisciplinary falls assessment and intervention at Day hospitals can reduce the incidence of falls in older people identified within primary care as being at high risk of falling. This will be tested by a pragmatic parallel-group randomised controlled trial in which the participants, identified as at high risk of falling, will be randomised into either the intervention Day hospital arm or to a control (current practice) arm. Those participants preferring not to enter the full randomised study will be offered the opportunity to complete brief diaries only at monthly intervals. This data will be used to validate the screening questionnaire. Three day hospitals (2 Nottingham, 1 Derby) will provide the interventions, and the University of Nottingham's Departments of Primary Care, the Division of Rehabilitation and Ageing Unit, and the Trent Institute for Health Service Research will provide the methodological and statistical expertise. Four hundred subjects will be randomised into the two arms. The primary outcome measure will be the rate of falls over one year. Secondary outcome measures will include the proportion of people experiencing at least one fall, the proportion of people experiencing recurrent falls (>1), injuries, fear of falling, quality of life, institutionalisation rates, and use of health services. Cost-effectiveness analyses will be performed to inform health commissioners about resource allocation issues. The importance of this trial is that the results may be applicable to any UK day hospital setting. SITES: General practices across Nottinghamshire and Derbyshire. Day hospitals: Derbyshire Royal Infirmary (Southern Derbyshire Acute Hospitals NHS Trust) Sherwood Day Service (Nottingham City Hospital Trust) Leengate Day Hospital (Queen's Medical Centre Nottingham University Hospital NHS Trust

Advancing prostate cancer survivorship research in Australia

Prostate cancer is the most common cancer affecting Australian men, with 1 in 7 males diagnosed before the age of 75 years and most now surviving long-term in the absence of adequate and accessible supportive care for their wellbeing. A substantive proportion of men with prostate cancer experience heightened psychological distress and ongoing unmet needs for supportive care in the domains of sexuality and psychosocial care. This perspective focuses on: men's psychosocial and psychosexual needs; the role of exercise in survivorship care; health economics; and geographic and sociodemographic disparities in outcomes. It is proposed that prostate cancer survivorship research, translation and education needs to articulate with key factors that influence the acceptability and uptake of services. Stepped care approaches are also needed to meet the challenges of increasing prostate cancer prevalence taking into account constraints in health care resources and unique barriers to care such as geographic location, health literacy, and other aspects of social disadvantage. Finally, close linkage to to community with the patient and family placed at the centre of the care model will be crucial

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 Trial