Multifactorial home visits by community nurses did not reduce falls and impairments in mobility among a group of elderly people at risk. Furthermore, the home visits had no effects on physical complaints, perceived health, perceived gait problems, mental health, social functioning, and loneliness. The home visits did have favourable effects on fear of falling and daily activity after 12 months of follow up, but these effects diminished after 18 months of follow up.
There may be several explanations for the fact that we observed no effects of our intervention on falls and impairments of mobility. Firstly, because people in the home visit group showed less fear of falling and higher levels of daily activity than those in the usual care group at follow up, it is possible that the risk abatement was partly counterbalanced by an increase in risk behaviour in the home visit group, leading to a slightly increased number of people falling. Secondly, our intervention programme may not have added enough extra elements to the range of care and services already available for elderly people in the Netherlands.
Thirdly, a lack of adherence by the participants with the intervention programme might have influenced the outcomes of our study. The fact that 138 people completed the whole programme and a further nine completed part of the programme, however, does not indicate that lack of adherence was a large problem. Compliance with the advice given by the nurses also seemed reasonable.
What is already known on this topic
Programmes of multifactorial interventions targeted to the risk profile of the individual showed favourable effects on falls among elderly people living in the community in settings in the United States
Little evidence is yet available about the effects of this kind of intervention on falls and impairments in mobility among elderly people in European settings
What this study adds
A programme of multifactorial home visits aimed at reducing falls and impairments in mobility in elderly people at risk living in the community is not effective in the Dutch healthcare setting
This may also apply to comparable healthcare settings in other European countries
Fourthly, the drop out rate during follow up could have influenced the outcomes of our trial. It turned out that those people who were expected to benefit most from the intervention (people at higher risk for falls and with more impairments to mobility) dropped out of the study. We therefore performed subgroup analyses among a selection of people with the highest baseline scores for falls and range of mobility. The results were comparable to those of our main analyses, which makes it highly unlikely that selective drop out negatively influenced the internal validity of our trial.
The results of our study contrast with those of Gillespie et al's meta-analysis in which they concluded that multifactorial interventions for screening followed by targeted interventions resulted in a notable reduction in falls in elderly people.3
This conclusion was, however, primarily based on the results of four trials performed in the United States.5,22–24
It is likely that the observed differences in effectiveness between our intervention and those undertaken in the United States are related to differences in healthcare settings. Other explanations may be differences between components of the programmes. Owing to the multifactorial character and diversity of the interventions, however, it was not possible to isolate the effective components of the interventions undertaken in the United States.3
We conclude that a programme of multifactorial home visits aimed at reducing falls and impairments in mobility in elderly people at risk who live in the community is not effective in the Dutch healthcare setting. This may also apply to comparable healthcare settings in other European countries. Because falls and impairments in mobility remain a serious problem among elderly people, alternative strategies to prevent falls and reduce impairments in mobility need to be developed and tested in different healthcare settings.