Please note: In 2003, the CTF updated its Grades of Recommendations to include an "I Recommendation" for situations where insufficient evidence exists to allow a recommendation to be made. (Formerly, these situations were captured under a "C Recommendation".) This change is not retroactive, and all "C Recommendations" made prior to 2003 have not been reevaluated in light of the new "I" recommendation grade. For a discussion of these recommendation grades, please link to the 2003 article in the Canadian Medical Association Journal here.
Other causes of unintentional death among Canadian adults over age 65
include drowning (12 % of 429 drowning deaths in 1987), burns, scalds and
fire-related accidents (21% of 402 fire-related deaths in 1988), poisoning
(16% of 424 poisoning deaths in 1987), and suffocation (13% of 415 suffocation
deaths 1987).
Options
Public health education, legislation and environmental modification,
individual counselling. Multidisciplinary post-fall assessment and monitoring
of patients for medical impairment.
Outcomes
Outcomes included falls and fall-related mortality, hospitalizations
and hospital days (p915). Incidence and severity of fire and burn injuries
were also considered.
Evidence
MEDLINE was searched for the years 1981 to November 1991 using the
major MeSH heading "accidents" with subheadings "diagnosis", "economics",
"epidemiology", "law and jurisprudence", "mortality", "prevention and control",
"standards and trends" and not "aviation, occupational or traffic accidents".
Other data sources included Statistics Canada, Health and Welfare Canada,
the Insurance Bureau of Canada, the Poison Control Centre, supporting documents
from other recommending bodies and citations from identified references.
Values
The 13-member Task Force of experts in family medicine, geriatric medicine,
pediatrics, psychiatry and epidemiology used an evidence-based method for
evaluating the effectiveness of preventive health care interventions. Recommendations
were not based on cost-effectiveness of options. Patient preferences were
not discussed.
Background papers providing critical appraisal of the evidence and tentative
recommendations prepared by the chapter author were pre-circulated to the
members. Evidence for this topic was presented and deliberated upon in
1- to 2-day meetings, 2 to 3 times per year from January 1993 to June 1993.
Consensus was reached on final recommendations.
Benefits, Harms, and Costs
A 1989 review found no controlled trials on examining the effectiveness
for reducing falls of detecting disease, counselling about or changing
medications, promoting exercise, home visits to assess environmental hazards,
educating patients, physical therapy, and balance and gait training on
reducing falls.
An RCT evaluated the effectiveness of care given in a ‘Falls Clinic’ which provided coordinated care by a geriatrician, neurologist, cardiologist and psychiatrist with resources in audiology, ophthalmology and podiatry and home visits by occupational therapists. For 1 year, there were no falls in 77% of patients. An RCT of post-fall assessment including physical examination and environmental assessment by a nurse practitioner, laboratory tests and 24-hour Holter monitoring reduced hospitalizations by 26% (p<0.05) and hospital days by 52% (p<0.01), but did not significantly reduce falls (9% reduction) or mortality (17% reduction) during 2 years of follow-up.
Evidence on individual counselling or public education about the use
of safety aids and the use of non-flammable fabrics and self-extinguishing
cigarettes is limited to expert opinion.
Recommendations
Recommendation grade [A, B, C, D, E] and level of evidence
[I, II-1, II-2, II-3, III] are indicated after each recommendation. Citations
in support of individual recommendations are identified in the guideline
text.