Concord Falls and Bone Service Study: An evaluation of the effectiveness of a specialist service on reducing falls in community dwelling older people who have fallen.

Specialist Falls and Bone service - coordinating targeted multifactorial falls prevention interventions and adequate assessment and treatment of osteoporosis. The falls prevention interventions are not the intervention of interest rather the service model to provide them. The specialist service consists of a registered nurse who performs the baseline assessments. A geriatrician assesses participants in a hospital based clinic setting or domicilary visit. The first clinic visit lasts 90 minutes and includes a comprehensive geriatric medical assessment with focused clinical examination including gait and balance assessment with Timed Up and Go Test, Sit to Stand Times Five and Static Balance Assessment. Investigations performed at this clinic and ordered by the Geriatrician include blood tests to assess osteoporosis risk, Bone Mineral Denistometry (BMD), Computerised Tomography (CT) of the brain, x-rays of the thoraco-lumbo-sacral spine and 24 hour ambulatory blood pressure monitoring. The participant is seen again at 6 weeks, 4 months and 12 months after the initial assessment and seen initially within 2 weeks of randomization (aiming for 1 week). These subsequent visits will again be with a Geriatrician. At the week 6 visit the participant will have the results of the relevant investigations reviewed and treatment instituted, such as osteoporosis treatment according to national treatment guidelines including Calcium and Vitamin D supplementation. Falls prevention interventions will be coordinated and arranged by the Geriatrician with the assistance of community based physiotherapists, occupational therapists and podiatrists not employed by the research team per se. Telephone and postal communication with participants and their General Practitioner will be used to communicate changes in treatment. At the 4 month and 12 month visits the Geriatrician will review the falls prevention interventions employed and coordinate additional interventions depending on the outcome of these interventions. For example, should a participant wish to continue an exercise programme following the completion of a programme, community based classes will be sourced or the participant will be referred to a more complex class such as Tai Chi, if they were unable to participate in this previously. In addition, compliance with medication changes will be reviewed and additional changes made as necessary.