Individually-Tailored Multifactorial Intervention To Reduce Falls In The Malaysian Falls Assessment And Intervention Trial (Myfait): A Randomized Controlled Trial

ObjectiveTo determine the effectiveness of an individually-tailored multifactorial intervention in reducing falls among at risk older adult fallers in a multi-ethnic, middle-income nation in South-East Asia.DesignPragmatic, randomized-controlled trial.SettingEmergency room, medical outpatient and primary care clinic in a teaching hospital in Kuala Lumpur, Malaysia.ParticipantsIndividuals aged 65 years and above with two or more falls or one injurious fall in the past 12 months.InterventionIndividually-tailored interventions, included a modified Otago exercise programme, HOME-FAST home hazards modification, visual intervention, cardiovascular intervention, medication review and falls education, was compared against a control group involving conventional treatment.Primary and secondary outcome measuresThe primary outcome was any fall recurrence at 12-month follow-up. Secondary outcomes were rate of fall and time to first fall.ResultsTwo hundred and sixty-eight participants (mean age 75.3 +/- 7.2 SD years, 67% women) were randomized to multifactorial intervention (n = 134) or convention treatment (n = 134). All participants in the intervention group received medication review and falls education, 92 (68%) were prescribed Otago exercises, 86 (64%) visual intervention, 64 (47%) home hazards modification and 51 (38%) cardiovascular intervention. Fall recurrence did not differ between intervention and control groups at 12-months [Risk Ratio, RR = 1.037 (95% CI 0.613-1.753)]. Rate of fall [RR = 1.155 (95% CI 0.846-1.576], time to first fall [Hazard Ratio, HR = 0.948 (95% CI 0.782-1.522)] and mortality rate [RR = 0.896 (95% CI 0.335-2.400)] did not differ between groups.ConclusionIndividually-tailored multifactorial intervention was ineffective as a strategy to reduce falls. Future research efforts are now required to develop culturally-appropriate and affordable methods of addressing this increasingly prominent public health issue in middle-income nations.