Table 4 Components included/excluded from the PreFIT MFFP assessment
Included | Excluded | Rationale for exclusion |
|---|---|---|
Assessment of:- Falls history Red flags Balance and Gait Postural hypotension Medications Vision Foot problems Environmental hazards | Hearing | Not recommended within NICE/AGS/BGS guidance (8,14). Screening questions about hearing difficulties included in baseline participant questionnaire. |
Osteoporosis | Risk assessment was not undertaken to avoid confounding between bone health and falls prevention interventions. NICE guidelines on prevention and treatment of osteoporosis and Vitamin D for fracture prevention were under revision at the time of intervention development. Prescription data on bisphosphonate medications and mineral supplementation were also collected from all participating general practices. | |
Cognitive impairment | Patients with known severe cognitive impairment were excluded from study entry. No evidence that cognitive or behavioural interventions alone reduce the incidence of falls in community-dwelling older people [8]. | |
Neurological function | AGS/BGS guidance recommends assessment of neurological function, including cognitive evaluation, lower extremity peripheral nerves, proprioception, reflexes and tests of cortical, extrapyramidal and cerebellar function in older people. The PreFIT assessment includes a test of proprioception (toe movement) and a further test for numbness and sensation if foot numbness is suspected. It was not feasible to conduct more intricate tests of cerebellar function in the primary care setting. | |
Carotid sinus hypersensitivity | Cardiac pacing is effective in reducing falls and syncope in adult fallers with cardio-inhibitory carotid sinus hypersensitivity. PreFIT assessment includes a check of heart rate, rhythm and postural hypotension. For safety reasons, we did not recommend that carotid artery stimulation be conducted in the community setting, where there was the potential for limited access to immediate clinical support. | |
Urinary incontinence screening tool | The PreFIT falls intervention interview includes a list of question prompts, including enquiring about any incontinence occurring before, during or after a fall event. |