Lack of Effectiveness of a Multidisciplinary Fall-Prevention Program in Elderly People at Risk: A Randomized, Controlled Trial Marike R. C. Hendriks, MSc, à wz § Michel H. C. Bleijlevens, MSc, à w Jolanda C. M. van Haastregt, PhD, wk Harry F. J. M. Crebolder, PhD, MD, w# Joseph P. M. Diederiks, PhD, w Silvia M. A. A. Evers, PhD, wz Wubbo J. Mulder, PhD, MD, Ãà Gertrudis I. J. M. Kempen, PhD, wk Erik van Rossum, PhD, wk ww Joop M. Ruijgrok, PhD, MD, zz Paul A. Stalenhoef, PhD, MD, w# and Jacques Th. M. van Eijk, PhD à w [See editorial comments by Dr. Mary Tinetti on pp 1563–1565] OBJECTIVES: To assess whether a pragmatic multidisci- plinary fall-prevention program was more effective than usual care in preventing new falls and functional decline in elderly people. DESIGN: A two-group, randomized, controlled trial with 12 months of follow-up. SETTING: University hospital and home-based interven- tion, the Netherlands. PARTICIPANTS: Three hundred thirty-three community- dwelling Dutch people aged 65 and over who were seen in an emergency department after a fall. INTERVENTION: Participants in the intervention group underwent a detailed medical and occupational-therapy assessment to evaluate and address risk factors for re- current falls, followed by recommendations and referral if indicated. People in the control group received usual care. MEASUREMENTS: Number of people sustaining a fall (fall calendar) and daily functioning (Frenchay Activity Index). RESULTS: Results showed no statistically significantly fa- vorable effects on falls (odds ratio 5 0.86, 95% confidence interval (CI) 5 0.50–1.49) or daily functioning (regression coefficient 5 0.37, CI 5  0.90 to 1.63) after 12 months of follow-up. CONCLUSION: The multidisciplinary fall-prevention pro- gram was not effective in preventing falls and functional de- cline in this Dutch healthcare setting. Implementing the program in its present form in the Netherlands is not recom- mended. This trial shows that there can be considerable dis- crepancy between the ‘‘ideal’’ (experimental) version of a program and the implemented version of the same program. The importance of implementation research in assessing fea- sibility and effectiveness of such a program in a specific health- care setting is therefore stressed. J Am Geriatr Soc 56:1390– 1397, 2008. Key words: accidental falls; elderly; multidiscipline; pre- vention; intervention studies F alls are common occurrences in elderly people world- wide and may have several adverse consequences, such as physical injuries and psychological distress, leading to decreased functioning and quality of life. 1,2 Injurious falls in particular are associated with greater healthcare utiliza- tion. 3 The need for effective falls-prevention strategies is thus evident. There is now considerable evidence for the effectiveness of multidisciplinary and multifactorial inter- ventions that screen for health and environmental risk factors and address these factors. 1,4,5 A medical and occu- pational-therapy (OT) assessment for elderly persons Parts of the results described in this paper were presented at the 59th Annual Meeting of the Gerontological Society of America, Dallas, Texas, November 2006. The symposium presentation was entitled: ‘‘Effects of a multidisci- plinary fall prevention program among community-dwelling elderly people: implications for practice.’’ Address correspondence to Marike Hendriks, Maastricht University, Faculty of Health, Medicine and Life Sciences, Department of Health Organization, Policy and Economics, P.O. Box 616, 6200 MD Maastricht, the Netherlands. E-mail: Marike.Hendriks@beoz.unimaas.nl DOI: 10.1111/j.1532-5415.2008.01803.x From the à Department of Social Medicine; w School for Public Health and Primary Care (Caphri); z Department of Health Organization, Policy and Economics; k Department of Health Care and Nursing Science; # Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maast- richt University, Maastricht, the Netherlands; § Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, the Netherlands; Ãà Department of Internal Medi- cine, Division Medicine and Geriatrics; zz Department of Rehabilitation, Maastricht University Hospital, Maastricht, the Netherlands; and ww Faculty of Health and Technology, Professional University Zuyd, Heerlen, the Netherlands. JAGS 56:1390–1397, 2008 r 2008, Copyright the Authors Journal compilation r 2008, The American Geriatrics Society 0002-8614/08/$15.00