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Functional aspects and economic evaluation of health in case management in a fall prevention program for elderly people in the community: randomized controlled clinical study

Abstract

The falls are considered public health problems and are responsible for a large part of the public and private health network's expenses with the elderly population, it is important to promote measures to prevent falls in the elderly. One of the forms of intervention for elderly fallers is case management, based on a promising multifactorial intervention, individualized and based on the risk factors for falls identified. In this sense, assessing the economic impact, functional aspects after a fall prevention intervention based on case management and obtaining greater knowledge about its effects on falls and potentially modifiable risk factors are of great importance. Objective: To verify the effects of a case management intervention based on the prevention of falls on the risk factors for falls, in the functional aspects (functional capacity, balance and pain) of elderly people who fall from the community and the economic viability of this program. Method: This is a randomized, single-center, parallel group controlled clinical trial. Elderly people from the community and with a history of at least two falls in the last year will be divided into two groups (Intervention Group and Control Group). The Intervention Group will be submitted to a case management for elderly fallers, which will involve: multidimensional assessment, explanation of the risk factors of falls identified for the elderly, realization of an intervention proposal based on the identified risks, elaboration of an intervention plan for individualized falls, implementation, monitoring and review of the intervention plan. Managers will accompany the elderly person at home for 16 weeks, once a week. The Control Group will not carry out any intervention and will be encouraged to maintain its routine. All volunteers will carry out the evaluation in four moments (initial, after 16 weeks of intervention, after 6 weeks and 1 year of follow-up). The initial assessment will consist of a survey of clinical and sociodemographic data, physical functions (balance and mobility), mental functions (cognition, depression and fear of falling), risk and education about falls. After 16 weeks of intervention and after 6 weeks of follow-up, the same evaluation will be performed. In addition, at the end of the intervention, the participants will answer two questionnaires, one on the satisfaction of the intervention and the other on adherence to the intervention. The falls will be collected through calendars and monthly phone calls from the beginning to 1 year of follow-up. The economic health issue will be assessed after 1 year of follow-up. For the analyses, a significance level of ± = 0.05 will be adopted and the SPSS software (22.0) will be used to perform the statistical tests. The analysis will be carried out by intention of treatment. Expected results: Participants in the Intervention Group are expected to improve risk factors, functional aspects, and the program will show favorable economic viability. (AU)

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