Response to Lavan and Colleagues

Abstract

To the Editor: We thank Lavan and colleagues for their interest in our article,1 and we are pleased to respond to the issues that were raised in their letter.2 Because the outcome variable “number of falls” was not normally distributed, we used the appropriate Mann–Whitney and Wilcoxon nonparametric tests to compare between and within groups.3 Comprehensive discussion of the differences in the primary outcome between control and intervention groups was too lengthy to be included in the abstract. Those findings are provided in the Results section of the text: “The average number of falls in the intervention group dropped significantly during the follow-up period (P = .006), whereas that of the control group did not (P = .66), although there was no similar group difference in the average number of falls (P = .28) or the prevalence of falls (P = .60).” The suggested additional statistical analysis will be performed in future publications. The training that started at the time of study onset refers to the use of the Functional Independence Measure and Medical Outcomes Study 12-item Short-Form Survey questionnaire and not to the manner in which falls are defined and recorded. Head nurses in geriatric facilities in Israel routinely reported falls in the patient files. The same criteria were used before and during the study. We found that the application of Screening Tool of Older People's potentially inappropriate Prescriptions/Screening Tool to Alert Doctors to Right Treatment (STOPP/START) criteria reduced recurrent falls in the intervention group. The chief physician accepted all the recommendations on first-generation antihistamines, benzodiazepines, long-term opiates, and vasodilators with persistent postural hypotension included in the list of “drugs that adversely affect fallers.” In addition, 12 of 13 recommendations to stop long-term neuroleptics as long-term hypnotics were accepted, as were most of the recommendations to stop long-acting benzodiazepines and alpha-blockers in men. There is little argument that falls are among the major causes of morbidity in older adults;4 as many as half of nursing home residents fall each year, and 10% to 25% of those events cause serious injuries.5 The results of our study demonstrated that the STOPP/START criteria may serve as a supplementary tool in the risk assessment of falls in people with recurrent falls. Conflict of Interest: The authors report no conflicts of interest related to the letter. There was no funding source to this paper. Author Contributions: Preparation of the letter: DF, YL, EK, YL. All authors contributed to this paper. Sponsor's Role: No role.