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Articles by J Gladman
Total Records ( 2 ) for J Gladman
  S Conroy , D Kendrick , R Harwood , J Gladman , C Coupland , T Sach , A Drummond , J Youde , J Edmans and T. Masud

Objective: to determine the clinical effectiveness of a day hospital-delivered multifactorial falls prevention programme, for community-dwelling older people at high risk of future falls identified through a screening process.

Design: multicentre randomised controlled trial.

Setting: eight general practices and three day hospitals based in the East Midlands, UK.

Participants: three hundred and sixty-four participants, mean age 79 years, with a median of three falls risk factors per person at baseline.

Interventions: a day hospital-delivered multifactorial falls prevention programme, consisting of strength and balance training, a medical review and a home hazards assessment.

Main outcome measure: rate of falls over 12 months of follow-up, recorded using self-completed monthly diaries.

Results: one hundred and seventy-two participants in each arm contributed to the primary outcome analysis. The overall falls rate during follow-up was 1.7 falls per person-year in the intervention arm compared with 2.0 falls per person-year in the control arm. The stratum-adjusted incidence rate ratio was 0.86 (95% CI 0.73–1.01), P = 0.08, and 0.73 (95% CI 0.51–1.03), P = 0.07 when adjusted for baseline characteristics. There were no significant differences between the intervention and control arms in any secondary outcomes.

Conclusion: this trial did not conclusively demonstrate the benefit of a day hospital-delivered multifactorial falls prevention programme, in a population of older people identified as being at high risk of a future fall.

  J Gribbin , R Hubbard , C Smith , J Gladman and S. Lewis

Background: Despite the role of primary care in the falls care pathway, there are almost no data on the extent of falls seen in general practices.

Aim: To quantify the incidence and mortality of falls amongst older people in primary care in the UK.

Methods: Cohort study of people aged >=60 years and registered in a UK practice contributing data to The Health Improvement Network primary care database (THIN) throughout 2003–06. Analysis of crude incidence and estimation of incidence rate ratios using negative binomial regression, and survival using Cox regression. Sensitivity analysis of criteria for distinguishing discrete fall events from follow-up appointments.

Results: Amongst people aged >=60 years the overall crude incidence rate of recorded falls was 3.58/100 person-years (95% CI 3.56–3.61). The rate of recurrent falls was 0.67/100 person-years (95% CI 0.66–0.68). The incidence rate of recorded falls and recurrent falls was higher in older age groups, in women and least advantaged social groups. Incidence of recorded falls was constant through the time period 2003–06. Mortality for recurrent fallers was about twice that of general population controls.

Conclusions: These data suggest that more than 475 000 fall events in older people are recorded in general practice each year in the UK, and are associated with increased mortality and relative deprivation. The underlying incidence rate has remained stable in recent years.

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