BMJ 2002;325:128 ( 20 July )

Papers

Randomised factorial trial of falls prevention among older people living in their own homes

Lesley Day, senior research fellow, a Brian Fildes, professor, a Ian Gordon, associate professor, b Michael Fitzharris, research fellow, a Harold Flamer, consultant geriatrician, c Stephen Lord, National Health and Medical Research Council research fellow. d

a Accident Research Centre, PO Box 70A, Monash University, Clayton, Victoria 3800, Australia, b Statistical Consulting Centre, University of Melbourne, Melbourne, Victoria 3052, Australia, c Division of Geriatric Medicine, Maimonides Medical Center, Brooklyn, New York, NY 11219, USA, d Prince of Wales Medical Research Institute, Sydney, NSW 3021, Australia

Correspondence and reprint requests to: L Day Lesley.Day{at}general.monash.edu.au

Objective: To test the effectiveness of, and explore interactions between, three interventions to prevent falls among older people.
Design: A randomised controlled trial with a full factorial design.
Setting: Urban community in Melbourne, Australia.
Participants: 1090 aged 70 years and over and living at home. Most were Australian born and rated their health as good to excellent; just over half lived alone.
Interventions: Three interventions (group based exercise, home hazard management, and vision improvement) delivered to eight groups defined by the presence or absence of each intervention.
Main outcome measure: Time to first fall ascertained by an 18 month falls calendar and analysed with survival analysis techniques. Changes to targeted risk factors were assessed by using measures of quadriceps strength, balance, vision, and number of hazards in the home.
Results: The rate ratio for exercise was 0.82 (95% confidence interval 0.70 to 0.97, P=0.02), and a significant effect (P<0.05) was observed for the combinations of interventions that involved exercise. Balance measures improved significantly among the exercise group. Neither home hazard management nor treatment of poor vision showed a significant effect. The strongest effect was observed for all three interventions combined (rate ratio 0.67 (0.51 to 0.88, P=0.004)), producing an estimated 14.0% reduction in the annual fall rate. The number of people needed to be treated to prevent one fall a year ranged from 32 for home hazard management to 7 for all three interventions combined.
Conclusions: Group based exercise was the most potent single intervention tested, and the reduction in falls among this group seems to have been associated with improved balance. Falls were further reduced by the addition of home hazard management or reduced vision management, or both of these. Cost effectiveness is yet to be examined. These findings are most applicable to Australian born adults aged 70-84 years living at home who rate their health as good.

What is already known on this topic
Multiple interventions are known to prevent falls among older people, but the relative importance of the different strategies is unknown

What this study adds
A weekly exercise programme focusing on balance, plus exercises at home, can help to prevent falls among Australians aged 70 years and over living at home and in good health

Home hazard management and vision screening and referral are not markedly effective in reducing falls when used alone but add value when combined with the exercise programme




© BMJ 2002
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

Relevant Article

Exercise can prevent falls in older people
BMJ 2002 325: 0. [Full Text]

This article has been cited by other articles:

  • Riebe, D., Blissmer, B. J., Greaney, M. L., Ewing Garber, C., Lees, F. D., Clark, P. G. (2009). The Relationship Between Obesity, Physical Activity, and Physical Function in Older Adults. J Aging Health 21: 1159-1178 [Abstract]  
  • Mercer, V. S., Gross, M. T., Sharma, S., Weeks, E. (2009). Comparison of Gluteus Medius Muscle Electromyographic Activity During Forward and Lateral Step-up Exercises in Older Adults. ptjournal 89: 1205-1214 [Abstract] [Full text]  
  • Close, J. C.T. (2009). Falls in Older People: Risk Factors, Assessment and Intervention. IBMS BoneKEy 6: 368-384 [Abstract] [Full text]  
  • Evron, L., Schultz-Larsen, K., Fristrup, T. (2009). Barriers to participation in a hospital-based falls assessment clinic programme: an interview study with older people. Scand J Public Health 37: 728-735 [Abstract]  
  • Steinman, B. A., Pynoos, J., Nguyen, A. Q. D. (2009). Fall Risk in Older Adults: Roles of Self-Rated Vision, Home Modifications, and Limb Function. J Aging Health 21: 655-676 [Abstract]  
  • Petridou, E. Th., Manti, E. G., Ntinapogias, A. G., Negri, E., Szczerbinska, K. (2009). What Works Better for Community-Dwelling Older People at Risk to Fall?: A Meta-Analysis of Multifactorial Versus Physical Exercise-Alone Interventions. J Aging Health 21: 713-729 [Abstract]  
  • Laforest, S., Pelletier, A., Gauvin, L., Robitaille, Y., Fournier, M., Corriveau, H., Filiatrault, J. (2009). Impact of a Community-Based Falls Prevention Program on Maintenance of Physical Activity Among Older Adults. J Aging Health 21: 480-500 [Abstract]  
  • Blahak, C, Baezner, H, Pantoni, L, Poggesi, A, Chabriat, H, Erkinjuntti, T, Fazekas, F, Ferro, J M, Langhorne, P, O'Brien, J, Visser, M C, Wahlund, L-O, Waldemar, G, Wallin, A, Inzitari, D, Hennerici, M G, on behalf of the LADIS Study Group, (2009). Deep frontal and periventricular age related white matter changes but not basal ganglia and infratentorial hyperintensities are associated with falls: cross sectional results from the LADIS study. J. Neurol. Neurosurg. Psychiatry 80: 608-613 [Abstract] [Full text]  
  • Spice, C. L., Morotti, W., George, S., Dent, T. H. S., Rose, J., Harris, S., Gordon, C. J. (2009). The Winchester falls project: a randomised controlled trial of secondary prevention of falls in older people. Age Ageing 38: 33-40 [Abstract] [Full text]  
  • Clemson, L., Mackenzie, L., Ballinger, C., Close, J. C. T., Cumming, R. G. (2008). Environmental Interventions to Prevent Falls in Community-Dwelling Older People: A Meta-Analysis of Randomized Trials. J Aging Health 20: 954-971 [Abstract]  
  • Ganz, D A, Alkema, G E, Wu, S (2008). It takes a village to prevent falls: reconceptualizing fall prevention and management for older adults. Inj. Prev. 14: 266-271 [Abstract] [Full text]  
  • Day, L., Lord, S. (2008). Individual and community fall prevention strategies. Age Ageing 37: 352-353 [Full text]  
  • Campbell, A. J., Robertson, M. C. (2008). Reply. Age Ageing 37: 353-353 [Full text]  
  • Prince, R. L., Austin, N., Devine, A., Dick, I. M., Bruce, D., Zhu, K. (2008). Effects of Ergocalciferol Added to Calcium on the Risk of Falls in Elderly High-Risk Women. Arch Intern Med 168: 103-108 [Abstract] [Full text]  
  • Sjosten, N. M., Salonoja, M., Piirtola, M., Vahlberg, T. J., Isoaho, R., Hyttinen, H. K., Aarnio, P. T., Kivela, S.-L. (2007). A multifactorial fall prevention programme in the community-dwelling aged: predictors of adherence. Eur J Public Health 17: 464-470 [Abstract] [Full text]  
  • Cattaneo, D., Jonsdottir, J., Zocchi, M., Regola, A. (2007). Effects of balance exercises on people with multiple sclerosis: a pilot study. Clin Rehabil 21: 771-781 [Abstract]  
  • Haines, T. P., Hill, K. D., Bennell, K. L., Osborne, R. H. (2007). Additional exercise for older subacute hospital inpatients to prevent falls: benefits and barriers to implementation and evaluation. Clin Rehabil 21: 742-753 [Abstract]  
  • Donat, H., Ozcan, A. (2007). Comparison of the effectiveness of two programmes on older adults at risk of falling: unsupervised home exercise and supervised group exercise. Clin Rehabil 21: 273-283 [Abstract]  
  • Yardley, L., Donovan-Hall, M., Francis, K., Todd, C. (2007). Attitudes and Beliefs That Predict Older People's Intention to Undertake Strength and Balance Training. Journals of Gerontology Series B: Psychological Sciences and Social Science 62: P119-P125 [Abstract] [Full text]  
  • Albertsson, D. M., Mellstrom, D., Petersson, C., Eggertsen, R. (2007). Validation of a 4-Item Score Predicting Hip Fracture and Mortality Risk Among Elderly Women. Ann Fam Med 5: 48-56 [Abstract] [Full text]  
  • Snooks, H. A, Halter, M., Close, J. C T, Cheung, W.-Y., Moore, F., Roberts, S. E (2006). Emergency care of older people who fall: a missed opportunity. Qual Saf Health Care 15: 390-392 [Abstract] [Full text]  
  • Cook, W. L., Tomlinson, G., Donaldson, M., Markowitz, S. N., Naglie, G., Sobolev, B., Jassal, S. V. (2006). Falls and Fall-Related Injuries in Older Dialysis Patients. CJASN 1: 1197-1204 [Abstract] [Full text]  
  • Yardley, L., Bishop, F. L., Beyer, N., Hauer, K., Kempen, G. I. J. M., Piot-Ziegler, C., Todd, C. J., Cuttelod, T., Horne, M., Lanta, K., Holt, A. R. (2006). Older People's Views of Falls-Prevention Interventions in Six European Countries.. Gerontologist 46: 650-660 [Abstract] [Full text]  
  • Stevens, J A, Corso, P S, Finkelstein, E A, Miller, T R (2006). The costs of fatal and non-fatal falls among older adults.. Inj. Prev. 12: 290-295 [Abstract] [Full text]  
  • Yardley, L, Donovan-Hall, M, Francis, K, Todd, C (2006). Older people's views of advice about falls prevention: a qualitative study. Health Educ Res 21: 508-517 [Abstract] [Full text]  
  • Whitehead, C. H, Wundke, R., Crotty, M. (2006). Attitudes to falls and injury prevention: what are the barriers to implementing falls prevention strategies?. Clin Rehabil 20: 536-542 [Abstract]  
  • Foss, A. J. E., Harwood, R. H., Osborn, F., Gregson, R. M., Zaman, A., Masud, T. (2006). Falls and health status in elderly women following second eye cataract surgery: a randomised controlled trial. Age Ageing 35: 66-71 [Abstract] [Full text]  
  • Powell, M. W., Carnegie, D. H., Burke, T. J. (2006). Reversal of diabetic peripheral neuropathy with phototherapy (MIRETM) decreases falls and the fear of falling and improves activities of daily living in seniors. Age Ageing 35: 11-16 [Abstract] [Full text]  
  • Alexander, N. B., Ashton-Miller, J. A., Giordani, B., Guire, K., Schultz, A. B. (2005). Age Differences in Timed Accurate Stepping With Increasing Cognitive and Visual Demand: A Walking Trail Making Test. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 60: 1558-1562 [Abstract] [Full text]  
  • Robitaille, Y., Laforest, S., Fournier, M., Gauvin, L., Parisien, M., Corriveau, H., Trickey, F., Damestoy, N. (2005). Moving Forward in Fall Prevention: An Intervention to Improve Balance Among Older Adults in Real-World Settings. AJPH 95: 2049-2056 [Abstract] [Full text]  
  • Peek-Asa, C., Zwerling, C. (2003). Role of Environmental Interventions in Injury Control and Prevention. Epidemiol Rev 25: 77-89 [Full text]  
  • Roberts, B. L. (2003). FALLS: WHAT A TANGLED WEB. Gerontologist 43: 598-601 [Full text]  
  • Fields, S. (2003). Group based exercise reduced falls in community dwelling people >=70 years of age. Evid. Based Med. 8: 57-57 [Full text]  
  • Simey, P. W, Skelton, D., Dinan, S., Laventure, B. (2002). Tailored exercise is key to preventing falls. BMJ 325: 1177-1177 [Full text]  
  • (2002). Exercise Helps Prevent Falls in Elders. JWatch General 2002: 1-1 [Full text]  

Rapid Responses:

Read all Rapid Responses

Old people and physical exercises.
Sergio Stagnaro
bmj.com, 19 Jul 2002 [Full text]
Cognitive and Emotional benefits of exercise may mediate fall reduction.
Michael J. Hogan
bmj.com, 20 Jul 2002 [Full text]
Specific exercise is the key
Piers W Simey, et al.
bmj.com, 15 Aug 2002 [Full text]
Access jobs at BMJ Careers
Whats new online at Student BMJ