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

doi:10.1136/bmj.325.7356.128

BMJ 2002;325:128 ( 20 July )

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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 exploreinteractions between, three interventions to prevent falls amongolderpeople.
Design: A randomised controlled trial with a fullfactorialdesign.
Setting: Urban community in Melbourne,Australia.
Participants: 1090 aged 70 years and over and living athome. Most were Australian born and rated their health as goodto excellent; just over half livedalone.
Interventions: Three interventions (group based exercise,home hazard management, and vision improvement) delivered to eightgroups defined by the presence or absence of eachintervention.
Main outcome measure: Time to first fall ascertained by an 18 monthfalls calendar and analysed with survival analysis techniques.Changes to targeted risk factors were assessed by using measuresof quadriceps strength, balance, vision, and number of hazardsin thehome.
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 thatinvolved exercise. Balance measures improved significantly amongthe exercise group. Neither home hazard management nor treatmentof poor vision showed a significant effect. The strongest effectwas observed for all three interventions combined (rate ratio0.67 (0.51 to 0.88, P=0.004)), producing an estimated 14.0% reductionin the annual fall rate. The number of people needed to be treatedto prevent one fall a year ranged from 32 for home hazard managementto 7 for all three interventionscombined.
Conclusions: Group based exercise was the most potent singleintervention tested, and the reduction in falls among this groupseems to have been associated with improved balance. Falls werefurther reduced by the addition of home hazard management or reducedvision management, or both of these. Cost effectiveness is yetto be examined. These findings are most applicable to Australianborn adults aged 70-84 years living at home who rate their healthasgood.

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

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Rapid Responses:

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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]