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

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7356.128 (Published 20 July 2002) Cite this as: BMJ 2002;325:128
  1. Lesley Day, senior research fellow (Lesley.Day{at}general.monash.edu.au)a,
  2. Brian Fildes, professora,
  3. Ian Gordon, associate professorb,
  4. Michael Fitzharris, research fellowa,
  5. Harold Flamer, consultant geriatricianc,
  6. Stephen Lord, National Health and Medical Research Council research fellowd
  1. a Accident Research Centre, PO Box 70A, Monash University, Clayton, Victoria 3800, Australia
  2. b Statistical Consulting Centre, University of Melbourne, Melbourne, Victoria 3052, Australia
  3. c Division of Geriatric Medicine, Maimonides Medical Center, Brooklyn, New York, NY 11219, USA
  4. d Prince of Wales Medical Research Institute, Sydney, NSW 3021, Australia
  1. Correspondence and reprint requests to: L Day
  • Accepted 2 January 2002

Abstract

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.

Footnotes

  • Funding This work was funded by the National Health and Medical Research Council (Commonwealth Department of Health and Aged Care), Victorian Department of Human Services (Aged Care), City of Whitehorse, Victorian Health Promotion Foundation, Rotary, and the National Safety Council.

  • Competing interests None declared.

  • Accepted 2 January 2002
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