title: Preventing falls in older people: outcome evaluation of a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate the outcome of an intervention to reduce hazards in the home on the rate of falls in seniors.
  
  
  METHODS
  Randomized controlled trial, with follow-up of subjects for 1 year.
  
  
  METHODS
  Community-based study in Perth, Western Australia.
  
  
  METHODS
  People age 70 and older.
  
  
  METHODS
  One thousand eight hundred seventy-nine subjects were recruited and randomly allocated by household to the intervention and control groups in the ratio 1:2. Because of early withdrawals, 1,737 subjects commenced the study. All members of both groups received a single home visit from a research nurse. Intervention subjects (n = 570) were offered a home hazard assessment, information on hazard reduction, and the installation of safety devices, whereas control subjects (n = 1,167) received no safety devices or information on home hazard reduction.
  
  
  METHODS
  Both groups recorded falls on a daily calendar. Reported falls were confirmed by a semistructured telephone interview and were assigned to one of three overlapping categories: all falls, falls inside the home, and falls involving environmental hazards in the home. Analysis was by multivariate modelling of rate ratios and odds ratios for falls, corrected for household clustering, using Poisson regression and logistic regression with robust variance estimation.
  
  
  RESULTS
  Overall, 86% of study subjects completed the 1 year of follow-up. The intervention was not associated with any significant reduction in falls or fall-related injuries. There was no significant reduction in the intervention group in the incidence rate of falls involving environmental hazards inside the home (adjusted rate ratio, 1.11; 95% CI = 0.82-1.50), or the proportion of the intervention group who fell because of hazards inside the home (adjusted odds ratio, 0.97; 95% CI = 0.74-1.28). No reduction was seen in the rate of all falls (adjusted rate ratio, 1.02; 95% CI = 0.83-1.27) or the rate of falls inside the home (adjusted rate ratio, 1.17; 95% CI = 0.85-1.60). There was no significant reduction in the rate of injurious falls in intervention subjects (adjusted rate ratio, 0.92; 95% CI = 0.73-1.14).
  
  
  CONCLUSIONS
  The intervention failed to achieve a reduction in the occurrence of falls. This was most likely because the intervention strategies had a limited effect on the number of hazards in the homes of intervention subjects. The study provides evidence that a one-time intervention program of education, hazard assessment, and home modification to reduce fall hazards in the homes of healthy older people is not an effective strategy for the prevention of falls in seniors.
authors.affiliation: Department of Public Health, The University of Western Australia, Nedlands, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Stevens
authors.forename: C D
authors.initials: CD
authors.lastname: Holman
authors.forename: N
authors.initials: N
authors.lastname: Bennett
authors.forename: N
authors.initials: N
authors.lastname: de Klerk
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006266:Health Education; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011482:Protective Devices; D012931:Social Environment; D014904:Western Australia