Randomised factorial trial of falls prevention among older people living in their own homes.
OBJECTIVE
To test the effectiveness of, and explore interactions between, three interventions to prevent falls among older people.


METHODS
A randomised controlled trial with a full factorial design.


METHODS
Urban community in Melbourne, Australia.


METHODS
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.


METHODS
Three interventions (group based exercise, home hazard management, and vision improvement) delivered to eight groups defined by the presence or absence of each intervention.


METHODS
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.
Day
Lesley
L
Accident Research Centre, PO Box 70A, Monash University, Clayton, Victoria 3800, Australia. Lesley.Day@general.monash.edu.au
Fildes
Brian
B
Gordon
Ian
I
Fitzharris
Michael
M
Flamer
Harold
H
Lord
Stephen
S
D000058:Accidental Falls / Q000517:prevention & control*; D000061:Accidents, Home / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D011379:Prognosis; D012044:Regression Analysis; D012307:Risk Factors; D012308:Risk Management; D017751:Safety Management / Q000379:methods; D014504:Urban Health; D014786:Vision Disorders / Q000534:rehabilitation