title: The effectiveness of a community-based program for reducing the incidence of falls in the elderly: a randomized trial.
abstract: OBJECTIVE
  To test whether Stepping On, a multifaceted community-based program using a small-group learning environment, is effective in reducing falls in at-risk people living at home.
  
  
  METHODS
  A randomized trial with subjects followed for 14 months.
  
  
  METHODS
  The interventions were conducted in community venues, with a follow-up home visit.
  
  
  METHODS
  Three hundred ten community residents aged 70 and older who had had a fall in the previous 12 months or were concerned about falling.
  
  
  METHODS
  The Stepping On program aims to improve fall self-efficacy, encourage behavioral change, and reduce falls. Key aspects of the program are improving lower-limb balance and strength, improving home and community environmental and behavioral safety, encouraging regular visual screening, making adaptations to low vision, and encouraging medication review. Two-hour sessions were conducted weekly for 7 weeks, with a follow-up occupational therapy home visit.
  
  
  METHODS
  The primary outcome measure was falls, ascertained using a monthly calendar mailed by each participant.
  
  
  RESULTS
  The intervention group experienced a 31% reduction in falls (relative risk (RR)=0.69, 95% confidence interval (CI)=0.50-0.96; P=.025). This was a clinically meaningful result demonstrating that the Stepping On program was effective for community-residing elderly people. Secondary analysis of subgroups showed that it was particularly effective for men (n=80; RR=0.32, 95% CI=0.17-0.59).
  
  
  CONCLUSIONS
  The results of this study renew attention to the idea that cognitive-behavioral learning in a small-group environment can reduce falls. Stepping On offers a successful fall-prevention option.
authors.affiliation: School of Occupation and Leisure Sciences, Faculty of Health Sciences, University of Sydney, Sydney, Australia. L.Clemson@fhs.usyd.edu.au
authors.forename: Lindy
authors.initials: L
authors.lastname: Clemson
authors.forename: Robert G
authors.initials: RG
authors.lastname: Cumming
authors.forename: Hal
authors.initials: H
authors.lastname: Kendig
authors.forename: Megan
authors.initials: M
authors.lastname: Swann
authors.forename: Robert
authors.initials: R
authors.lastname: Heard
authors.forename: Kirsty
authors.initials: K
authors.lastname: Taylor
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000061:Accidents, Home / Q000517:prevention & control / Q000706:statistics & numerical data; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015928:Cognitive Behavioral Therapy / Q000458:organization & administration; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006299:Health Services for the Aged / Q000458:organization & administration*; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D015994:Incidence; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D009788:Occupational Therapy / Q000458:organization & administration*; D010353:Patient Education as Topic / Q000458:organization & administration; D015397:Program Evaluation; D012044:Regression Analysis; D012648:Self Care; D020377:Self Efficacy; D012657:Self-Help Groups / Q000458:organization & administration*