title: Pragmatic exercise-oriented prevention of falls among the elderly: a population-based, randomized, controlled trial.
abstract: OBJECTIVE
  To assess the effectiveness of an intervention planned and implemented by regional geriatric care teams in order to prevent falls in an elderly population.
  
  
  METHODS
  The study was conducted among 555 (67%) home-dwelling Finnish persons aged 85 years or older of a representative population sample (N=827) in 2000-2003. Altogether 486 subjects (88%) had a history of recurrent falls or at least one risk factor for disability in the activities of daily living or mobility and were randomly assigned to receive suggestions for a programme consisting of home exercise, walking exercise, group activities or self-care exercise or alternatively routine care. Falls were monitored for a median of 16 months during the intervention.
  
  
  RESULTS
  The time to first four falls and all falls did not significantly differ in the targeted intervention group (N=217); compared to controls (N=220), hazard ratio 0.88 (95% CI 0.74 to 1.04) and 0.93 (0.80-1.09), respectively. Among those able to move outdoors, the corresponding hazard ratios in the intervention group (N=168) compared to the controls (N=178) were 0.78 (0.64-0.94) and 0.88 (0.74-1.05). After the intervention period, impaired balance was less common in the intervention than in the control subjects; 64 (45%) and 89 (59%) (p<0.05).
  
  
  CONCLUSIONS
  A pragmatic intervention was not effective in reducing the falling risk at the population level, but slowed down the reduction of balance performance. Among those able to move outdoors, the intervention was also effective in reducing the risk of first four falls.
authors.affiliation: Department Public Health Science and General Practice, University of Oulu, Unit of General Practice, Oulu University Hospital, Oulu, Finland. heikki.luukinen@oulu.fi
authors.forename: Heikki
authors.initials: H
authors.lastname: Luukinen
authors.forename: Sari
authors.initials: S
authors.lastname: Lehtola
authors.forename: Jari
authors.initials: J
authors.lastname: Jokelainen
authors.forename: Rauni
authors.initials: R
authors.lastname: Väänänen-Sainio
authors.forename: Sinikka
authors.initials: S
authors.lastname: Lotvonen
authors.forename: Pentti
authors.initials: P
authors.lastname: Koistinen
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000203:Activities of Daily Living; D000369:Aged, 80 and over; D015444:Exercise / Q000502:physiology* / Q000523:psychology; D005260:Female; D005387:Finland / Q000453:epidemiology; D006126:Group Processes; D006299:Health Services for the Aged / Q000706:statistics & numerical data / Q000639:trends; D006699:Home Care Services; D006801:Humans; D015994:Incidence; D008297:Male; D009788:Occupational Therapy; D026741:Physical Therapy Modalities; D004856:Postural Balance / Q000502:physiology*; D015397:Program Evaluation; D012307:Risk Factors; D011795:Surveys and Questionnaires