Kenosha County falls prevention study: a randomized, controlled trial of an intermediate-intensity, community-based multifactorial falls intervention.
OBJECTIVE
To decrease the rate of falls in high-risk community-dwelling older adults.


METHODS
Randomized, controlled trial.


METHODS
Community-based.


METHODS
Three hundred forty-nine adults aged 65 and older with two falls in the previous year or one fall in the previous 2 years with injury or balance problems.


METHODS
Subjects received two in-home visits from a trained nurse or physical therapist who assessed falls risk factors using an algorithm. The intervention consisted of recommendations to the subject and their primary physician, referrals to physical therapy and other providers, 11 monthly telephone calls, and a balance exercise plan. Control subjects received a home safety assessment.


METHODS
The primary outcome was rate of falls per year in the community. Secondary outcomes included all-cause hospitalizations and nursing home admissions per year.


RESULTS
There was no difference in rate of falls between the intervention and control groups (rate ratio (RR)=0.81, P=.27). Nursing home days were fewer in the intervention group (10.3 vs 20.5 days, P=.04). Intervention subjects with a Mini-Mental State Examination (MMSE) score of 27 or less had a lower rate of falls (RR=0.55; P=.05) and, if they lived with someone, had fewer hospitalizations (RR=0.44, P=.05), nursing home admissions (RR=0.15, P=.003), and nursing home days (7.5 vs 58.2, P=.008).


CONCLUSIONS
This multifactorial intervention did not decrease falls in at-risk community-living adults but did decrease nursing home utilization. There was evidence of efficacy in the subgroup who had an MMSE score of 27 or less and lived with a caregiver, but validation is required.
Mahoney
Jane E
JE
Department of Medicine, Section of Geriatrics, School of Medicine and Public Health, University of Wisconsin Madison, Madison, Wisconsin, USA. jm2@medicine.wisc.edu
Shea
Terry A
TA
Przybelski
Robert
R
Jaros
LaVerne
L
Gangnon
Ronald
R
Cech
Sandy
S
Schwalbe
Alice
A
D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015444:Exercise; D005260:Female; D005853:Geriatrics; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D004856:Postural Balance; D012307:Risk Factors; D014922:Wisconsin