title: Can the provision of a home help service for the elderly population reduce the incidence of fall-related injuries? A quasi-experimental study of the community-level effects on hospital admissions in Swedish municipalities.
abstract: Fall-related injuries are a global public health problem, especially in elderly populations. The effect of an intervention aimed at reducing the risk of falls in the homes of community-dwelling elderly persons was evaluated. The intervention mainly involves the performance of complicated tasks and hazards assessment by a trained assessor, and has been adopted gradually over the last decade by 191 of 290 Swedish municipalities.
  
  
  
  A quasi-experimental design was used where intention-to-treat effect estimates were derived using panel regression analysis and a regression discontinuity (RD) design. The outcome measure was the incidence of fall-related hospitalisations in the treatment population, the age of which varied by municipality (≥65 years, ≥67 years, ≥70 years or ≥75 years).
  
  
  
  We found no statistically significant reductions in injury incidence in the panel regression (IRR 1.01 (95% CI 0.98 to 1.05)) or RD (IRR 1.00 (95% CI 0.97 to 1.03)) analyses. The results are robust to several different model specifications, including segmented panel regression analysis with linear trend change and community fixed effects parameters.
  
  
  
  It is unclear whether the absence of an effect is due to a low efficacy of the services provided, or a result of low adherence. Additional studies of the effects on other quality-of-life measures are recommended before conclusions are drawn regarding the cost-effectiveness of the provision of home help service programmes.
authors.affiliation: Division of Risk Management, Department of Environmental and Life Sciences, Karlstad University, Sweden.|Centre for Public Safety, Karlstad University, Karlstad, Sweden.
authors.forename: Carl
authors.initials: C
authors.lastname: Bonander
authors.affiliation: Division of Risk Management, Department of Environmental and Life Sciences, Karlstad University, Sweden.|Centre for Public Safety, Karlstad University, Karlstad, Sweden.
authors.forename: Johanna
authors.initials: J
authors.lastname: Gustavsson
authors.affiliation: Division of Risk Management, Department of Environmental and Life Sciences, Karlstad University, Sweden.|Centre for Public Safety, Karlstad University, Karlstad, Sweden.
authors.forename: Finn
authors.initials: F
authors.lastname: Nilson
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; D002947:Cities; D004779:Environment Design; D006804:Ergonomics; D005260:Female; D019538:Health Care Surveys; D006299:Health Services for the Aged / Q000458:organization & administration*; D006699:Home Care Services / Q000458:organization & administration*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D015397:Program Evaluation; D012044:Regression Analysis; D012107:Research Design; D013548:Sweden / Q000453:epidemiology; D014947:Wounds and Injuries / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*