title: Strategies to reduce the risk of falling: Cohort study analysis with 1-year follow-up in community dwelling older adults.
abstract: BACKGROUND
  According to the CDC, falls rank among the leading causes of accidental death in the United States, resulting in significant health care costs annually. In this paper we present information about everyday lifestyle decisions of the older adult that may help reduce the risk of falling. We pursued two lines of inquiry: first, we identify and then test known mutable fall risk factors and ask how the resolution of such problems correlates with changes in fall rates. Second, we identify a series of everyday lifestyle options that persons may follow and then ask, does such engagement (e.g., engagement in exercise programs) lessen the older adult's risk of falling and if it does, will the relationship hold as the count of risk factors increases?
  
  
  METHODS
  Using a secondary analysis of lifestyle choices and risk changes that may explain fall rates over one year, we drew on a data set of 13,623 community residing elders in independent housing sites from 24 US states. All older adults were assessed at baseline, and a subset assessed one year later (n = 4,563) using two interRAI tools: the interRAI Community Health Assessment and interRAI Wellness Assessment.
  
  
  RESULTS
  For the vast majority of risk measures, problem resolution is followed by lower rate of falls. This is true for physical measures such as doing housework, meal preparation, unsteady gait, transferring, and dressing the lower body. Similarly, this pattern is observed for clinical measures such as depression, memory, vision, dizziness, and fatigue. Among the older adults who had a falls risk at the baseline assessment, about 20 % improve, that is, they had a decreased falls rate when the problem risk improved. This outcome suggests that improvement of physical or clinical states potentially may result in a decreased falls rate. Additionally, physical exercise and cognitive activities are associated with a lower rate of falls.
  
  
  CONCLUSIONS
  The resolution of risk problems and physical and cognitive lifestyle choices are related to lower fall rates in elders in the community. The results presented here point to specific areas, that when targeted, may reduce the risk of falls. In addition, when there is problem resolution for specific clinical conditions, a decreased risk for falls also may occur.
authors.affiliation: Hebrew SeniorLife, Institute for Aging Research, 1200 Centre Street, Boston, MA, 02131, USA.
authors.forename: John N
authors.initials: JN
authors.lastname: Morris
authors.affiliation: School of Nursing, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA. e.howard@neu.edu.
authors.forename: Elizabeth P
authors.initials: EP
authors.lastname: Howard
authors.affiliation: Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ, 07601, USA.
authors.forename: Knight
authors.initials: K
authors.lastname: Steel
authors.affiliation: Department of Physical Therapy and Rehabilitation Sciences Institute, University of Toronto, 160-500 University Avenue, Toronto, Ontario, M5G 1V7, Canada.
authors.forename: Katherine
authors.initials: K
authors.lastname: Berg
authors.affiliation: Geriatric Medicine Department, Limoges University, IFR 145 Geist; EA 6310 HAVAE, CHU Limoges, Limoges, F-87025, France.
authors.forename: Achille
authors.initials: A
authors.lastname: Tchalla
authors.affiliation: Northeastern University, 360 Huntington Ave, Boston, MA, 02115, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Munankarmi
authors.affiliation: VA Quality Scholar, Geriatrics, Palliative and Extended Care Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, 94121, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: David
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015444:Exercise / Q000502:physiology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057187:Independent Living / Q000523:psychology* / Q000639:trends; D008297:Male; D012307:Risk Factors; D040242:Risk Reduction Behavior; D057566:Self Report; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: Community-dwelling older adults; Strategies to reduce risk of falls; interRAI assessment