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Effectiveness of a Community-Based Multifactorial Intervention on Falls and Fall Risk Factors in Community-Living Older Adults: A Randomized, Controlled Trial

¹ Department of Rehabilitation Medicine, University of Washington, Seattle. ² Injury & Violence Prevention Program, Washington State Department of Health, Olympia. ³ NorthWest Orthopaedic Institute, Tacoma. ⁴ Department of Epidemiology and Harborview Injury Prevention and Research Center, University of Washington, Seattle.

Address correspondence to Anne Shumway-Cook, PhD, Department of Rehabilitation Medicine, Box 356490, University of Washington, Seattle, WA 98195. E-mail: ashumway{at}u.washington.edu

Objective. The purpose of this study was to evaluate the effectiveness of a 12-month community-based intervention on falls and risk factors (balance, lower extremity strength, and mobility) in community-living older adults.

Methods. Four hundred fifty-three sedentary adults (65 years old or older) were randomized to either a multifaceted intervention (3 times a week group exercise, 6 hours of fall prevention education, comprehensive falls risk assessment results sent to primary health care provider) or control group (written materials on falls prevention). Primary outcome was fall incidence rates calculated from self-reported falls reported monthly for 12 months. Secondary outcomes were tests of leg strength, balance, and mobility prior to and following the 12-month intervention.

Results. Twelve-month follow-up was completed on 95% of participants. Intent-to-treat analysis found that the incidence rate of falls was 25% lower among those in the intervention group compared with control group (1.33 vs 1.77 falls/person-year, rate ratio 0.75, 95% confidence interval [CI], 0.52–1.09). This difference was not statistically significant. The risk ratio for any fall was 0.96 (95% CI, 0.82–1.13). Small but significant improvements were found on the Berg Balance Test (adjusted mean difference +1.5 points, 95% CI, 0.8–2.3), the Chair Stand Test (adjusted mean difference +1.2, 95% 0.6–1.9), and the Timed Up and Go Test (adjusted mean difference –0.7, 95% CI, –1.2 to –0.2).

Conclusions. A community-based multifaceted intervention was effective in improving balance, mobility, and leg strength, all known fall risk factors. Although the incidence of falls was lower, the confidence interval included the possibility of no intervention effect on falls.