THE EFFECTIVENESS OF A COMMUNITY-BASED MULIFACTORIAL INTERVENTION ON FALLS AND FALL RISK FACTORS IN COMMUNITY LIVING OLDER ADULTS

Abstract

Purpose/Hypothesis: Falls represent a significant health risk to older adults, with one in three community living elders falling each year. Falls are associated with increased risk for mortality, morbidity and institutionalization. This study used a randomized controlled clinical trial to evaluate the effectiveness of a community-based intervention on falls and risk factors (balance, lower extremity strength and mobility) in community-living older adults. Subjects: 453 sedentary adults age 65 years or older living in the community. Materials/Methods: A randomized, controlled trial of 12 months duration examined the effects of a multifaceted intervention, which included 3 times a week group exercise program, 6 hours of fall prevention education, and a comprehensive falls risk assessment with results sent to primary health care provider. Control group received written materials on falls prevention. Primary outcome was fall rates calculated from self-reported falls reported monthly for 12 months. Secondary outcomes were tests of lower extremity strength (repeated Chair Stand), balance (Berg Balance Test), and mobility (Timed Up and Go) measured prior to and following the 12-month intervention. Results: Twelve month follow-up was completed on 95% of participants. Intent to treat analysis found the incidence rate of falls was 25% less among those in intervention group compared with control group (1.77 vs. 1.33 falls/person-year, rate ratio 0.75, 95% CI 0.52 to 1.09). Significant changes were found on the Berg Balance Test (adjusted mean difference +1.5 points, 95% CI 0.8 to 2.3), the Chair Stand Test (adjusted mean difference +1.2, 95% 0.6 to 1.9), and the Timed Up and Go Test (adjusted mean difference 0.7, 95% CI −1.1 to −0.2). Conclusions: Community-based multifaceted intervention was effective in improving balance, mobility, and leg strength, known fall risk factors. The incidence of falls was less in the intervention group, but did not reach significance. Clinical Relevance: A community based multifaceted intervention that includes exercise is an effective approach to improving risk factors for falls, however further research is needed to determine the optimal dose of such an intervention in order to effectively reduce falls in community living elders.