Fall-related Hospital Research Articles

Rural older people had lower mortality after accidental falls than non-rural older people.

ObjectiveThis study aimed to investigate the mortality rate after falls of rural and non-rural older people and to explore the risk factors of mortality after falls among older people.Patients and methodsThis population-based case–control study identified two groups from a nationwide claim database (National Health Insurance Research Database in Taiwan): a rural group and a non-rural group, which included 3,897 and 5,541 older people, respectively, who were hospitalized for accidental falls (The International Classification of Diseases, Ninth Revision, Clinical Modification: E880–E888) during 2006–2009. Both groups were followed up for 4 years after falls. Four-year cumulative all-cause mortality rate after falls was calculated, and the demographic factor, comorbidity, and medications were considered as the potential risk factors of mortality after falls.ResultsThe rural group had a significantly higher frequency of fall-related hospitalizations (7.4% vs 4.3%, P<0.001), but a lower 4-year cumulative all-cause mortality rate after falls than the non-rural group (8.8% vs 23.4%, P<0.001). After adjusting for age, gender, comorbidity, and medication use, the rural group had a significantly lower risk of mortality after falls than the non-rural group (adjusted odds ratio =0.32, 95% confidence interval =0.28–0.37, P<0.001). Age, gender, place of residence, comorbidity, number of medications, and inappropriate medication use were independent risk factors of mortality after falls.ConclusionThe rural older people had a higher frequency of fall-related hospitalizations but lower mortality after falls than the non-rural older people. Fall prevention programs should be adjusted for difference in place of residence.

Differences on hospital environment safety appraisal for elderly fall between aged patients and nurses

Objective To probe into the differences on hospital environment appraisal for elderly fall between aged patients and nursing, and provide evidence for improving a elderly patients safety hospital environment. Methods By Delphi method to make elderly fall related hospital environment safety risks scale, a total of 970 elderly patients and 236 nurses in 24 hospitals were involved the investigation of hospital environment appraise for patient′s safety and the results were analyzed by SPSS 13.0. The elderly inpatients and nurses appraise the hospital environment safety by descriptive statistical analysis method, and the differences between them analyzed by t test. Results The elderly patients and nurses given beyond 4 points for ward public environment and equipment; the low score clauses were ward toilet (3.65±0.74), ward floor and corridor (3.86±0.78), ward room equipment (3.98±0.60) from elderly patients which were lower than that of nurses (t=-2.724, -2.473, -2.650; P<0.05). Conclusions Elderly patient give lower score than nurses for elderly fall related hospital environment safety appraisal, nurses should pay attention to elderly patients feeling towards hospital environment safety in clinical work and strengthen safety management for ward toilet, ward floor, corridor and equipment, so as to ensure environment safety and prevent patient fall. Key words: Nurse; Fall; Elderly patient; Environment safety

Associations of Guideline Recommended Medications for Acute Coronary Syndromes With Fall-Related Hospitalizations and Cardiovascular Events in Older Women With Ischemic Heart Disease.

Guidelines for acute coronary syndrome recommend statins, β-blockers, angiotensin-converting-enzyme inhibitors or renin-angiotensin system blockers, and antiplatelet agents for the secondary prevention of cardiovascular events. The aim was to examine associations between guideline recommended medications and fall-related hospitalizations and cardiovascular events in robust and frail older women. 2002-2011 surveys from the Australian Longitudinal Study on Women's Health linked with administrative hospital, pharmaceutical and death registry data (2003-mid-2011) were used. Eight hundred eighty-five women (82.7±2.7 years, range 76-90) had prior admission for ischemic heart disease and ≥1 claims for any of the four medication classes. Four hundred thirteen (46.7%) were robust and 472 (53.3%) were frail. Fall-related admissions; cardiovascular event-related admissions or death; and cardiovascular death were recorded. Associations between each of the exposures and outcomes were analyzed using survival analyses with noncardiovascular death as a competing risk. There were 192 fall-related admissions and 314 cardiovascular events including 82 deaths. Using four recommended classes (compared to using one) was associated with increased risks of fall-related admissions (hazard ratio [HR] = 2.57, 95% confidence interval [CI] = 1.24-5.33), but not with cardiovascular events (HR = 1.41, CI = 0.97-2.05) or cardiovascular death (HR = 0.68, CI = 0.35-1.34). Associations for fall-related admissions were stronger in frail participants (HR = 5.46, CI = 1.34-22.30) than robust (HR = 1.37, CI = 0.48-3.95). In older women with ischemic heart disease, the combination of the four recommended medication classes was associated with increased risk of falls, particularly among frail women, with no statistically significant gain in cardiovascular health. The risks of falls and consequential morbidity in women over 75 needs consideration when prescribing medications after myocardial infarction.

Differing trends in fall-related fracture and non-fracture injuries in older people with and without dementia

ObjectivesTo explore the impact of dementia on the trends in fall-related fracture and non-fracture injuries for older people. MethodsIndividuals aged ≥65years who were admitted to a NSW hospital for at least an over-night stay for a fall-related injury from 2003 to 2012 were identified. Age-standardised hospitalisation rates, length of stay, access to in-hospital rehabilitation, 30-day and 1-year mortality were examined. Annual percentage change (PAC) over time was calculated using negative binomial regression. ResultsOf the 228,628 fall-related injury hospitalisations, 20.6% were for people with dementia. People with dementia were more likely to be admitted with a hip fracture, and less likely to be admitted with a fracture of the forearm/wrist, and received less in-hospital rehabilitation than people without dementia. Fall-related hip-fracture rates for people with dementia decreased by 4.2% (95%CI −5.6 to −2.7, p<0.001) per annum; there was no change over time for people without dementia (PAC-0.2%; 95%CI −0.8 to 0.5, p=0.643). Rates for other fractures decreased by 1.2% (95%CI −1.9 to −0.5, p<0.001) per annum in people with dementia, while rates increased by 2.2% (95%CI 1.9–2.5, p<0.001) for people without dementia. By contrast, non-fracture injuries including traumatic brain injury increased significantly for both people with and without dementia. ConclusionRates of fall-related fracture and non-fracture hospitalisations for people with dementia remain higher than for those without dementia. However, fall-related fracture hospitalisation rates have decreased for people with dementia, while there has not been a corresponding decrease in people without dementia.

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

BackgroundFall-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...

Straight and Curved Path Walking Among Older Adults in Primary Care: Associations With Fall-Related Outcomes

BackgroundMost falls among community-dwelling older adults occur while walking. Simple walking tests that require little resources and can be interpreted quickly are advocated as useful screening tools for fall prone patients. ObjectiveTo investigate 2 clinically feasible walking tests consisting of straight- and curved-path walking and examine their associations with history of previous falls and fall-related outcomes among community-living older adults. DesignA cross-sectional analysis was performed on baseline data from a longitudinal cohort study. SettingParticipants were recruited through primary care practices. ParticipantsParticipants included 428 primary care patients ≥65 years of age at risk for mobility decline. Participants had a median age of 76.5 years, 67.8% were women, and 82.5% were white. MethodsStraight-path walking performance was measured as the time needed to walk a 4-meter straight path at usual pace from standstill using a stopwatch (timed to 0.1 second). Curved-path walking performance was timed while participants walked from standstill in a figure-of-8 pattern around two cones placed 5 feet apart. Main Outcome MeasurementsMultivariable negative binomial regression analyses were performed to assess the relationship between straight-path walking or curved-path walking and self-reported history of number of falls. For fall-related injuries, and fall-related hospitalizations, logistic regression models were used. ResultsIn the fully adjusted model, an increase of 1 second in straight path walking time was associated with 26% greater rate of falls (rate ratio 1.26, 95% confidence interval 1.10-1.45). An increase in curved-path walking time was associated with 8% greater rate of falls (rate ratio 1.08, 95% confidence interval = 1.03-1.14). Neither walk test was associated with history of fall-related injuries or hospitalizations. ConclusionsPoor performance on straight- and curved-path walking performance was associated with a history of greater fall rates in the previous year but not with a history of fall-related injuries or hospitalizations. This information helps inform how previous fall history is related to performance on walking tests in the primary care setting.

Differences in fall injury hospitalization and related survival rates among older adults across age, sex, and areas of residence in Canada

BackgroundFalls are the leading cause of injury-related hospital admissions in Canadian older adults, accounting for 85 % of injury hospitalizations among older adults aged over 65 years. While many of these injuries can lead to death, the survival rates of fall-related injuries are rarely examined. This surveillance study examined the fall injury hospitalization and survival rates among older adults in the context of place.MethodsSaskatchewan’s health administrative data on injury hospitalizations among individuals aged 65 years and over (n = 39,867) was utilized for this study. Variables of interest included age group, sex, and the geographical area of residence at the time of hospitalization (rural, urban, north). Logistic regression analysis was applied to determine the association of variables of interest (age group, sex, and area of residence at the time of hospitalization as the covariate) with frequency of fall injury hospitalizations. Probable time to death due to fall-related injury hospitalization was determined by survival analysis.ResultsThree key findings that emerged from the present study are the following: (1) fall injury hospitalizations accounted for 77 % of all injury hospitalizations; (2) fall injury hospitalization rates varied by age group, sex, and area of residence, with advancing age, women, and certain geographical areas showing higher rates; and (3) survival rates also varied by sex and area of residence. Women had longer survival estimates after a fall injury hospitalization compared to men, and those living in the north have the shortest survival estimates.ConclusionsThe findings from the study highlighted the high rate of fall-related injury hospitalization among older adults varying with their age group, sex, and area of residence. These factors need to be considered in injury surveillance and fall prevention research as well as programs and policies that support the reduction of falls.

Recent trends in hospitalization and in-hospital mortality associated with traumatic brain injury in Canada: A nationwide, population-based study.

Traumatic brain injury (TBI) is the leading cause of traumatic death and disability worldwide.We examined nationwide trends in TBI-related hospitalizations and in-hospital mortality between April 2006 and March 2011 using a nationwide, population based database that is mandatory for all hospitals in Canada. Trends in hospitalization rates for all acute hospital separations in Canada were analyzed using linear regression. Independent predictors of in-hospital mortality were evaluated using logistic regression. Hospitalization rates remained stable for children and young adults but increased considerably among elderly adults (age Q65 years). Falls and motor vehicle collisions (MVCs) were the most common causes of TBI hospitalizations. TBIs caused by falls increased by 24% (p = 0.01), while MVC-related hospitalization rates decreased by 18% (p = 0.03). Elderly adults were most vulnerable to falls and experienced the greatest increase (29%) in fall-related hospitalization rates. Young adults (ages, 15Y24 years) were most at risk for MVCs but experienced the greatest decline (28%) in MVC-related admissions. There were significant trends toward increasing age, injury severity, comorbidity, hospital length of stay, and rate of in-hospital mortality.However, multivariate regression showed that odds of death decreased over time after controlling for relevant factors. Injury severity, comorbidity, and advanced age were the most important predictors of in-hospital mortality for TBI inpatients. Hospitalizations for TBI are increasing in severity and involve older populations with more complex comorbidities. Although preventive strategies for MVC-related TBI are likely having some effects, there is a critical need for effective fall prevention strategies, especially among elderly adults.

A randomised controlled trial of low-dose aspirin for the prevention of fractures in healthy older people: protocol for the ASPREE-Fracture substudy

BackgroundDisability, mortality and healthcare burden from fractures in older people is a growing problem worldwide. Observational studies suggest that aspirin may reduce fracture risk. While these studies provide room for...

Recent trends in hospitalization and in-hospital mortality associated with traumatic brain injury in Canada: a nationwide, population-based study

Background: Traumatic brain injury (TBI) is the leading cause of traumatic death and disability worldwide. We examined nationwide trends in TBI-related hospitalizations and in-hospital mortality between April 2006 and March 2010 using a population-based database that is mandatory for all hospitals in Canada. Methods: Trends in hospitalization rates were analyzed using linear regression. Independent predictors of in-hospital mortality were evaluated using logistic regression. Results: Hospitalization rates remained stable for children and young adults, but increased considerably among elderly adults (ages 65 and older). Falls and motor vehicle collisions (MVCs) were the most common causes of TBI hospitalizations. TBIs caused by falls increased by 24% (p=0.01), while MVC-related hospitalization rates decreased by 18% (p=0.03). Elderly adults were most vulnerable to falls, and experienced the greatest increase (29%) in fall-related hospitalization rates. Young adults (ages 15-24) were most at risk for MVCs, but experienced the greatest decline (28%) in MVC-related admissions. There were significant trends towards increasing age, injury severity, comorbidity, hospital length of stay, and in-hospital mortality. However, multivariate regression showed that the odds of death decreased over time after controlling for relevant factors. Conclusions: Hospitalizations for TBI are increasing in severity and involve older populations with more complex comorbidities.

Associations of Potentially Inappropriate Medicine Use with Fall-Related Hospitalisations and Primary Care Visits in Older New Zealanders: A Population-Level Study Using the Updated 2012 Beers Criteria

BackgroundIdentifying potentially inappropriate medicines (PIMs) leading to adverse drug events may reduce the risk of morbidity and mortality in older people.ObjectiveThe aim of this study was to examine the relationship between exposure to PIMs and risk of Fall-related hospitalisations (FRH) and frequency of primary care visits in older New Zealanders.MethodsPharmaceutical collections (2011), diagnostic (2007–2011) and events (2012) information derived from the National Minimum Datasets were used to extract demographics, medication and diagnostic information for 537,387 individuals aged ≥65 years. Prescription and diagnostic information were matched through unique National Health Index numbers. The updated Beers 2012 criteria were used to identify PIMs. Polypharmacy was defined as five or more medicines dispensed concurrently for ≥90 days.ResultsIndividuals exposed to one or more PIMs had an increased risk of FRH with an incidence rate ratio (IRR) of 1.45 (95 % confidence interval [CI] 1.37–1.52) and a greater number of primary care visits (IRR 1.15; 95 % CI 1.15–1.16). Individuals exposed to polypharmacy had an IRR of 1.41 (95 % CI 1.33–1.50) for FRH and an IRR of 1.14 (95 % CI 1.13–1.15) for primary care visits.ConclusionPIMs identified by the 2012 Beers criteria showed an increased risk of FRH and a greater number of primary care visits. Age ≥85 years and female sex were identified as significant predictors of FRH and primary care visits.

Disparities in occupational injury hospitalization rates in five states (2003–2009)

Achievement of health equity and elimination of disparities are overarching goals of Healthy People 2020, yet there is a paucity of population-based data regarding race/ethnicity-based disparities in occupational injuries. Hospital discharge data for five states (Arizona, California, Florida, New Jersey, and New York) were obtained from the Healthcare Cost & Utilization Project (HCUP) for 2003-2009. Age-adjusted rates and trends for work-related injury hospitalizations were calculated using negative binomial regression (reference category: non-Latino white). Latinos were significantly more likely to have a work-related traumatic injury hospitalization. The disparity for Latinos was greatest for machinery-related hospitalizations. Latinos were also more likely to have a fall-related hospitalization. African-Americans were more likely to have an occupational assault-related hospitalization, but less likely to have a fall-related hospitalization. We found evidence of substantial multistate disparities in occupational injury-related hospitalizations. Enhanced surveillance and further research are needed to identify and address underlying causes.

Geospatial distribution of fall-related hospitalization incidence in Texas

IntroductionWith the rapid growth of the aging U.S. population, the incidence of falls and fall-related injuries is expected to rise. We examined incidence and characteristics of fall-related hospitalizations (falls) among Texans aged 50 and older, by geography and across time. MethodWe calculated fall-related hospitalization incidence rates (65 and older), identified fall ‘hot spots,’ and examined availability of fall-prevention programming. ResultsThe incidence of fall-related hospitalizations for older adults increased by nearly 20% from 2007 to 2011. There were clusters of ‘hot spot’ counties throughout the state, many of which lack fall prevention programs. ConclusionsIncreased efforts are needed to identify older adults at elevated risk for falling and develop referral systems for promoting evidence-based fall prevention programs at multiple levels accounting for geographic settings. Practical applicationsGeospatial investigations can inform strategic planning efforts to develop clinical-community partnerships to offer fall prevention programming in high risk areas.

A multicenter retrospective study on falls in elderly population. Epidemiology and impact on hospital workload in two Emergency Departments of Northern Italy

Aims of this study were to evaluate the incidence of falls in subjects aged ≥65 years in Parma Province (Northern Italy), and the burden of fall-related hospitalizations. All the Emergency Department (ED) visits for domestic or trivial falls were retrieved from the database of the two EDs of Parma Province during 2013. All cases were classified according to age and gender. Out of 129,898 total ED visits, 3720 (2.9%) were related to trivial falls in patients aged ≥65 years. Females accounted for 2648 visits and males for 1072. The absolute number of visits due to falls increased with age in both genders, with a peak between 80 and 84 yrs. When related with the actual number of residents by age groups, females showed a continuous increase, peaking at age >100 yrs, and males a continuous increase, peaking at age 95-99 yrs. Of these patients, 963 (25.9%) needed hospitalization, 605 in the orthopedic ward, 342 in medical wards, and 16 in specialist surgical units. In conclusion, falls represent a major cause of morbidity in the elderly in Northern Italy, representing 13.3% of the ED visits for people aged ≥65, with a high impact on hospital workload.

Cost of fall-related hospitalizations among older adults: environmental comparisons from the 2011 Texas hospital inpatient discharge data.

In the United States, 30% of older adults suffer a fall annually with tremendous personal and societal burden. Although estimates of national-level costs are available, most of these often cited estimates are dated, and less has been published about statewide estimates. This article documents fall-related medical costs by age, sex, and different geographic regions based on admission status of 2,937,579 hospital discharges reported in 2011, with special attention to trends over time. There were 77,086 fall-related hospitalizations in 2011, of which 78.4% represent those aged 50 and older. Among this same age group, total fall-related costs rose to $3.1 billion in 2011, from $1.9 billion in 2007. Those aged 75 and older experienced the highest cost, while average cost was lower in nonmetropolitan areas. Understanding the distribution of fall-related burden across groups and rurality allows researchers to identify social and environmental circumstances of falls and identify community resources necessary to prevent falls.

Trends in fall-related hospitalisations in older people living in aged care facilities.

The aim is to describe the trends in fall-related hospitalisations for older people living in aged care facilities. Over the 9-year period investigated, there were dramatic increases in fall-related hospitalisations. This worrying trend highlights that we may not be addressing falls in aged care facilities sufficiently. The purposes of this study are to describe the trends in fall-related hospitalisations in older people living in aged care facilities and to compare these trends across different demographic groups and injury types. This study was conducted in Australia's second most populous state, Victoria. Aged care facilities in Australia provide high- and low-level nursing care for people who can no longer live independently. Included in this study were hospital admitted episodes of care which met the following criteria: age 65+ years at admission, an admission source indicating a transfer from an aged care facility, an external cause indicating a fall, a care type of 'acute', a Victorian postcode of residence, and an admission date between July 1, 2003 and June 30, 2012 (inclusive). Rate denominator data were Victorian aged care bed years. Over the last 9 years, 7098 episodes of care met the inclusion criteria. The age-standardised rate of hospitalisation increased by 11% (95% confidence interval [CI] 9%, 12%) per year. Serious injury increased at a slower pace than less serious injury. The slowest rate increase was for hip fracture (incidence rate ratio: 1.03 (95% CI 1.00, 1.06), the most common fracture type. Rates of fall-related hospitalisations in older people living in aged care facilities increased at a dramatic pace in the period studied. The relative slower increase in hip fracture may point towards changing referral practices, possible success in osteoporosis management, body mass index increases in older people living in aged care facilities or a combination of these factors.

What factors influence community-dwelling older people's intent to undertake multifactorial fall prevention programs?

PurposeTo investigate previous, current, or planned participation in, and perceptions toward, multifactorial fall prevention programs such as those delivered through a falls clinic in the community setting, and to identify factors influencing older people’s intent to undertake these interventions.Design and methodsCommunity-dwelling people aged >70 years completed a telephone survey. Participants were randomly selected from an electronic residential telephone listing, but purposeful sampling was used to include equal numbers with and without common chronic health conditions associated with fall-related hospitalization. The survey included scenarios for fall prevention interventions, including assessment/multifactorial interventions, such as those delivered through a falls clinic. Participants were asked about previous exposure to, or intent to participate in, the interventions. A path model analysis was used to identify factors associated with intent to participate in assessment/multifactorial interventions.ResultsThirty of 376 participants (8.0%) reported exposure to a multifactorial falls clinic-type intervention in the past 5 years, and 16.0% expressed intention to undertake this intervention. Of the 132 participants who reported one or more falls in the past 12 months, over one-third were undecided or disagreed that a falls clinic type of intervention would be of benefit to them. Four elements from the theoretical model positively influenced intention to participate in the intervention: personal perception of intervention effectiveness, self-perceived risk of falls, self-perceived risk of injury, and inability to walk up/down steps without a handrail (P<0.05).ConclusionMultifactorial falls clinic-type interventions are not commonly accessed or considered as intended fall prevention approaches among community-dwelling older people, even among those with falls in the past 12 months. Factors identified as influencing intention to undertake these interventions may be useful in promoting or targeting these interventions.

Living Lab Falls-MACVIA-LR: The falls prevention initiative of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) in Languedoc-Roussillon

Falls represent a major cause of burden and death in older adults. The MACVIA-LR (fighting chronic diseases for active and healthy ageing in Languedoc-Roussillon) falls initiative is a cross-cutting Living Lab based on the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) at the regional level. It covers all action plans (A1, A2, A3, B3, C2 and D4) of the EIP on AHA. The Living Lab will: (i) raise awareness, (ii) drive attitude change with respect to falls and falls prevention and (iii) improve access to information on falls prevention. It aims to reduce fall-related hospitalisations by 30% in 2020 in the région Languedoc-Roussillon (LR). It includes: (i) a falls prevention clinic for the assessment of subjects (with a falls risk) in the two teaching hospitals of Montpellier and Nîmes, (ii) the Regional Ageing Institute (CARSAT-LR), (iii) the Low Vision Institute of Nîmes, (iv) the Lattes Social Welfare Centre, (v) the home automation Institut méditerranéen des métiers de longévité, (vi) teaching, training and coaching as well as (vii) industrial partnership. Two care pathways have been developed (stroke and falls) and are being applied to remote rural areas of the région. The MACVIA-falls prevention initiative is an output of the EIP on AHA.

Associations of drug burden index with falls, general practitioner visits, and mortality in older people.

On a population level in people aged ≥65 years old living in New Zealand, the aim of this study is to quantify each individual's cumulative exposure to anticholinergic and sedative medicines using the Drug Burden Index (DBI) and examine the impact of DBI on fall-related hospitalisations, general practitioner (GP) visits, and all-cause mortality. The study used data extracted from Pharmaceutical Claims Data Mart (2011), National Minimum Data set (2012), Births, Death and Marriages (2012) and GP Visits (2012) for patient demographics, hospitalisations and mortality. Cumulative anticholinergic and sedative exposure was measured using the DBI. Polypharmacy was defined as greater than or equal to five medicines dispensed concurrently at any time during the study period. Amongst the study population (n = 537,387; 45% male), 43.22% were exposed to DBI drugs (95% confidence intervals (CIs) = 43.09-43.35). The odds of DBI exposure for individuals with polypharmacy are 4.92 (95%CI = 4.86-4.98) times greater than that for individuals without polypharmacy. DBI drugs were associated with fall-related hospitalisations (incidence rate ratio (IRR) 1.56, 95%CI = 1.47-1.65) and greater number of GP visits (IRR 1.13, 95%CI = 1.12-1.13). Individuals with DBI > 0 had a 1.29 times higher mortality risk (95%CI = 1.25-1.33). Polypharmacy is also associated with a higher mortality risk with a hazard ratio (HR) of 1.66 (95%CI = 1.59-1.73). Polypharmacy and exposure to DBI drugs were independently associated with fall-related hospitalisations, frequency of GP visits, and risk of mortality. On a population level, DBI may be useful as a quality indicator to guide policy to improve prescribing and optimize clinical outcomes in older people.

The Otago Exercise Program Performed as Group Training Versus Home Training in Fall‐prone Older People: A Randomized Controlled Trial

Exercise programs targeting muscle strength and balance can reduce falls. The study aimed to compare the Otago Exercise Program (OEP), originally designed as supervised home training (HT), with the same programme performed as GT, on functional balance and muscle strength, mobility, fall efficacy and self-reported health. A single-blind randomized controlled trial with assessments at baseline (T1), following the 12-week intervention (T2), and 3 months following intervention (T3), was performed. 125 people, mean age 82.5 (SD = 5.7) years, 73% women, referred to a Falls Outpatient Clinic, participated. 74% had fallen, and 37% had a fall-related hospital stay during the previous year. OEP supervised by physiotherapists was performed as GT twice weekly or as HT three times a week, for 12 weeks. Total exercise time was comparable between groups. The primary outcome was the Berg Balance Scale assessed at T2. From T1-T2, Berg Balance Scale improved significantly more in the GT group than in the HT group (mean group difference in change of 3.2 points, 95%CI = 0.7-5.8, p = 0.014). Of the secondary outcomes, the 30-second sit-to-stand test (p = 0.004), and physical health measured by the Short Form-36 (p = 0.004), improved significantly more for the GT group. Change in mobility measured by the Timed Up and Go test, mental health by the Short Form-36, and fall efficacy by the Fall Efficacy Scale International did not differ between groups. The 30-second sit-to-stand test and the Timed Up and Go, but not the Berg Balance Scale, was still better in the GT group at T3. In fall-prone home-dwelling older people, the OEP performed as GT is more effective for improving functional balance, muscle strength and physical health, but not fall efficacy and mental health than when performed as HT. The OEP provided as GT should be considered in this population.