The Effectiveness of a Community-Based Program for Reducing the Incidence of Falls in the Elderly: A Randomized Trial

School of Occupation and Leisure Sciences, Faculty of Health Sciences, University of Sydney, Sydney, Australia.
Journal of the American Geriatrics Society (Impact Factor: 4.57). 10/2004; 52(9):1487-94. DOI: 10.1111/j.1532-5415.2004.52411.x
Source: PubMed


To test whether Stepping On, a multifaceted community-based program using a small-group learning environment, is effective in reducing falls in at-risk people living at home.
A randomized trial with subjects followed for 14 months.
The interventions were conducted in community venues, with a follow-up home visit.
Three hundred ten community residents aged 70 and older who had had a fall in the previous 12 months or were concerned about falling.
The Stepping On program aims to improve fall self-efficacy, encourage behavioral change, and reduce falls. Key aspects of the program are improving lower-limb balance and strength, improving home and community environmental and behavioral safety, encouraging regular visual screening, making adaptations to low vision, and encouraging medication review. Two-hour sessions were conducted weekly for 7 weeks, with a follow-up occupational therapy home visit.
The primary outcome measure was falls, ascertained using a monthly calendar mailed by each participant.
The intervention group experienced a 31% reduction in falls (relative risk (RR)=0.69, 95% confidence interval (CI)=0.50-0.96; P=.025). This was a clinically meaningful result demonstrating that the Stepping On program was effective for community-residing elderly people. Secondary analysis of subgroups showed that it was particularly effective for men (n=80; RR=0.32, 95% CI=0.17-0.59).
The results of this study renew attention to the idea that cognitive-behavioral learning in a small-group environment can reduce falls. Stepping On offers a successful fall-prevention option.

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Available from: Lindy Clemson, Oct 07, 2015
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    • "Community-based services can be a method to decrease the pressure on the healthcare system by moving care from medical institutions towards local community services. Collaborations between primary care, volunteers, and community services have been shown, among other things, to be able to predict poor nutrition among older adults [12], to prevent hospitalizations and major disabilities among chronically ill older adults [13], and to prevent the number of falls among older adults with a history of falling or having concerns about falling [14]. eHealth (or " health services and information delivered or enhanced through the internet and related technologies " [15]) has been proposed as a solution for overcoming the aforementioned challenges and is associated with great promises, such as improved access to health information, greater quality of care, and higher adoption of healthy behavior [16]. "
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    ABSTRACT: Frailty is a multifaceted condition that afects many older adults and marks decline on areas such as cognition, physical condition, and nutritional status. Frail individuals are at increased risk for the development of disability, dementia, and falls. Tere are hardly any health services that enable the identifcation of prefrail individuals and that focus on prevention of further functional decline. In this paper, we discuss the development of a community-based, technology-supported health service for detecting prefrailty and preventing frailty and further functional decline via participatory design with a wide range of stakeholders. Te result is an innovative service model in which an online platform supports the integration of traditional services with novel, Information Communication Technology supported tools. Tis service is capable of supporting the diferent phases of screening and ofers training services, by also integrating them with community-based services. Te service model can be used as a basis for developing similar services within a wide range of healthcare systems.We present the service model, the general functioning of the technology platform, and the diferent ways in which screening for and prevention of frailty has been localized. Finally, we refect on the added value of participatory design for creating such health services.
    Journal of aging research 09/2015; 501:216084. DOI:10.1155/2015/216084
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    • "(Lorig, Sobel, Ritter, Laurent, & Hobbs, 2001; Lorig et al., 1999), Stepping On [SO] (Clemson et al., 2004), Tai Chi Moving for Better Balance [TCMBB] (Li, Harmer, Glasgow, et al., 2008; Li, Harmer, Mack, et al., 2008)). Thus, increasing the offering of community-based programs is recommended to cover the range of need. "
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    ABSTRACT: With 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. We calculated fall-related hospitalization incidence rates (65 and older), identified fall 'hot spots,' and examined availability of fall-prevention programming. The 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. Increased 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. Geospatial investigations can inform strategic planning efforts to develop clinical-community partnerships to offer fall prevention programming in high risk areas. Copyright © 2015 Elsevier Ltd and National Safety Council. All rights reserved.
    Journal of Safety Research 02/2015; 53. DOI:10.1016/j.jsr.2015.01.002 · 1.29 Impact Factor
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    • "monthly calendar of falls Clemson et al. 19 (2004) "
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