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.

Download full-text


Available from: Lindy Clemson
  • Source
    • "Several recent studies have reported on the cost saving potential of both community-and clinic-based falls prevention programs. Based on data from a series of randomized control trials, Carande-Kulis et al. (2014) calculated the net benefit and return on investment (ROI) of three falls prevention programs: the Otago Exercise Program (Robertson et al. 2002), Tai Chi: Moving for Better Balance (Li, et al., 2005) and Stepping On (Clemson, et al., 2004). The Otago Exercise Program, a 6-month, individually tailored program delivered in the home by a physical therapist or other healthcare provider and targeting frail older adults, had a one-year net benefit of $121.85 and a ROI of 36 % for each dollar invested. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Falls among older adults are a common and serious public health problem. Evidence-based fall prevention programs delivered in community settings and targeting older adults living independently are increasingly deployed throughout the nation. These programs tend to be offered by public and private organizations that serve older adults, and recruitment usually occurs through direct marketing to the target population, rather than through referrals from healthcare providers. Matter of Balance, a program developed to reduce fear of falling and associated activity restriction in community-dwelling older adults, is currently being delivered in 38 of the 50 United States. In this study, we estimate the one-year medical care cost savings if older adults treated at Massachusetts hospitals for fall-related injuries were referred by healthcare providers to participate in Matter of Balance. Methods: Data from several sources were used for this study. We estimated annual cost savings in older adult falls recidivism for a hypothetical 100 patients presenting at an emergency department for a fall-related injury, assuming that all were referred to, and 50 % completed, Matter of Balance. This cost-saving estimate was subsequently expanded based on the actual number (43,931) of older adult patients presenting at, and discharged from Massachusetts emergency departments for all fall-related injuries in 2012. Cost savings were calculated for two additional participation rates: 25 % and 75 %. The return on investment (ROI), was calculated based on the percentage of return per each dollar invested. Results: The calculated ROI for Matter of Balance was 144 %. Statewide savings ranged from $2.79 million assuming a 25 % participation rate to $8.37 million, assuming a 75 % participation rate. Conclusions: Referral to evidence-based falls prevention programs of older adult patients presenting at EDs with a fall-related injury could reduce subsequent falls and associated treatment costs.
    Full-text · Article · Oct 2015
  • Source
    • "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]. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Sep 2015 · Journal of aging research
  • Source
    • "The separation of constructs in fall prevention research has resulted in the exclusion of those with fof from standard fall remediation research (Clemson et al., 2004). A new measurement strategy utilizing a Falls Weight Function (FWF) allows analysis incorporating both fof and falls to better identify effective intervention strategies. "

    Preview · Article · Jul 2015
Show more