Randomised factorial trial of falls prevention among older people living in their own homes

Abstract

Objective: To test the effectiveness of, and explore interactions between, three interventions to prevent falls among older people.

Design: A randomised controlled trial with a full factorial design.

Setting: Urban community in Melbourne, Australia.

Participants: 1090 aged 70 years and over and living at home. Most were Australian born and rated their health as good to excellent; just over half lived alone.

Interventions: Three interventions (group based exercise, home hazard management, and vision improvement) delivered to eight groups defined by the presence or absence of each intervention.

Main outcome measure: Time to first fall ascertained by an 18 month falls calendar and analysed with survival analysis techniques. Changes to targeted risk factors were assessed by using measures of quadriceps strength, balance, vision, and number of hazards in the home.

Results: The rate ratio for exercise was 0.82 (95% confidence interval 0.70 to 0.97, P=0.02), and a significant effect (P<0.05) was observed for the combinations of interventions that involved exercise. Balance measures improved significantly among the exercise group. Neither home hazard management nor treatment of poor vision showed a significant effect. The strongest effect was observed for all three interventions combined (rate ratio 0.67 (0.51 to 0.88, P=0.004)), producing an estimated 14.0% reduction in the annual fall rate. The number of people needed to be treated to prevent one fall a year ranged from 32 for home hazard management to 7 for all three interventions combined.

Conclusions: Group based exercise was the most potent single intervention tested, and the reduction in falls among this group seems to have been associated with improved balance. Falls were further reduced by the addition of home hazard management or reduced vision management, or both of these. Cost effectiveness is yet to be examined. These findings are most applicable to Australian born adults aged 70-84 years living at home who rate their health as good.

Figures

Figure 1

Flow chart showing stages in study protocol and numbers of participants

Figure 2

Kaplan-Meier plots showing the probability of remaining fall-free, for each of the three interventions separately. All participants are represented in each of the three graphs