Australian Group Exercise Program–Lord, et al.
This study evaluated a 12-month group exercise group for frail older adults. The program was tailored to each participant’s abilities. Overall, the fall rate was 22 percent lower among people who took part in the program, and 31 percent lower among participants who had fallen in the previous year, compared with those who were not in the program.
POPULATION: Ages ranged from ages 62 to 95 although nearly all were 70 years or older. Most study participants were female. Participants lived in retirement villages and most were independent.
GEOGRAPHIC LOCALE: Sydney and Wollongong, Australia
FOCUS: Increase participants’ strength, coordination, balance and gait, and increase their ability to carry out activities of daily living such as rising from chair and climbing stairs.
PROGRAM SETTING: Programs were conducted in common rooms in residential care community centers and senior centers within the retirement villages.
DURATION: One-hour classes were held twice a week for 12 months. The program consisted of 4 successive 3-month terms.
KEY ELEMENTS: Information was not provided by the principal investigator.
CONTACT: Practitioners interested in using this intervention may contact the principal investigator for more information: Stephen R. Lord, PhD Neuroscience Research. Australia Barker Street, Randwick Sydney NSW 2031, Australia Tel: +61 (2) 9399 1061 Fax: +61 (2) 9399 1005 e-mail: s.lord@neura.edu.au
Yaktrax Walker — McKiernan.
This study tested the effectiveness of the Yaktrax Walker, a lightweight traction device that fits over shoes, to prevent falls among older adults when walking outdoors on ice and snow. During the winter months, participants in the Yaktrax intervention group were half as likely to slip and about 60 percent less likely to fall compared to the group that wore their usual winter footwear. Participants in the intervention group also experienced significantly fewer minor fall-related injuries.
POPULATION: Participants were community-dwelling adults aged 65 or older who had fallen at least once in the previous year. About 60 percent were female.
GEOGRAPHIC LOCALE: Rural central and northern Wisconsin, United States FOCUS: Using a traction device that fits on shoes to improve stability when walking on ice and snow.
PROGRAM SETTING: Participants used the Yaktrax Walker on their own in the community.
DURATION: This study took place during the winter of 2003-04.
KEY ELEMENTS: People must be able to safely put on and take off the Yaktrax Walker or leave the device on a dedicated pair of shoes or boots that are only worn out of doors. Shoes should be measured to assure proper fit of Yaktrax Walker. Yaktrax Walker must not be worn indoors. Yaktrax Walker should be inspected for breakage and replaced if broken.
CONTACT: Practitioners interested in using this intervention may contact the principal investigator for more information: Fergus Eoin McKiernan, MD Center for Bone Diseases Marshfield Clinic 1000 North Oak Avenue Marshfield, WI 54449, United States e-mail: mckiernan.fergus@marshfieldclinic.org
Veterans Affairs Group Exercise Group — Rubenstein et al.
This study evaluated a structured group exercise program for fall-prone older men. During the 3-month program, participants were two-thirds less likely to fall compared with those who did not take part in the program. Note: This study calculated the fall rate as the number of falls per hour of physical activity.
POPULATION: All participants were aged 70 or older and lived in the community. All were males who had at least 1 of these fall risk factors: leg weakness, impaired gait, mobility, and/or balance; and had fallen 2 or more times in the previous 6 months.
GEOGRAPHIC LOCALE: Los Angeles, California, United States
FOCUS: Increase strength and endurance and improve mobility and balance using a low-to moderate-intensity group exercise program.
PROGRAM SETTING: The program was conducted at a Veterans Affairs ambulatory care center.
DURATION: Three 1 1/2-hour sessions a week for 12 weeks.
KEY ELEMENTS: Using a group format and providing a wide variety of exercise activities.
Focusing on strength, balance and endurance. Providing personal encouragement and reinforcement
CONTACT: Practitioners interested in using this intervention may contact the principal investigator for more information: Laurence Z. Rubenstein, MD, MPH VA Medical Center, GRECC (11e) 16111 Plummer St. Sepulveda, CA 91343, United States Tel: 818-895-9311. Fax: 818-891-8181 e-mail: laurence.rubenstein@va.gov
Falls Management Exercise (FaME) Intervention — Skelton et al.
This study examined the effectivenss of an individualized, tailored group and home-based exercise intervention designed to improve participants’ dynamic balance and core and leg strength, and to recover their ability to get down to and up from the floor. After 36 weeks, the fall rate in the exercise group was reduced by one-third. Over the entire study, which included a 50-week follow-up period, the fall rate was reduced by 54 percent.
POPULATION: Participants were women aged 65 or older, living independently, who had fallen 3 or more times in the previous year.
GEOGRAPHIC LOCALE: London, United Kingdom
FOCUS: Improve balance and strength
PROGRAM SETTING: Group classes were conducted at 4 locations in London in Community Leisure Centers (gym facilities that have rooms for exercise classes). Home exercises were performed in participants’ homes.
DURATION: The pre-exercise assessment lasted about 40 minutes. One-hour group classes were held once a week for 36 weeks. 30 minutes of home exercises were done twice a week.
KEY ELEMENTS: To be successful, the exercise program should last at least 36 weeks.It should include a minimum of 2 hours per week of combined group and home exercises. Exercise must be progressive, continually increasing in intensity, resistance, weight, and challenging balance. Exercises must be tailored to each individual’s needs and abilities, both in group classes and at home. It is desirable but not essential to include floor work to reduce fear of falling and improve falls efficacy.
CONTACT: Practitioners interested in using this intervention may contact the principal investigator for more information. Dr. Dawn Skelton Reader in Aging and Health School of Health, HealthQWest A236 Govan Mbeki Building Glasgow Caledonian University Cowcaddens Road, Glasgow G4 OBA, United Kingdom Tel: +44 (0) 141 331 8792 e-mail: dawn.skelton@manchester.ac.uk
Central Sydney Tai Chi Trial — Voukelatos, et al.
This study evaluated the effectiveness of a community-based Tai Chi program to reduce falls among people aged 60 or older. One-hour classes were offered once a week for 16 weeks in community settings by experienced instructors who taught their regular programs using several styles of Tai Chi. After the 24-week follow-up period, the fall rate among Tai Chi participants was one-third lower and the rate of multiple falls was 46 percent lower than the rates for participants who did not take Tai Chi.
POPULATION: Participants were healthy people aged 60 or older who lived in the community. About 84 percent were female.
GEOGRAPHIC LOCALE: Sydney, Australia
FOCUS: Improve balance and reduce falls.
PROGRAM SETTING: Tai Chi classes were conducted at community locations such as town halls and senior centers. Locations were chosen based on accessibility (e.g., accessible by public transportation, room accessible without climbing stairs), geographic diversity, and options for no- or low-cost sustainability after the study was completed.
DURATION: One-hour per week for 16 weeks.
KEY ELEMENTS: Limit class size to 12 people to maximize the attention each participant can get from the instructor. Incorporate relaxation and lowered center of gravity exercises into each class. It is important that participants maintain an upright (straight) posture at all times to reduce the risk of falling. Forms of Tai Chi that require participants to squat while moving or to get into positions that are not totally upright should be modified appropriately. Instructors need to be aware of participants’ comfort levels as well as any medical or physical conditions that may limit their ability to perform certain Tai Chi movements. Tai Chi movements should be introduced gradually so that participants are not exposed to too many new movements at once.
CONTACT: Practitioners interested in using this intervention may contact the principal investigator for more information: Alexander Voukelatos, PhD Sydney Southwest Area Health Promotion Service Level 9 (North), KGV building Missenden Road, Camperdown New South Wales 2050, Australia e-mail: avouk@email.cs.nsw.gov.au
Simplified Tai Chi — Wolf et al.
This study compared a 15-week program of Tai Chi classes that used 10 simplified movements, with a balance training program. After 4 months, the risk of falling more than once among participants in the Tai Chi classes was about half that of people in the comparison group. Participants reported that after the study they were better able to stop themselves from falling by using their environment and appropriate body maneuvers. After the study ended, almost half the participants chose to continue meeting informally to practice Tai Chi.
POPULATION: All were 70 years or older and lived in the community. Most study participants were female.
GEOGRAPHIC LOCALE: Atlanta, Georgia, United States
FOCUS: Improve strength, balance, walking speed, and other functional measures among seniors using Tai Chi.
PROGRAM SETTING: The program used facilities in a residential retirement community.
DURATION: The 15-week program included: Twice weekly 25-minute group sessions; Weekly 45-minute individual contact time with the instructor, and; Twice daily 15-minute individual practice sessions at home without an instructor.
KEY ELEMENTS: This program needs to be led by a very experienced Tai Chi grand master. No elements should be changed in order to replicate these results among seniors who are similar to study participants.
CONTACT: Practitioners interested in using this intervention may contact the principal investigator for more information: Steven L. Wolf, PhD, PT, FAPTA Department of Rehabilitation Medicine Emory University School of Medicine 1441 Clifton Road NE Atlanta, GA 30322, United States Tel: 404-712-4801 Fax: 404-712-5895 e-mail: swolf@emory.edu
HOME MODIFICATION INTERVENTIONS
The VIP Trial — Campbell et al.
This study looked at the effectiveness of 2 interventions to reduce falls and fall injuries in older people with poor vision. The home safety program consisted of a home hazard assessment by an occupational therapist followed by home modifications and recommendations for behavior change. The home exercise program consisted of a combination of strength and balance exercises (the Otago Exercise Program modified for people with poor vision) plus vitamin D supplements. Only the home safety program was effective in reducing falls. The home safety group had 61 percent fewer falls and 44 percent fewer injuries compared to those who received social visits.
POPULATION: Participants were community-dwelling seniors aged 75 or older with poor vision. Two-thirds of the participants were female.
GEOGRAPHIC LOCALE: Dunedin and Auckland, New Zealand
FOCUS: Assess and reduce home hazards and encourage changes in behavior.
PROGRAM SETTING: The program took place in participants’ homes of equipment that could lead to falls. The occupational therapist and participant then agreed on which recommendations to implement. The occupational therapist helped the participant obtain any necessary equipment and oversaw payment for the home modifications. Home modifications and equipment costing more than NZ$200 were funded by the local Board of Health and items costing less than this were funded by the participant or from research funds. The occupational therapist made a follow-up visit if equipment needed to be installed.
DURATION: The intervention consisted of 1 or 2 home visits. The first visit lasted about 2 hours. If the occupational therapist needed to approve new equipment, they made a second visit 2 to 3 weeks later. The second visit lasted about 45 minutes.
KEY ELEMENTS: The occupational therapist’s advice rather than the environmental changes was key. A trained and experienced occupational therapist is critical to the success of this intervention.
CONTACT: Practitioners interested in using this intervention may contact the principal investigator for more information: A. John Campbell, MD Department of Medical and Surgical Sciences Dunedin School of Medicine Dunedin, New Zealand e-mail: john.campbell@otago.ac.nz
Home Visits by an Occupational Therapist — Cumming et al.
This intervention used an occupational therapist (OT) who visited participants in their homes, identified environmental hazards and unsafe behaviors, and recommended home modifications and behavior changes. Fall rates were reduced by one-third but only among men and women who had experienced 1 or more falls in the year before the study.
POPULATION: All participants were 65 or older and lived in the community. More than half of the participants were female.
GEOGRAPHIC LOCALE: Sydney, Australia
FOCUS: Assess and reduce home hazards.
PROGRAM SETTING: The program was conducted in participants’ homes.
DURATION: One-hour home visit with a follow-up telephone call 2 weeks later. Total contact time was approximately 2 hours.
KEY ELEMENTS: Using an experienced occupational therapist is critical. These researchers emphasized that this study should not be used to justify widespread, untargeted home modification programs implemented by people who do not have skills in caring for older people.
CONTACT: Practitioners interested in using this intervention may contact the principal investigator for more information: Robert G. Cumming, PhD School of Public Health, Building A27 University of Sydney Sydney NSW 2006, Australia Tel: +61 (2) 9036 6407 Fax: +61 (2) 9351 5049 e-mail: robert.cumming@sydney.edu.au
Falls-HIT (Home Intervention Team) Program — Nikolaus, et al.
This intervention provided home visits to identify environmental hazards that can increase the risk of falling, provided advice about possible changes, offered assistance with home modification, and provided training in using safety devices and mobility aids. The fall rate for participants was reduced 31 percent. The intervention was most effective among those who had experienced 2 or more falls in the previous year; the fall rate for these participants was reduced 37 percent.
POPULATION: Participants were frail community-dwelling older adults who had been hospitalized for conditions unrelated to a fall, and then discharged to home. Participants showed functional decline, especially in mobility. All were 65 or older and lived in the community. Three-quarters were female.
GEOGRAPHIC LOCALE: Mid-sized town, Southern Germany
FOCUS: Assess and reduce fall hazards in participants’ homes.
PROGRAM SETTING: Intervention team members contacted patients once or twice while they were hospitalized to explain the program. The program took place in participants’ homes.
DURATION: The program consisted of 2 or more home visits, each lasting about 1 1/2 hours. After the participant was discharged from the hospital, 3 home visits typically were needed to provide advice on recommended home modifications and to teach the participant how to use safety devices and mobility aids. On average, the total individual contact time was 8 hours.
KEY ELEMENTS: Participants met all intervention team members at the hospital before they were discharged, which facilitated follow-up.
CONTACT: Practitioners interested in using this intervention may contact the principal investigator for more information: Thorsten Nikolaus, MD Medical Director/CEO Bethesda Geriatric Clinic and Professor of Geriatric Medicine University of Ulm Zollernring 26, 89073 Ulm, Germany Tel: +49 731 187 185 Fax: +49 731 187 389 e-mail: thorsten.nikolaus@bethesda-ulm.de
MULTIFACETED INTERVENTIONS
Stepping On — Clemson, et al.
This study used a series of small group sessions to teach fall prevention strategies to community-dwelling older adults. The fall rate among participants was reduced about 30 percent compared with those who did not receive the intervention. The intervention was especially effective for men. The fall rate among male participants was reduced almost two-thirds.
POPULATION: Participants were individuals who had fallen in the previous year or who were concerned about falling. All were 70 or older and lived in the community. Most study participants were female.
GEOGRAPHIC LOCALE: Sydney, Australia
FOCUS: Improve self-efficacy, empower participants to make better decisions and learn about fall prevention techniques, and make behavioral changes.
PROGRAM SETTING: Initial sessions were conducted in easily accessible community settings. Refreshments were provided before and after the sessions to give participants an opportunity to talk to each other and with the facilitators and content experts. Follow-up visits took place in the participants‘ homes.
DURATION: • Seven weekly 2-hour program sessions • A 1- to 11⁄2-hour home visit, 6 weeks after the final session • A 1-hour booster session 3 months after the final session
KEY ELEMENTS: Using content experts is critical. It is also important to let each expert know what is expected of them, to provide feedback, and to make sure each focuses on fall prevention. The Stepping On manual is essential for all program facilitators and provides a step-by-step guide to running the 7-week group program. It outlines topic areas and provides the background information for each content expert. Chapters include: Essential background information for understanding the conceptual underpinning of the program and the group process; Valuable content information for all the key fall prevention areas that can be used to train local experts participating in the program; A guide to useful resources; Handouts for group participants; Ideas on recruitment and evaluation, and; Work is ongoing to develop training workshops and certification for Stepping On program leaders.
CONTACT: Practitioners interested in using this intervention may contact the principal investigator for more information: Lindy Clemson, PhD Associate Professor in Aging, Head of Discipline (Occupational Therapy) Faculty of Health Sciences, The University of Sydney Cumberland Campus, PO Box 170 Lidcombe 1825, Australia Tel: +61 (2) 9351 9372 Fax: +61 (2) 9351 9166 E-mail: lindy.clemson@sydney.edu.au
PROFET (Prevention of Falls in the Elderly Trial) — Close, et al.
This intervention provided medical assessments for fall risk factors with referrals to relevant services and an occupational therapy home hazard assessment with recommendations for home modifications. After 12 months, those in the intervention group were 60 percent less likely to fall once and 67 percent less likely to fall repeatedly (at least 3 times), compared with those who did not receive the intervention.
POPULATION: Participants were seniors who had been treated for a fall in a hospital emergency department. All were aged 65 or older and lived in the community. Two-thirds of participants were female.
GEOGRAPHIC LOCALE: London, United Kingdom
FOCUS: Identify medical risk factors and home hazards, and provide referrals and/or recommendations to reduce fall risk and improve home safety.
PROGRAM SETTING: The medical assessment took place in an outpatient hospital clinic. The occupational therapy assessment took place in participants’ homes.
DURATION: The average length of the medical assessment was 45 minutes. The average length of the home assessment was 60 minutes.
KEY ELEMENTS: For medication review and modification, a medical specialist rather than a general practitioner is recommended.
CONTACT: Practitioners interested in using this intervention may contact the principal investigator for more information: Jacqueline Close, MD Neuroscience Research Australia Barker Street, Randwick Sydney NSW 2031, Australia Tel: +61 (2) 9399 1055 Fax: +61 (2) 9399 1005 E-mail: j.close@neura.edu.au
Accident & Emergency Fallers — Davison, et al.
This multifaceted intervention was designed for people who fell repeatedly. Participants received a medical fall risk assessment by a geriatrician at the hospital and had in-home assessments by physical and occupational therapists. Each participant received an individualized intervention designed to reduce their fall risk factors. After 12 months, the fall rate in the intervention group was 36 percent lower than the rate in the comparison group.
POPULATION: Participants were men and women aged 65 or older. All had experienced at least 1 fall in the past year and also had been treated in the emergency department for another fall or fall injury. About three-quarters of participants were female.
GEOGRAPHIC LOCALE: Newcastle, United Kingdom
FOCUS: Identify and modify each participant’s fall risk factors.
PROGRAM SETTING: The medical assessment was conducted in a hospital and the physical therapy and home assessments were conducted in participants’ homes.
DURATION: On average, participants visited the hospital twice for the medical intervention. The initial hospital assessment took 1 hour and the medical intervention visit was 20 minutes. Participants received 2 physical therapy intervention visits; the initial physical therapy assessment took 45 minutes and the intervention lasted 15 minutes. The occupational therapy visit took 45 minutes and the follow-up visit about 1 month later lasted 20 minutes.
KEY ELEMENTS: Multifactorial assessments and interventions conducted by highly trained individuals in each of the 3 disciplines.
CONTACT: Practitioners interested in using this intervention may contact the principal investigator for more information: Dr. John Davison Falls and Syncope Service and Institute for Aging & Health Royal Victoria Infirmary Newcastle upon Tyne NEI 4LP, United Kingdom Fax: (+44) 191 222 5638 E-mail: john.davison@ncl.ac.uk
The No Falls Intervention — Day, et al.
This study looked at the effectiveness of group-based exercise in preventing falls when used alone or in combination with vision improvement and/or home hazard reduction. The intervention components focused on increasing strength and balance, improving poor vision, and reducing home hazards. The group-based exercise was the most potent single intervention; when used alone, it reduced the fall rate by 20 percent. Falls were reduced further when vision improvement or home hazard reduction was combined with exercise. The most effective combination was the group-based exercise with both vision improvement and home hazard reduction. Participants who received all 3 components were one- third less likely to fall.
POPULATION: All participants were aged 70 and older and lived in the community. Sixty percent were female.
GEOGRAPHIC LOCALE: City of Whitehorse, Melbourne, Australia
FOCUS: Increase strength and balance, improve poor vision, and reduce home hazards.
PROGRAM SETTING: The exercise program was delivered in community settings such as exercise rooms in fitness centers and community health centers. The vision intervention was delivered via usual services available in the community. Participants went to their optometrist or ophthalmologist if they had one. If any further action was required, it was facilitated using normal services such as hospitals for cataract surgery, optometrists for new glasses, and general practitioners or ophthalmologists for medication if required. The home hazard intervention was conducted in participants’ homes.
DURATION: Exercise: Weekly 1-hour group classes for 15 weeks and 25 minutes of daily home exercises. Vision improvement: Duration depended on the specific intervention (such as cataract surgery or new glasses). Home hazard reduction: Duration depended on the length of time the home modifications were left in place by the participant.
KEY ELEMENTS: Although the most effective single component was the NoFalls exercise program, the complete program should be followed because partial implementation may not reduce falls.
CONTACT: Practitioners interested in using this intervention may contact the principal investigator for more information: Lesley Day, PhD, MPH Accident Research Centre Building 70, Monash University Wellington Road Clayton Victoria 3800, Australia Tel: +61 (3) 9905 1811 Fax: +61 (3) 9905 1809 E-mail: NoFalls.enquire@general.monash.edu.au
The SAFE Health Behavior and Exercise Intervention — Hornbrook, et al.
The Study of Accidental Falls in the Elderly (SAFE) health behavior intervention was a program of 4 group classes on how to prevent falls. The classes addressed environmental, behavioral, and physical risk factors and included exercise with instructions and supervised practice. The home safety portion included a home inspection with guidance and assistance in reducing fall hazards. Overall, participants were 15 percent less likely to fall compared with those who did not receive the intervention. Male participants showed the greatest benefit.
POPULATION: All were participants were 65 or older and lived in the community. About 60 percent of participants were female.
GEOGRAPHIC LOCALE: Portland, Oregon, and Vancouver, Washington, United States
FOCUS: Reduce risky behaviors, improve physical fitness through exercise, and reduce fall hazards in the home.
PROGRAM SETTING: No information was available on where risk education and group exercise classes took place. Home safety inspections were conducted in participants’ homes.
DURATION: Two home visits, each lasting about 15 minutes. Four weekly 11⁄2-hour classes (including 20 minutes of supervised exercise) over a 1-month period
KEY ELEMENTS: Information was not provided by the principal investigator.
CONTACT: Practitioners interested in using this intervention may contact the principal investigator for more information: Mark C. Hornbrook, PhD Chief Scientist The Center for Health Research, NW/HI/SE Kaiser Permanente Northwest 3800 North Interstate Avenue Portland, OR 97227-1110, United States Tel: 503-335-6746 Fax: 503-335-2428 E-mail: mark.c.hornbrook@kpchr.org
Multifactorial Fall Prevention Program — Salminen, et al.
This multifaceted fall intervention consisted of a geriatric fall risk assessment with counseling and guidance in fall prevention; home hazards assessment and modification; group and home-based exercise; group lectures on topics related to fall prevention; and monthly participation in a psychosocial group. The intervention did not reduce falls overall. However, falls were decreased 41 percent in participants who had experienced 3 or more falls in the previous year and 50 percent in participants with more symptoms of depression.
POPULATION: Participants were seniors aged 65 or older who lived in the community or in housing that provided occasional assistance, had no or little cognitive impairment, and had experienced at least 1 fall in the past year. Eighty- four percent of participants were female.
GEOGRAPHIC LOCALE: Pori, Finland
FOCUS: Assess and address each participant’s specific fall risk factors, improve physical fitness, provide information and counseling on fall prevention, assess and modify home hazards, and provide psychological support.
PROGRAM SETTING: The fall risk assessment, counseling, and group exercise classes were conducted in the Pori Health Center or at home for those participants living in assisted housing. Lectures and psychosocial groups were held in a senior center. The home-based exercises and home assessment were carried out in participants’ homes.
DURATION: • 45-minute fall risk assessment • 45-minute home hazard assessment • 45-minute information and counseling session • 45- to 50-minute group exercise class once every 2 weeks plus 25 minutes of exercise at home 3 times per week • 1-hour health lecture once a month • 1-hour psychosocial group session once a month.
KEY ELEMENTS: • Individual risk factor assessment, treatment, and/or referral by a physician. Exercise classes led by a trained physical therapist or physical therapy student, combined with at-home exercises tailored to each participant • Exercise intensity must increase progressively over time • Monthly lectures by various health professionals on topics related to • falling, followed by a question and answer period • Individual guidance on fall prevention • Home hazards assessment and written safety recommendations • Monthly psychosocial group sessions.
CONTACT: Practitioners interested in using this intervention may contact the principal investigator for more information: Marika J. Salminen, PhD Family Medicine Lemminkäisenkatu 1 FI-20014 University of Turku Turku, Finland E-mail: majosa@utu.fi
The Winchester Falls Project — Spice, et al.
This study evaluated the effectiveness of 2 fall interventions. The primary care intervention consisted of fall risk assessments by nurses followed by referrals to other professionals. The secondary care intervention involved multidisciplinary fall risk assessments (by a doctor, nurse, physical therapist, and occupational therapist), followed by appropriate interventions and follow-up if necessary. Only the secondary care intervention was effective in reducing falls. Compared to the group who received usual care, participants in the secondary care multidisciplinary intervention were half as likely to fall, a third less likely to sustain a fall-related fracture, and 55 percent less likely to die in the year following the intervention.
POPULATION: Participants were community-dwelling adults aged 65 or older who had sustained 2 or more falls in the previous year. About three- quarters were female.
GEOGRAPHIC LOCALE: Mid Hampshire, United Kingdom
FOCUS: Assess fall risk factors and provide individualized interventions.
PROGRAM SETTING: Baseline assessments were conducted in a multidisciplinary clinic with referrals for interventions and follow-up if necessary.
DURATION: Fall risk assessments took about 2 hours. The amount and duration of the follow-up interventions varied by the type of interventions received.
KEY ELEMENTS: Doctors, nurses, physical therapists, and occupational therapists used a structured in-depth assessment instrument.
CONTACT: Practitioners interested in using this intervention may contact the principal investigator for more information: Dr. Claire Spice Department of Medicine for Older People Portsmouth Hospitals NHS Trust Queen Alexandra Hospital Southwick Hill, Cosham PO6 3LY, United Kingdom E-mail: claire.spice@porthosp.nhs.uk
Yale FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques) — Tinetti, et al.
This study used a tailored combination of intervention strategies based on an assessment of each participant’s fall risk factors. Participants were about 30 percent less likely to fall compared with people who did not receive the intervention.
POPULATION: Participants were members of a health maintenance organization. All were 70 or older and lived in the community. Most participants were female.
GEOGRAPHIC LOCALE: Farmington, Connecticut, United States
FOCUS: Identify and modify each participant’s risk factors.
PROGRAM SETTING: The intervention was delivered to participants in their homes.
DURATION: The intervention was conducted over a 3-month period. The amount and duration of contacts varied by the type of interventions received.
KEY ELEMENTS: The assessments need to be clearly linked to the intervention components. The minimum risk factor interventions include (1) postural blood pressure and behavioral recommendations; (2) medication review and reduction (especially psychoactive medications); (3) balance, strength, and gait assessments and interventions; and (4) environmental assessment and modification. It is essential that the progressive balance and strength exercise program includes both supervised and at-home (unsupervised) components.
CONTACT: Practitioners interested in using this intervention may contact the principal investigator for more information: Mary Tinetti, MD Department of Epidemiology and Public Health Yale University School of Medicine Internal Medicine-Geriatrics, PO Box 208025, New Haven, CT 06520-8025, United States Tel: 203-688-5238 Fax: 203-688-4209 E-mail: mary.tinetti@yale.edu
A Multifactorial Program — Wagner, et al.
This study tested a moderate-intensity intervention that used tailored strategies based on assessments of each participant’s risk factors. After 1 year, participants were 10 percent less likely to fall and 5 percent less likely to have an injurious fall, compared with people who received usual medical care.
POPULATION: All participants were 65 or older and lived in the community. About 60 percent of participants were female.
GEOGRAPHIC LOCALE: Seattle, Washington, United States
FOCUS: Reduce disability and/or falls by: improving physical fitness, modifying excessive alcohol use, improving home safety, reducing psychoactive medication use, and improving hearing and vision.
PROGRAM SETTING: Participants received the assessments and interventions from a nurse at local health maintenance organization (HMO) centers. Participants conducted a home assessment or had it done by a family member or volunteer.
DURATION: The initial visit consisted of a 1- to 11⁄2-hour interview. The length and number of subsequent sessions varied by the type of interventions selected for each participant.
KEY ELEMENTS: The nurse’s follow-up phone contacts and home visits may have had positive effects on participants’ health that were independent of the interventions for specific risk factors.
CONTACT: Practitioners interested in using this intervention may contact the principal investigator for more information: Edward H. Wagner, MD, MPH Group Health Research Institute 1730 Minor Avenue, Ste. 1290 Seattle, WA 98101, United States Tel: 206-287-2877. E-mail: wagner.e@ghc.org
SOURCES:
“Did You Know?” brochure, Active Rx Active Aging Centers, 201 E. Ogden Ave., Hinsdale, IL Corner of York and Ogden, (888) 960-4562.
“National Estimates of the 10 Leading Causes of Nonfatal Injuries Treated In Hospital Emergency Departments, United States,” Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Data Source: NEISS All Injury Program operated by the Consumer Product Safety Commission (CPSC), 2010.
Stevens, Judy A., PhD; A CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults; Second Edition, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, (2010),https://www.cdc.gov/HomeandRecreationalSafety/pdf/CDC_Falls_Compendium_lowres.pdf and http://www.cms.gov/PrevntionGenInfo/Downloads/Exercise%20Re-port.pdf
Stevens, Judy A., PhD; and Burns, Elizabeth, MPH, A CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults; Third Edition, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, (2015), https://www.cdc.gov/homeandrecreationalsafety/pdf/falls/cdc_falls_compendium-2015-a.pdf
“Stopping Elderly Accidents, Deaths and Injuries” (STEADI) Tool Kit, Center for Disease Control and Prevention’s (CDC) Injury Center for health care providers, http://www.cdc.gov/injury/STEADI.
