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

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 52; no. 9; pp. 1487 - 1494
• Main Authors: Clemson, Lindy, Cumming, Robert G., Kendig, Hal, Swann, Megan, Heard, Robert, Taylor, Kirsty
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Inc 01.09.2004; Blackwell; Wiley Subscription Services, Inc
• Subjects: accidental falls; Accidental Falls - prevention & control; Accidental Falls - statistics & numerical data; Accidents, Home - prevention & control; Accidents, Home - statistics & numerical data; Activities of Daily Living; Aged; Aged, 80 and over; Australia; Biological and medical sciences; Cognitive behavioural counselling; Cognitive Therapy - organization & administration; cognitive-behavioral; Community based programmes; Community living; elderly; Elderly people; Falls; Female; Follow-Up Studies; General aspects; Geriatric Assessment; Health Services for the Aged - organization & administration; Home Care Services - organization & administration; Humans; Incidence; Male; Medical research; Medical sciences; New South Wales - epidemiology; Occupational Therapy - organization & administration; Older people; Patient Education as Topic - organization & administration; Prevention; Prevention programs; Program Evaluation; Randomized controlled trials; Regression Analysis; Self Care; Self Efficacy; Self-Help Groups - organization & administration; Small groups; small-group intervention; New South Wales; Human; Gerontology; Program; Efficiency; Clinical trial; Fall; Epidemiology; Elderly; Community; Geriatrics; Incidence
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2004.52411.x

Objectives: 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. Design: A randomized trial with subjects followed for 14 months. Setting: The interventions were conducted in community venues, with a follow‐up home visit. Participants: Three hundred ten community residents aged 70 and older who had had a fall in the previous 12 months or were concerned about falling. Intervention: 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. Measurements: The primary outcome measure was falls, ascertained using a monthly calendar mailed by each participant. Results: 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). Conclusion: 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.