Effects of a multifactorial fall prevention program on fall incidence and physical function in community-dwelling older adults with risk of falls

Hsuei-Chen Lee, Ku-Chou Chang, Jau-Yih Tsauo, Jen-Wen Hung, Yu-Ching Huang, Sang-I Lin
Archives of Physical Medicine and Rehabilitation 2013, 94 (4): 606-15, 615.e1

OBJECTIVE: To evaluate effects of a multifactorial fall prevention program on fall incidence and physical function in community-dwelling older adults.

DESIGN: Multicenter randomized controlled trial.

SETTING: Three medical centers and adjacent community health centers.

PARTICIPANTS: Community-dwelling older adults (N=616) who have fallen in the previous year or are at risk of falling.

INTERVENTIONS: After baseline assessment, eligible subjects were randomly allocated into the intervention group (IG) or the control group (CG), stratified by the Physiological Profile Assessment (PPA) fall risk level. The IG received a 3-month multifactorial intervention program including 8 weeks of exercise training, health education, home hazards evaluation/modification, along with medication review and ophthalmology/other specialty consults. The CG received health education brochures, referrals, and recommendations without direct exercise intervention.

MAIN OUTCOME MEASURES: Primary outcome was fall incidence within 1 year. Secondary outcomes were PPA battery (overall fall risk index, vision, muscular strength, reaction time, balance, and proprioception), Timed Up & Go (TUG) test, Taiwan version of the International Physical Activity Questionnaire, EuroQol-5D, Geriatric Depression Scale (GDS), and the Falls Efficacy Scale-International at 3 months after randomization.

RESULTS: Participants were 76±7 years old and included low risk 25.6%, moderate risk 25.6%, and marked risk 48.7%. The cumulative 1-year fall incidence was 25.2% in the IG and 27.6% in the CG (hazard ratio=.90; 95% confidence interval, .66-1.23). The IG improved more favorably than the CG on overall PPA fall risk index, reaction time, postural sway with eyes open, TUG test, and GDS, especially for those with marked fall risk.

CONCLUSIONS: The multifactorial fall prevention program with exercise intervention improved functional performance at 3 months for community-dwelling older adults with risk of falls, but did not reduce falls at 1-year follow-up. Fall incidence might have been decreased simultaneously in both groups by heightened awareness engendered during assessments, education, referrals, and recommendations.

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