Home and Community Care Digest
Methods: 310 community-living men and women aged 70 or older with a previous fall in the past year were recruited for this study. Baseline assessments were conducted to obtain the participants' demographic information, incidence of falls and health history, functional measures of mobility and balance and standardized scores for a health questionnaire, and self-efficacy scale to avoid falls. Individuals were randomly assigned to the intervention group (n=157) or the control group (n=153). The intervention group participated in a community-based educational program that used a cognitivebehavioural approach to increase knowledge, and change attitudes and behaviours about fall prevention. The program targets the improvement of lower limb strength and balance, environmental and behavioural home safety, and regular medication reviews and visual screening. The intervention group was led by an experienced occupational therapist over a 7 week period at a predetermine community venue. The control group partook in social visits by an occupational therapy student during the time period of the community program. Participants were evaluated for fall occurrence using a self-reported incidence of fall schedule from baseline up to 14 months post randomization. Follow-up assessment was conducted at the 14-month post randomization.
Findings: After the 14 months of follow-up there were 255 falls reported in the control group and 179 falls in the intervention group (i.e., a risk reduction of 31%; p=0.025). The number of falls reported each month post randomization was consistently lower for the intervention group. The intervention group was able to maintain their confidence to avoid falls while performing a variety of functional daily living tasks over the follow-up period as opposed to the control group who experienced decreased confidence (p=0.042). The intervention group also used more protective behavioural strategies and maintained a higher level of physical activity than the control group (p=0.06).
Conclusions: A multifaceted community-based program aimed at the at-risk elderly populations can be effective in reducing the incidence of falls. While this study gives support to community-based programs to reduce incidence of falls, further research is needed to determine the cost-effectiveness of such programs on reducing health care costs.
Reference: Clemson, L, Cumming, RG, Kendig, H, Swann, M, Heard, R, Taylor, K. "The effectiveness of a Community-Based program for Reducing the Incidence of Falls in the Elderly: A Randomized Trial." Journal of American Geriatric Society, 2004, 52: 1487-1494.
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