Original article| Volume 93, ISSUE 10, P1677-1684, October 2012

Effectiveness of a Multifactorial Intervention Program to Reduce Falls Incidence Among Community-Living Older Adults: A Randomized Controlled Trial


      Pérula LA, Varas-Fabra F, Rodríguez V, Ruiz-Moral R, Fernández JA, González J, Pérula CJ, Roldán AM, de Dios C, and the EPICA Study Collaborative Group. Effectiveness of a multifactorial intervention program to reduce falls incidence among community-living older adults: a randomized controlled trial.


      To determine the effectiveness of a multifactorial intervention program to prevent falls among older adults as compared with a brief intervention.


      Randomized controlled trial.


      Eleven health centers located in Córdoba, Spain.


      People over 70 years old (N=404), who are residents in the community.


      The centers were randomized to either 1 of the 2 groups: intervention group (IG), of a multifactorial nature (individual advice, information leaflet, physical exercise workshop, and home visits), or control group (CG) (brief individual advice and information leaflet).

      Main Outcome Measures

      Fall rates and time until the fall; estimates of the relative and absolute risk of falls; and survival analysis and Cox regression.


      Of the patients recruited, 133 were in the IG and 271 were in the CG. Around 33% in the IG and 30.25% in the CG had had a fall in the previous year (P=.56). After 12 months, the fall incidence rate was 17.29% in the IG and 23.61% in the CG (relative risk=0.73; 95% confidence interval [CI], 0.48–1.12; P=.146). Around 60% of the IG patients said they had increased the time spent on physical activity. In the IG, the incidence of falls at home was 27.5% compared with 49.3% in the CG (P=.04). Being a woman (odds ratio [OR]=1.62; 95% CI, 1.03–2.54), having a history of falls (OR=1.15; 95% CI, 1.05–1.26), suffering acute health problems (OR=2.19; 95% CI, 1.09–4.40), and doing moderate exercise (OR=1.91; 95% CI, 1.08–3.38) were found as factors associated with a higher risk of falls.


      Although the reduction of falls in the IG was nearly halved, and after the intervention there was a significant reduction in the number of falls at these patients' homes, the multifactorial intervention program is no more effective than the brief intervention to reduce the overall risk of falls.

      Key Words

      List of Abbreviations:

      CG (control group), IG (intervention group), PC (primary care), POMA (Performance Oriented Mobility Assessment)
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        • Rubenstein L.Z.
        • Josephson K.R.
        The epidemiology of falls and syncope.
        Clin Geriatr Med. 2002; 18: 141-158
        • Sattin R.W.
        Falls among older persons: a public health perspective.
        Annu Rev Public Health. 1992; 13: 489-508
        • Berg W.
        • Alessio H.
        • Mills E.
        • Tong C.
        Circumstances and consequences of falls in independent community-dwelling older adults.
        Age Ageing. 1997; 26: 261-268
        • Campbell A.J.
        • Borrie M.J.
        • Spears G.F.
        • Jackson S.L.
        • Brown J.S.
        • Fitzgerald J.L.
        Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study.
        Age Ageing. 1990; 19: 136-141
        • Tinetti M.E.
        • Mendes de Leon C.F.
        • Doucette J.T.
        • Baker D.I.
        Fear of falling and fall-related efficacy in relationship to functioning among community-living elders.
        J Gerontol Med Sci. 1994; 49: M140-M147
        • Vellas B.J.
        • Wayne S.H.
        • Romero L.J.
        • Baumgartner R.N.
        • Garry P.J.
        Fear of falling and restriction of mobility in elderly fallers.
        Age Ageing. 1997; 26: 189-193
        • European Network for Safety among Elderly (EUNESE) Partners
        Five-year strategic plan for the prevention of unintentional injuries among EU senior citizens.
        EUNESE, Athens2006
        • Stevens M.
        • Holman C.D.
        • Bennett N.
        Preventing falls in older people: impact of an intervention to reduce environmental hazards in the home.
        J Am Geriatr Soc. 2001; 49: 1442-1447
        • Nevitt M.C.
        • Cummings S.R.
        • Hudes E.S.
        Risk factors for injurious falls: a prospective study.
        J Gerontol. 1991; 46: M164-M170
        • Tinetti M.E.
        • Doucette J.
        • Claus E.
        • Marottoli R.
        Risk factors for serious injury during falls by older persons in the community.
        J Am Geriatr Soc. 1995; 43: 1214-1221
        • Close J.
        • Ellis M.
        • Hooper R.
        • Glucksman E.
        • Jackson S.
        • Swift C.
        Prevention of falls in the elderly trial (PROFET): a randomized controlled trial.
        Lancet. 1999; 353: 93-97
        • Tinetti M.E.
        Preventing falls in elderly persons.
        N Engl J Med. 2003; 348: 42-49
        • Gillespie L.D.
        • Gillespie W.J.
        • Robertson M.C.
        • Lamb S.E.
        • Cumming R.G.
        • Rowe B.H.
        Interventions for preventing falls in elderly people.
        Cochrane Database Syst Rev. 2003; (CD000340)
        • Chang J.T.
        • Morton S.C.
        • Rubenstein L.Z.
        • et al.
        Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials.
        BMJ. 2004; 328: 680-687
        • Gillespie L.D.
        • Robertson M.C.
        • Gillespie W.J.
        • et al.
        Interventions for preventing falls in older people living in the community.
        Cochrane Database Syst Rev. 2009 Apr 15; (CD007146)
        • Campbell A.J.
        • Robertson M.C.
        Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial interventions.
        Age Ageing. 2007; 36 (656-2)
        • Michael Y.L.
        • Whitlock E.P.
        • Lin J.S.
        • Fu R.
        • O'Connor E.A.
        • Gold R.
        Primary care–relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S. Preventive Services Task Force.
        Ann Intern Med. 2010; 153: 815-825
        • Gobierno J.
        • Pérez de las Casas M.O.
        • Madam M.T.
        • Baute D.
        • Manzaneque C.
        • Domínguez S.
        [Can we prevent falls in the elderly from primary care?] [Spanish].
        Aten Primaria. 2010; 42: 284-291
        • Pujiula Blanch M.
        • Quesada Sabaté M.
        • Avellana Revuelta E.
        • Ramos Blanes R.
        • Cubí Monfort R.
        • Grupo APOC ABS Salt
        [Final results of a multifactorial and community intervention study for the prevention of falls in the elderly] [Spanish].
        Aten Primaria. 2010; 42: 211-217
        • Varas-Fabra F.
        • Castro E.
        • Pérula de Torres L.A.
        • Fernández M.J.
        • Ruiz R.
        • Enciso I.
        [Falls in the elderly in the community: prevalence, consequences and associated factors] [Spanish].
        Aten Primaria. 2006; 38: 450-455
        • Da Silva Z.A.
        • Gómez A.
        • Sobral M.
        [Epidemiology of falls in the elderly in Spain. A systematic review] [Spanish].
        Rev Esp Salud Pública. 2008; 82: 43-56
        • Campbell A.J.
        • Robertson M.C.
        • Gardner M.M.
        • Norton R.N.
        • Tilyard M.W.
        • Buchner D.M.
        Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women.
        BMJ. 1997; 315: 1065-1069
        • Campbell A.
        • Robertson C.
        • Gardner M.
        • Norton R.
        • Buchner D.
        Falls prevention over 2 years: a randomized controlled trial in women over 80 years and older.
        Age Ageing. 1999; 28: 513-518
        • Lord S.
        • Ward J.
        • Williams P.
        Exercise effect on dynamic stability in older women: a randomized controlled trial.
        Arch Phys Med Rehabil. 1996; 77: 232-236
        • Lord S.R.
        • Castell S.
        • Corcoran J.
        • et al.
        The effect of group exercise on physical functioning and falls in frail older people living in retirement villages: a randomized, controlled trial.
        J Am Geriatr Soc. 2003; 51: 1685-1692
        • Vidán M.T.
        • Vellas B.
        • Montemayor T.
        • Romero C.
        • Garry P.J.
        • Ribera J.M.
        [WHO questionnaire for the study of falls in the elderly] [Spanish].
        Rev Esp Geriatr y Gerontol. 1993; 28: 41-48
      1. The Anatomical Classification of Pharmaceutical Products.
        (Accessed August 6, 2011)
        • Leipzig R.M.
        • Cumming R.G.
        • Tinetti M.E.
        Drugs and falls in older people: a systematic review and meta-analysis: I.
        J Am Geriatr Soc. 1999; 47: 30-39
        • Leipzig R.M.
        • Cumming R.G.
        • Tinetti M.E.
        Drugs and falls in older people: a systematic review and meta-analysis: II.
        J Am Geriatr Soc. 1999; 47: 40-50
        • Tinetti M.E.
        Performance-oriented assessment of mobility problems in elderly patients.
        J Am Geriatr Soc. 1986; 34: 119-126
        • International Physical Activity Questionnaire
        (Accessed August 9, 2011)
        • National Center for Injury Prevention and Control. Centers for Disease Control and Prevention
        [Checklist to prevent falls. Manual for the elderly.] [Spanish].
        (Accessed December 19, 2010)
        • World Health Organization
        World Health Organization global report on falls prevention in older age.
        (Accessed August 6, 2011)
        • Gehlsen G.M.
        • Whaley M.H.
        Falls in the elderly: part II, balance, strength, and flexibility.
        Arch Phys Med Rehabil. 1990; 71: 739-741
        • Whipple R.H.
        • Wolfson L.I.
        • Amerman P.M.
        The relationship of knee and ankle weakness to falls in nursing home residents: an isokinetic study.
        J Am Geriatr Soc. 1987; 35: 13-20
        • Chang J.T.
        • Morton S.C.
        • Rubenstein L.Z.
        • et al.
        Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomized clinical trials.
        BMJ. 2004; 328: 680-683
        • Lord S.R.
        • Ward J.A.
        • Williams P.
        • et al.
        The effect of a 12-month exercise trial on balance, strength, and falls in older women: a randomized controlled trial.
        J Am Geriatr Soc. 1995; 43: 1198-1206
        • Judge J.O.
        • Whipple R.H.
        • Wolfson L.I.
        Effects of resistive and balance exercises on isokinetic strength in older persons.
        J Am Geriatr Soc. 1994; 42: 937-946
        • Fiatarone M.A.
        • Marks E.C.
        • Ryan R.C.
        • Meredith C.
        • Lipsitiz L.A.
        • Evans W.J.
        High-intensity strength training in nonagenarians.
        JAMA. 1990; 263: 3029-3034
        • Wolfson L.
        • Whipple R.
        • Derby C.
        • et al.
        Balance and strength training in older adults: intervention gains and Tai Chi maintenance.
        J Am Geriatr Soc. 1996; 44: 498-506
        • Rubenstein L.Z.
        • Josephson K.R.
        • Trueblood P.R.
        • et al.
        Effects of a group exercise program on strength, mobility, and falls among fall-prone elderly men.
        J Gerontol A Biol Sci Med Sci. 2000; 55: M317-M321
        • Bath P.A.
        • Morgan K.
        Differential risk factor profiles for indoor and outdoor falls in older people living at home in Nottingham, UK.
        Eur J Epidemiol. 1999; 15: 65-73
        • O'Loughlin J.L.
        • Robitalle Y.
        • Bolvin J.F.
        • Soissa S.
        Incidence of and risk for falls and injurious falls among the comunity-dwelling elderly.
        Am J Epidemiol. 1993; 137: 342-354
        • Resnick B.
        Falls in a community of older adults: putting research into practice.
        Clin Nurs Res. 1999; 8: 251-266
        • Párraga I.
        • Navarro B.
        • Andrés F.
        • Noé J.
        • Elisegui R.P.
        • López-Torres J.
        [Fear of falls among non institutionalized older people] [Spanish].
        Gac Sanit. 2010; 24: 453-459
        • Méndez J.I.
        • Zunzunegui M.V.
        • Béland F.
        [Prevalence and factors associated with falls in people seniors living in the community] [Spanish].
        Med Clin (Barc). 1997; 108: 128-132
        • Papiol M.
        [Falls in the elderly] [Spanish].
        Aten Primaria. 2001; 28: 77-78
        • Sheldon J.H.
        On the natural history of falls in old age.
        Br Med J. 1960; 2: 1685-1690
        • Nevitt M.C.
        • Cummings S.R.
        • Hudes E.S.
        Risk factors for injurious falls: a prospective study.
        J Gerontol. 1991; 46: 164-170
        • Leveille S.G.
        • Jones R.N.
        • Kiely D.K.
        • et al.
        Chronic musculoskeletal pain and the occurrence of falls in an older population.
        JAMA. 2009; 302: 2214-2221
        • Rubenstein L.Z.
        • Josephson K.R.
        • Robbins A.S.
        Falls in the nursing home.
        Ann Intern Med. 1994; 121: 442-451
        • Tideiksaar R.
        Caídas en ancianos.
        (Barcelona: Masson SA)2005
        • Woolcott J.C.
        • Richardson K.J.
        • Wiens M.O.
        • et al.
        Meta-analysis of the impact of 9 medication classes on falls in elderly persons.
        Arch Intern Med. 2009; 169: 1952-1960
        • Lamb S.E.
        • Jørstad-Stein E.C.
        • Hauer K.
        • Becker C.
        • Prevention of Falls Network Europe and Outcomes Consensus Group
        Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus.
        J Am Geriatr Soc. 2005; 53: 1618-1622