Abstract
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.
Keywords
List of abbreviations:
BI (Barthel Index), CG (control group), FPIT (Fall Prevention Initiatives in Taiwan), GDS (Geriatric Depression Scale), IG (intervention group), IPAQ (International Physical Activity Questionnaire), PPA (Physiological Profile Assessment), TUG (Timed Up & Go)To read this article in full you will need to make a payment
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References
- Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: systematic review and meta-analysis.BMJ. 2008; 336: 130-133
- Interventions for preventing falls in elderly people living in the community (Review).Cochrane Database Syst Rev. 2009 Apr 15; : CD007146
- Falls in older people: epidemiology, risk factors and strategies for prevention.Age Ageing. 2006; 35: ii37-ii41
- Implementation of multifactorial interventions for fall and fracture prevention.Age Ageing. 2006; 35: ii60-ii64
- What works better for community-dwelling older people at risk to fall?: a meta-analysis of multifactorial versus physical exercise-alone interventions.J Aging Health. 2009; 21: 713-729
- The role of exercise in fall prevention for older adults.Clin Geriatr Med. 2010; 26: 607-631
- Effective exercise for the prevention of falls: a systematic review and meta-analysis.J Am Geriatr Soc. 2008; 56: 2234-2243
- Patients with recurrent falls attending Accident & Emergency benefit from multifactorial intervention–a randomised controlled trial.Age Ageing. 2005; 34: 162-168
- The Winchester falls project: a randomised controlled trial of secondary prevention of falls in older people.Age Ageing. 2009; 38: 33-40
- Falls prevention for the elderly.GMS Health Technol Assess. 2012; 8: Doc01
- Effectiveness of a falls-and-fracture nurse coordinator to reduce falls: a randomized, controlled trial of at-risk older adults.J Am Geriatr Soc. 2008; 56: 1383-1389
- Long-term effects of three multicomponent exercise interventions on physical performance and fall-related psychological outcomes in community-dwelling older adults: a randomized controlled trial.J Am Geriatr Soc. 2012; 60: 437-446
- Lack of effectiveness of a multidisciplinary fall-prevention program in elderly people at risk: a randomized, controlled trial.J Am Geriatr Soc. 2008; 56: 1390-1397
- The effect of an individualized fall prevention program on fall risk and falls in older people: a randomized, controlled trial.J Am Geriatr Soc. 2005; 53: 1296-1304
- Kenosha County falls prevention study: a randomized, controlled trial of an intermediate-intensity, community-based multifactorial falls intervention.J Am Geriatr Soc. 2007; 55: 489-498
- The long-term effect of a multifactorial fall prevention programme on the incidence of falls requiring medical treatment.Public Health. 2009; 123: 809-813
- Effect of a risk-based multifactorial fall prevention program on the incidence of falls.J Am Geriatr Soc. 2009; 57: 612-619
- Effectiveness of a community-based multifactorial intervention on falls and fall risk factors in community-living older adults: a randomized, controlled trial.J Gerontol A Biol Sci Med Sci. 2007; 62: 1420-1427
- An outpatient multifactorial falls prevention intervention does not reduce falls in high-risk elderly Danes.J Am Geriatr Soc. 2009; 57: 971-977
- A multicentre randomised controlled trial of day hospital-based falls prevention programme for a screened population of community-dwelling older people at high risk of falls.Age Ageing. 2010; 39: 704-710
- Multifactorial intervention to reduce falls in older people at high risk of recurrent falls: a randomized controlled trial.Arch Intern Med. 2010; 170: 1110-1117
- A randomized controlled trial of a multifactorial falls prevention intervention for older fallers presenting to emergency departments.J Am Geriatr Soc. 2010; 58: 2265-2274
- Effectiveness of a multifactorial intervention program to reduce falls incidence among community-living older adults: a randomized controlled trial.Arch Phys Med Rehabil. 2012; 93: 1677-1684
- Community-based interventions to reduce falls among older adults in Taiwan—long time follow-up randomised controlled study.J Clin Nurs. 2010; 19: 959-968
- Effectiveness of home visit falls prevention strategy for Taiwanese community-dwelling elders: randomized trial.Public Health Nurs. 2004; 21: 247-256
- Randomized controlled trial of exercise intervention for the prevention of falls in community-dwelling elderly Japanese women.J Bone Miner Metab. 2004; 22: 602-611
- Effectiveness of a community-based multifaceted fall-prevention intervention in active and independent older Chinese adults.Inj Prev. 2009; 15: 248-251
- American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention.J Am Geriatr Soc. 2001; 49: 664-672
- Strategies for fall-prevention in older people.Taiwan J Public Health. 2008; 27: 447-462
- The timed “Up & Go”: a test of basic functional mobility for frail elderly persons.J Am Geriatr Soc. 1991; 39: 142-148
- Promoting and prescribing exercise for the elderly.Am Fam Physician. 2002; 65: 419-426
- Taiwanese version of the EQ-5D: validation in a representative sample of the Taiwanese population.J Formos Med Assoc. 2007; 106: 1023-1031
- Screening, detection and management of depression in elderly primary care attenders. I: The acceptability and performance of the 15 item Geriatric Depression Scale (GDS15) and the development of short versions.Fam Pract. 1994; 11: 260-266
- Development and initial validation of the Falls Efficacy Scale-International (FES-I).Age Ageing. 2005; 34: 614-619
- Functional evaluation: the Barthel Index.Md State Med J. 1965; 14: 61-65
- Selection of appropriate Chinese terms to represent intensity and types of physical activity terms for use in the Taiwan version of IPAQ.J Nurs Res. 2008; 16: 252-263
- Chinese version and norms of the Mini-Mental State Examination.Taiwan J Phys Med Rehabil. 1988; 16: 52-59
- A physiological profile approach to falls risk assessment and prevention.Phys Ther. 2003; 83: 237-252
- Guo J.L. Huang C.M. Brochure for the prevention of falls in older people. 2nd ed. Bureau of Health Promotion, Department of Health, Executive Yuan, New Taipei City2007
- Guo J.L. Huang C.M. Manual for home environmental hazards assessment and modifications. 3rd ed. Bureau of Health Promotion, Department of Health, Executive Yuan, New Taipei City2006
- Guidelines for the prevention of falls in people over 65. The Guidelines' Development Group.BMJ. 2000; 321: 1007-1011
- Community-based intervention to optimise falls risk management: a randomised controlled trial.Age Ageing. 2009; 38: 724-730
- Falls incidence, risk factors, and consequences in Chinese older people: a systematic review.J Am Geriatr Soc. 2011; 59: 536-543
- Depressive symptoms in addition to visual impairment, reduced strength and poor balance predict falls in older Taiwanese people.Age Ageing. 2012; 41: 606-612
- Otago home-based strength and balance retraining improves executive functioning in older fallers: a randomized controlled trial.J Am Geriatr Soc. 2008; 56: 1821-1830
- Evidence of detraining after 12-week home-based exercise programs designed to reduce fall-risk factors in older people recently discharged from hospital.Arch Phys Med Rehabil. 2012; 93: 1685-1691
- A multifactorial approach to understanding fall risk in older people.J Am Geriatr Soc. 2010; 58: 1679-1685
- Determinants of disparities between perceived and physiological risk of falling among elderly people: cohort study.BMJ. 2010; 341: c4165
Article info
Publication history
Published online: December 10, 2012
Footnotes
The Fall Prevention Initiatives in Taiwan Investigators include the following: Jau-Yih Tsauo, PhD, PT, School and Graduate Institute of Physical Therapy, National Taiwan University, Taipei, Taiwan; Ku-Chou Chang, MD, Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Sang-I Lin, PhD, PT, Department of Physical Therapy, National Cheng Kung University, Tainan, Taiwan; Hsuei-Chen Lee, PhD, PT, Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan; Jen-Wen Hung, MD, Department of Rehabilitation Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Yu-Ching Huang, MS, RN, Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Rong-Sen Yang, MD, PhD, Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan; Sheng-Jean Huang, MD, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Shyr-Chyr Chen, MD, PhD, Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Chin-Ying Chen, MD, MS, Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan; Yih-Jian Tsai, MD, MS, Division of Adult and Elderly Health, Bureau of Health Promotion, Department of Health, Taichung, Taiwan; Yi-Ching Yang, MD, MPH, Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Tsan-Shiun Lin, MD, Department of Emergency and Traumatic Surgery, Kaohsiung Chang Gang Memorial Hospital, Kaohsiung, Taiwan; Kuang-Chen Chu, MD, Niaosung District Health Office, Kaohsiung, Taiwan; Shu-Hui Wu, MS, PT, School and Graduate Institute of Physical Therapy, National Taiwan University, Taipei, Taiwan; Ya-Yun Yang, MS, PT, School and Graduate Institute of Physical Therapy, National Taiwan University, Taipei, Taiwan; Guo-Fan Kao Shiao, MS, PT, Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan.
Supported by the Bureau of Health Promotion, Department of Health, Executive Yuan, R.O.C. (Taiwan) (grant nos. DOH97-HP-1301, DOH98-HP-1303).
The findings and opinions reported here are those of the authors, and do not necessarily represent the views of any other organizations.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
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© 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
