A MULTIFACTORIAL INTERVENTION TO REDUCE THE RISK OF FALLING AMONG ELDERLY PEOPLE LIVING IN THE COMMUNITY

Background. Since falling is associated with serious morbidity among e lderly people, we investigated whether the risk of falling could be re duced by modifying known risk factors. Methods. We studied 301 men and women living in the community who were at least 70 years of age and w ho had at least one of the following risk factors for falling: postura l hypotension; use of sedatives; use of at least four prescription med ications; and impairment in arm or leg strength or range of motion, ba lance, ability to move safely from bed to chair or to the bathtub or t oilet (transfer skills), or gait. These subjects were given either a c ombination of adjustment in their medications, behavioral instructions , and exercise programs aimed at modifying their risk factors (interve ntion group, 153 subjects) or usual health care plus social visits (co ntrol group, 148 subjects). Results. During one year of follow-up, 35 percent of the intervention group fell, as compared with 47 percent of the control group (P = 0.04). The adjusted incidence-rate ratio for f alling in the intervention group as compared with the control group wa s 0.69 (95 percent confidence interval, 0.52 to 0.90). Among the subje cts who had a particular risk factor at base line, a smaller percentag e of those in the intervention group than of those in the control grou p still had the risk factor at the time of reassessment, as follows: a t least four prescription medications, 63 percent versus 86 percent, P = 0.009; balance impairment, 21 percent versus 46 percent, P = 0.001; impairment in toilet-transfer skills, 49 percent versus 65 percent, P = 0.05; and gait impairment, 45 percent versus 62 percent, P = 0.07. C onclusions. The multiple-risk-factor intervention strategy resulted in a significant reduction in the risk of falling among elderly persons in the community. In addition, the proportion of persons who had the t argeted risk factors for falling was reduced in the intervention group , as compared with the control group. Thus, risk-factor modification m ay partially explain the reduction in the risk of falling.