Preventing falls in older people: Outcome evaluation of a randomized controlled trial

OBJECTIVES: To evaluate the outcome of an intervention to reduce hazards in the home on the rate of falls in seniors. DESIGN: Randomized controlled trial, with follow-up of subjects for 1 year. SETTING: Community-based study in Perth, Western Australia. PARTICIPANTS: People age 70 and older. INTERVENTION: One thousand eight hundred seventy-nine subjects were recruit ed and randomly allocated by household to the intervention and control grou ps in the ratio 1:2. Because of early withdrawals, 1,737 subjects commenced the study. All members of both groups received a single home visit from a research nurse. Intervention subjects (n = 570) were offered a home hazard assessment, information on hazard reduction, and the installation of safety devices, whereas control subjects (n = 1,167) received no safety devices o r information on home hazard reduction. MEASUREMENTS: Both groups recorded falls on a daily calendar. Reported fall s were confirmed by a semistructured telephone interview and were assigned to one of three overlapping categories: all falls, falls inside the home, a nd falls involving environmental hazards in the home. Analysis was by multi variate modelling of rate ratios and odds ratios for falls, corrected for h ousehold clustering, using Poisson regression and logistic regression with robust variance estimation. RESULTS: Overall, 86% of study subjects completed the 1 year of follow-up. The intervention was not associated with any significant reduction in falls or fall-related injuries. There was no significant reduction in the interv ention group in the incidence rate of falls involving environmental hazards inside the home (adjusted rate ratio, 1.11; 95% Cl = 0.82-1.50), or the pr oportion of the intervention group who fell because of hazards inside the h ome (adjusted odds ratio, 0.97; 95% Cl = 0.74-1.28). No reduction was seen in the rate of all falls (adjusted rate ratio, 1.02; 95% Cl = 0.83-1.27) or the rate of falls inside the home (adjusted rate ratio, 1.17; 95% Cl = 0.8 5-1.60). There was no significant reduction in the rate of injurious falls in intervention subjects (adjusted rate ratio, 0.92; 95% CI = 0.73-1.14). CONCLUSIONS: The intervention failed to achieve a reduction in the occurren ce of falls. This was most likely because the intervention strategies had a limited effect on the number of hazards in the homes of intervention subje cts. The study provides evidence that a one-time intervention program of ed ucation, hazard assessment, and home modification to reduce fall hazards in the homes of healthy older people is not an effective strategy for the pre vention of falls in seniors.