The effect of an individualized fall prevention program on fall risk and falls in older people: a randomized, controlled trial.

OBJECTIVES

To determine whether an individualized falls prevention program comprising exercise, visual, and counseling interventions can reduce physiological falls risk and falls in older people.

DESIGN

Randomized, controlled trial of 12 months' duration.

SETTING

Falls Clinic, Royal North Shore Hospital, Sydney, Australia.

PARTICIPANTS

Six hundred twenty people aged 75 and older recruited from a health insurance company membership database.

INTERVENTIONS

Participants in the extensive intervention group (EIG) received individualized interventions comprising exercise and strategies for maximizing vision and sensation; the minimal intervention group (MIG) received brief advice; and the control group (CG) received no intervention.

MEASUREMENTS

Accidental falls, vision, postural sway, coordinated stability, reaction time, lower limb muscle strength, sit-to-stand performance, and physiological profile assessment (PPA) falls risk scores.

RESULTS

At the 6-month follow-up, PPA falls risk scores were significantly lower in the EIG than in the CG. EIG subjects assigned to the extensive exercise intervention group showed significant improvements in tests of knee flexion strength and sit-to-stand times but no improvements in balance. EIG subjects assigned to the extensive visual intervention group showed significant improvements in tests of visual acuity and contrast sensitivity. The rate of falls and injurious falls within the trial period were similar in the three groups.

CONCLUSION

The individualized intervention program reduced some falls risk factors but did not prevent falls. The lack of an effect on falls may reflect insufficient targeting of the intervention to an at-risk group.