Long term impact and cost benefit of a falls prevention program among community-based older people

Stay on Your Feet was a multi strategic, community-based, falls prevention program targeting older people at all levels of risk in the North Coast region of New South Wales, Australia between 1992 and 1996. We monitored the long term impact of the intervention by examining hospital admission rates for falls related conditions in the intervention region before, during, and for eight years after the program was completed. These were compared with overall trends in the states of New South Wales and Queensland. Cost benefit analysis compared the costs of the program with estimates of savings from avoided hospital admissions. Falls related hospitalisations in the intervention region had fallen two years after the program commenced and have remained lower than comparison regions over the subsequent follow-up. This effect now appears to be waning. Comparison of trends in other conditions including acute myocardial infarction did not mirror these findings, suggesting they are not simply the result of a regional demographic trend. Cost benefit analysis was limited to the intervention period alone and showed the program to be highly cost-effective. The overall benefit to cost ratio for the intervention as a whole over this period was 19.5:1. These findings suggest that well designed, community-based interventions for falls prevention among older people are likely to have lasting benefits. Cost benefit analysis suggests they are a wise investment for all levels of government.