Primary Prevention of Falls: Community-Based Comparative Effectiveness Research

Background: In adults 65 years of age and older, falls are highly prevalent and can lead to injury, disability, and death. Multicomponent group exercise programs and multifactorial interventions based on fall-risk assessment can reduce the risk of falling.

Methods: The research examines a preventive intervention in Pennsylvania that focuses on falls assessment, education, and referral (Healthy Steps for Older Adults, a 2-hr class with physical assessments to identify high-risk seniors) along with group exercise (Healthy Steps in Motion). Each year about 5000 older adults complete the programs in senior centers across the state. The research compares fall rates and hospitalizations for falls over 12 months among (i) seniors completing Healthy Steps programs, (ii) seniors taking the programs for a second time, and (iii) seniors from the same sites who did not complete the program.

Results: Preliminary results from the first 400 enrollees from nine counties indicate high levels of participation (about half those approached consented to study follow-up) and expected fall rates (about 30% reported a fall in the prior 12 months). The median age of participants was 77, with about 80% women and 10% meeting criteria for frailty. Automated monthly telephone follow-up to ascertain falls and changes in activity appears to be acceptable. Program costs and hospitalization data will allow estimates of cost-effectiveness.

Conclusions: Seniors, service providers, and state policy-makers can use results from this research to determine the comparative effectiveness of primary prevention of falls among vulnerable seniors.