Kenosha County Falls Prevention Study: A Randomized, Controlled Trial of an Intermediate-Intensity, Community-Based Multifactorial Falls Intervention

doi:10.1111/j.1532-5415.2007.01144.x

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Wiley InterScience

Journal of the American Geriatrics Society

Volume 55 Issue 4, Pages 489 - 498

Published Online: 5 Mar 2007

Journal compilation 2010 The American Geriatrics Society/Wiley Periodicals, Inc.

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CLINICAL INVESTIGATIONS

Kenosha County Falls Prevention Study: A Randomized, Controlled Trial of an Intermediate-Intensity, Community-Based Multifactorial Falls Intervention

Jane E. Mahoney, MD ^* , Terry A. Shea, PT ^‡ , Robert Przybelski, MD, MS ^* , LaVerne Jaros, MPA ^§ , Ronald Gangnon, PhD ^† , Sandy Cech, RN ^§ , and Alice Schwalbe, PT ^§

From the ^*Department of Medicine, Section of Geriatrics, and ^†Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin Madison, Madison, Wisconsin; ^‡Physical Therapy Department, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin; and ^§Kenosha County Aging and Disability Resource Center, Kenosha, Wisconsin

Address correspondence to Jane Mahoney, MD, 2870 University Ave, Suite 106, Madison, WI 53705. E-mail: jm2@medicine.wisc.edu

Presented at the 58th Annual Scientific Meeting of the Gerontological Society of America.

KEYWORDS

accidental falls • RCT • aged 65 and older • noninstitutionalized populations

ABSTRACT

OBJECTIVES: To decrease the rate of falls in high-risk community-dwelling older adults.

DESIGN: Randomized, controlled trial.

SETTING: Community-based.

PARTICIPANTS: Three hundred forty-nine adults aged 65 and older with two falls in the previous year or one fall in the previous 2 years with injury or balance problems.

INTERVENTION: Subjects received two in-home visits from a trained nurse or physical therapist who assessed falls risk factors using an algorithm. The intervention consisted of recommendations to the subject and their primary physician, referrals to physical therapy and other providers, 11 monthly telephone calls, and a balance exercise plan. Control subjects received a home safety assessment.

MEASUREMENTS: The primary outcome was rate of falls per year in the community. Secondary outcomes included all-cause hospitalizations and nursing home admissions per year.

RESULTS: There was no difference in rate of falls between the intervention and control groups (rate ratio (RR)=0.81, P=.27). Nursing home days were fewer in the intervention group (10.3 vs 20.5 days, P=.04). Intervention subjects with a Mini-Mental State Examination (MMSE) score of 27 or less had a lower rate of falls (RR=0.55; P=.05) and, if they lived with someone, had fewer hospitalizations (RR=0.44, P=.05), nursing home admissions (RR=0.15, P=.003), and nursing home days (7.5 vs 58.2, P=.008).

CONCLUSION: This multifactorial intervention did not decrease falls in at-risk community-living adults but did decrease nursing home utilization. There was evidence of efficacy in the subgroup who had an MMSE score of 27 or less and lived with a caregiver, but validation is required.

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1532-5415.2007.01144.x About DOI