The Effectiveness of a Community‐Based Program for Reducing the Incidence of Falls in the Elderly: A Randomized Trial

Abstract

Objectives: To test whether Stepping On, a multifaceted community‐based program using a small‐group learning environment, is effective in reducing falls in at‐risk people living at home. Design: A randomized trial with subjects followed for 14 months. Setting: The interventions were conducted in community venues, with a follow‐up home visit. Participants: Three hundred ten community residents aged 70 and older who had had a fall in the previous 12 months or were concerned about falling. Intervention: The Stepping On program aims to improve fall self‐efficacy, encourage behavioral change, and reduce falls. Key aspects of the program are improving lower‐limb balance and strength, improving home and community environmental and behavioral safety, encouraging regular visual screening, making adaptations to low vision, and encouraging medication review. Two‐hour sessions were conducted weekly for 7 weeks, with a follow‐up occupational therapy home visit. Measurements: The primary outcome measure was falls, ascertained using a monthly calendar mailed by each participant. Results: The intervention group experienced a 31% reduction in falls (relative risk (RR)=0.69, 95% confidence interval (CI)=0.50–0.96; P =.025). This was a clinically meaningful result demonstrating that the Stepping On program was effective for community‐residing elderly people. Secondary analysis of subgroups showed that it was particularly effective for men (n=80; RR=0.32, 95% CI=0.17–0.59). Conclusion: The results of this study renew attention to the idea that cognitive‐behavioral learning in a small‐group environment can reduce falls. Stepping On offers a successful fall‐prevention option.