Author/
Study Objectives
Year
Xia, Q.,
Jiang, Y.,
Niu, C.,
Tang, C., &
Xia, Z.
(2009)
Level/Design
Intervention and Outcome Measures
Results
Study Limitations
Behavioral and environmental
components, both done in an individual
and group setting. A multidisciplinary
group provided advice to the subjects
through a number of intervention
programs. Including education, brochure
distribution, poster exhibition, hazard
assessments, and community safety.
7.19% of the intervention
community sample reported
falls, compared with 17.86%
of the control community
sample. The actual fall rate
decreased by 10.52% in the
intervention communities.
Results were statistically
significant, p<0.000
Findings cannot be
generalized to older
people living in nursing
homes or hospital
settings because the
sample population only
included those living in
community settings.
Subjects
Explore the feasibility and
efficacy of a multifaceted fall
intervention in communities of
older urban Chinese.
Level One-RCT
Sample Size:
2,310
Control= 994
Intervention= 1316
Measures: Self-reported fall experience
and information on birth date, sex,
education, marital status, chronic disease
conditions, activities of daily living
Level One- RCT
Salminen et
al.
(2009)
To evaluate the effects of a
multifactorial fall prevention
program on falls and to
identify the subgroups that
benefit the most.
Sample size: 591
Intervention
group=293
Control group=298
Assessment by a geriatrician, resident
education regarding risk factors such as
healthy diet, calcium, vitamin D and the
use of hip protectors, home hazard
assessment was conducted, 45 Minute
exercise groups, psychosocial group
activities (IE recreational groups and
psychological support).
Measures:
 Berg Balance scale
 Snellen Chart,
 Geriatric Depression Scale and
 Mini Nutritional Assessment
 10-meter walk
 Diaries were given to residents
to report number of falls.
Intervention Group (n=292)
Falls =243
Incidence rate of fall (95%
CI) .87
Control Group (n=297)
Falls=271
Incidence of Falls (95% CI)
.94
Intervention did not reduce
the incidence of falls overall
Sub-groups that were found
to have a higher incidence
of falls were those with
depressive symptoms and
those with at least three falls
during the 12-month period
preceding the intervention.
Opportunistic
recruitment (newspaper
and handouts) for study
led to less diverse and
representative
population
Inclusion criteria was
not sufficiently stringent
Becker et al.
(2003)
Jensen et al.
(2002)
To evaluate the effectiveness
of multifaceted,
nonpharmaceutical
intervention on the incidence
of falls in LTC. Specifically,
density rate of falls, recurrent
falls and hip fractures.
Level One- RCT
To investigate whether a
multifactorial intervention
program would reduce falls
and fall-related injuries of
those in residential care
facilities. Outcome
measurements included
number of falls, time
occurrence of first fall along
and injuries resulting from
falls.
Level One- RCT
N=981 aged 60 or
older mean age 85;
79% female.
Sample: 402
Residents
Control:208
residents
Intervention:194
Intervention included a staff and
resident education on fall prevention,
advice on environmental adaptations,
progressive balance, and resistance
testing and hip protectors.
Measures
 Minimum Data Set of Resident
Assessment Instrument was
used to determine functional
differences between control
and intervention group.
 Reporting was done by staff
and residents.
An 11-week multidisciplinary program
that comprised of educating staff,
modifying the environment,
implementing exercise programs,
supplying adaptive equipment,
reviewing drug regimens, providing hip
protectors, having post-fall problemsolving conferences and guiding staff.
Measurements:
 Physician questionnaire of
drugs,
 Mini-Mental State
Examination,
 Barthel Index and Mobility
 Interaction Fall Chart.
Nurse’s aides and licensed practical
nurses registered each fall that were
personally witnessed or reported to
them.
Incidence of fallers: 247
fallers were detected in the
control group (52.3%) and
188 (36.9%) in Intervention
group. P=.0038
Self-report done by
residents with cognitive
impairments
During the 34 week period,
82 residents (44%) in the
intervention group sustained
a fall compares with 109
(56%) in the control group.
Relied on self-reporting.
Falls per resident in
intervention group ranged
from 0-16 and 0-26 in control
group. 48 of 188
(26%) residents in the
intervention group compared
with 64 of 196 (33%) in
control group. 51 injuries and
3 femoral factors in
intervention group and 61
with 12 femoral factors in the
control group.
Showing a significantly
reduced the number of fell,
total number of falls and time
of first falls and number of
femoral fractures.
Clemson et
al.
(2004)
Cummings
et al.
(2008)
Investigate if Stepping On, a
multifaceted community-based
program using a small-group
learning environment, effect in
reducing falls in at-risk people
living at home.
To determine the efficacy of a
targeted multifactorial fall
prevention program in elderly
care wards with relatively
short lengths of stay (1-2)
weeks.
Program (n-157)
Stepping On is a multifaceted
community-based program using a
small-group learning environment to
improve fall self-efficacy, encourage
behavioral change, and reduce falls.
Two-hour sessions were conducted
weekly for 7 weeks, with a follow-up
occupational therapy home visit.
Subjects followed for 14 months.
Level One-RCT
Measures Get up and Go test
 Rhomberg test
 Modified Falls Efficacy Scale
(MFES)
 Mobility efficacy Scale (MES)
Nurse and Physiotherapist provided a
multifactorial intervention including
a risk assessment of falls, staff and
patient education, drug review,
modification of room and ward
environment, exercise program, and
alarms for selected patients.
Level One- RCT
Control (n=153)
N=3,999
Mean age of 79
24 Hospital Wards
Measures:
 Modified Fall Risk
 Fall statistics were collected by
incidents and notes reported
in medical records, nurse
reports
The intervention group
experienced a 31% reduction
in falls
None addressed
This was a clinically
meaningful result
demonstrating that the
Stepping On program was
effective for communityresiding elderly people.
Overall 381 falls occurred
there was no difference in
fall rates between the
intervention and control
group
-No self-reporting was
performed
-Short length of stay and
to ensure effect and
adherence of program
Intervention Group
9.26 fall per 1000 beds
Control Group
9.21 falls per 1000 beds
95 percent CI
- Fall prevention was
already included in
control group before the
start of the study
McMurdo,
Millar &
Daly
(1999)
Sjosten et al.
(2007)
Effectiveness of falls risk
assessment/ modification and
seated balance exercise
training in reducing falls
among elderly people living in
residential care (nursing
home).
To describe the effects of a
multifactorial fall prevention
trial on the specified risk
factors of falling, incidence of
falls and injurious falls,
Level One-RCT
Intervention:
Sample: 133
Residents with a
mean age of 84
Environment Modification
Medication Review
Only 90 (67.7)
completed
intervention and 84
finished 7-12
month follow up.
Level One-RCT
Sample= 591
Program=293
Control=298
Median age-73.5
years old
Twice weekly 30-min exercise sessions
(group)
Measures:
 Philadelphia Geriatric Centre
Morale Scale
 Mini-Mental State Examination
The prevention program was based on
an individual risk factor analysis, and it
was separately tailored for each
participant according to risk factors,
functional abilities and health status.
The intervention consisted of seven
parts
Measurements





Berg’s Balance Scale,
Borg Rating of Perceived
Exertion Scale,
Adjustable Dynamometer
Chair
Geriatric Depression Scale
No difference between
control and intervention
groups in the number of falls
sustained (P value not
reported).
High dropout rate
reduced the power of
this study
Residents who sustained falls
represented 58% of the
control group and 38% of
intervention group.
Exercises were not
vigorous enough to
improve balance.
The control Group had also a
better functional ability in
basic activities of daily
living; mean ADL sum score
29.7 But no other statistically
significant differences were
found between the groups in
risk factors of falling or in
physical and cognitive
functional abilities.
Generalizability of the
results may be skewed
because of the selection
of the population.
Contamination of the
control group has to be
taken into account. It is
possible that some
people in the control
group have been
affected by information
aimed only at the
intervention group.
Russell et al.
(2009)
Ray et al.
(1997)
Determine whether falls and
injury can be prevented with
less-intensive multifactorial
intervention programs by
investigating the effect of a
referralbased targeted multifactorial
falls prevention intervention
on recurrent falls and injuries
in older people
Level One- RCT
To evaluate an intervention
program designed to prevent
associated injuries in highrisk nursing home residents.
Level One- RCT
Sample= 722
Intervention=361
Control= 351
60+
Measures
 Fall Risk for Older People
in the community
 Geriatric Depression Scale
short form
 Modified Falls Efficacy
Scale
Sample: 482
Control= 261
Intervention=221
Vind et al.
(2009)
To evaluate the effect of
multifactorial fall prevention
in community-dwelling
people aged 65 and older in
Denmark. This applies to our
research question because we
are looking at the effects of
multifactorial fall
Intervention group were offered a
targeted multifactorial falls
prevention program consisting of
referrals to existing community
services and health promotion
recommendations, in addition to
standard care.
Level One- RCT
N=392
Intervention=196
Control=196
No differences were found in
falls and mobility outcomes
between the intervention and
usual care groups.
Researchers had no control over
the nature, intensity, or scope of
the service
implemented
This study does not support
the use of a referral-based
targeted multifactorial
intervention program to reduce
subsequent falls or fall injuries
in older people who present to
an emergency department after
a fall.
Time between fall-related
presentation to the ED and the
participant receiving the
interventions may have
contributed to a null result.
Intervention- Falls Consultation
Service (Multifactorial Program)
Environmental Modification,
transfer education, medication
information and wheelchair
Maintenance
Measures
 Individual Safety
Assessment and Treatment
Planning
After a year of intervention
number of recurrent fallers in
intervention group (43.8%)
was 19.1% lower than in
control facilities (54.1%).
Intervention- Identification of
general medical, cardiovascular, and
physical risk factors for falls and
individual intervention in the
intervention group. Participants in the
control group received usual care.
The results revealed no effect
of the intervention on fall
rates. A two-sided significance
test was used throughout the
analyses and a P<.05 was
considered statistically
significant. Therefore this
intervention should not be
Of those invited, only 35.5%
agreed to participate, and they
were younger and less likely to
have been hospitalized than
those who did not participate.
Participants also were not
representative of the total group
of elderly people presenting at
intervention programs on
older adults.
Measures


Haines et. al.
To assess the effectiveness of
a targeted, multiple
intervention falls prevention
program in reducing falls and
injuries related to falls in a
sub-acute hospital.
Level one, RCT
N=626
Intervention=310
Control=316
Average 80 years
old
the hospital with a fall
Participants in the intervention
group experienced 30% fewer
falls than participants in the
control group. This difference
was significant ( P = 0.045)
and was most obvious after 45
days of observation.
The inability to completely blind
all staff may have influenced the
recording of the incidence of
falls and is considered a
limitation of the study.
Barthel Index (BI)
Frenchay Activity Index
(FAI)
Activity Balance
Confidence (ABC)
Intervention: The intervention
included falls risk alert card with
information brochure, exercise
program, education program, and
hip protectors.
Measures

recommended for fall
prevention in this setting.
PJC-FRAT