Preventing falls in the elderly at home: A community-based program

Objective: To analyse the effectiveness of an ongoing program for reducing the risk of falls in the elderly in their homes. Design: Retrospective questionnaire survey of the number of falls in the 12 months before home modifications were installed. Participants were followed up 12 months later to determine the number of falls since home modifications. Setting: Major city, November 1993 to July 1995. Participants: Healthy elderly people recruited at presentations made to gatherings of elderly people about the risks of falls in the home. Intervention: A free home safety inspection and simple home modifications, such as grab-rails and non-slip floor surfaces, were offered at subsidised prices. Main outcome measures: Number of falls in the 12 months before and after home modifications. Results: Nearly 4000 elderly people agreed to have a home safety inspection and, of these, 90% agreed to have their homes modified. Of the first 305 participants (mean age 74 years) for whom it had been 12 months since modifications, 69 (22.6%) had reported having fallen at least once in the 12 months before modifications. In the 12 months after modifications, 29 participants (9.5%) reported at least one or more falls - a 58% reduction (95% confidence interval [CI], 37%-72%). The total number of falls decreased from 121 to 45 - a 63% reduction (95% CI, 50%-73%). There was a significant decrease in falls in the 61-55, 66-70, 71-75 and 81-85 years age groups (P < 0.05). Conclusions: The risk of falling in the elderly can be lowered by more than a half by simple modifications to the home. Behavioural change, as well as environmental change, is important to the success of falls-prevention programs.