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Volume 331:821-827 September 29, 1994 Number 13 Next

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ABSTRACT

Background Since falling is associated with serious morbidity among elderly people, we investigated whether the risk of falling could be reduced by modifying known risk factors.

Methods We studied 301 men and women living in the community who were at least 70 years of age and who had at least one of the following risk factors for falling: postural hypotension; use of sedatives; use of at least four prescription medications; and impairment in arm or leg strength or range of motion, balance, ability to move safely from bed to chair or to the bathtub or toilet (transfer skills), or gait. These subjects were given either a combination of adjustment in their medications, behavioral instructions, and exercise programs aimed at modifying their risk factors (intervention group, 153 subjects) or usual health care plus social visits (control group, 148 subjects).

Results During one year of follow-up, 35 percent of the intervention group fell, as compared with 47 percent of the control group (P = 0.04). The adjusted incidence-rate ratio for falling in the intervention group as compared with the control group was 0.69 (95 percent confidence interval, 0.52 to 0.90). Among the subjects who had a particular risk factor at base line, a smaller percentage of those in the intervention group than of those in the control group still had the risk factor at the time of reassessment, as follows: at least four prescription medications, 63 percent versus 86 percent, P = 0.009; balance impairment, 21 percent versus 46 percent, P = 0.001; impairment in toilet-transfer skills, 49 percent versus 65 percent, P = 0.05; and gait impairment, 45 percent versus 62 percent, P = 0.07.

Conclusions The multiple-risk-factor intervention strategy resulted in a significant reduction in the risk of falling among elderly persons in the community. In addition, the proportion of persons who had the targeted risk factors for falling was reduced in the intervention group, as compared with the control group. Thus, risk-factor modification may partially explain the reduction in the risk of falling.

Source Information

From the Departments of Medicine (M.E.T., P.G., R.I.H.) and Epidemiology and Public Health (G.M., E.B.C., K.T.), Yale University School of Medicine, and the Yale University School of Nursing (D.I.B.), New Haven, Conn.; the Department of Rehabilitation Services, Yale-New Haven Hospital, New Haven, Conn. (M.G.); and the Department of Physical Therapy, Quinnipiac College, Hamden, Conn. (M.L.K.).

Address reprint requests to Dr. Tinetti at 333 Cedar St., P.O. Box 208025, New Haven, CT 06520-8025.

Full Text of this Article

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Reducing the Risk of Falls among the Elderly
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Extract | Full Text  
N Engl J Med 1995; 332:268-269, Jan 26, 1995. Correspondence

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