The effectiveness of a community-based program for reducing the incidence of falls in the elderly: a randomized trial

J Am Geriatr Soc. 2004 Sep;52(9):1487-94. doi: 10.1111/j.1532-5415.2004.52411.x.


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.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidental Falls / prevention & control*
  • Accidental Falls / statistics & numerical data
  • Accidents, Home / prevention & control
  • Accidents, Home / statistics & numerical data
  • Activities of Daily Living
  • Aged
  • Aged, 80 and over
  • Cognitive Behavioral Therapy / organization & administration
  • Female
  • Follow-Up Studies
  • Geriatric Assessment
  • Health Services for the Aged / organization & administration*
  • Home Care Services / organization & administration*
  • Humans
  • Incidence
  • Male
  • New South Wales / epidemiology
  • Occupational Therapy / organization & administration*
  • Patient Education as Topic / organization & administration
  • Program Evaluation
  • Regression Analysis
  • Self Care
  • Self Efficacy
  • Self-Help Groups / organization & administration*