The Whitehorse NoFalls trial: effects on fall rates and injurious fall rates.

BACKGROUND the burden of falls and fall-related injuries among older adults is well established. Contention surrounds the effectiveness, and hence value, of multi-component fall prevention interventions delivered in the community. OBJECTIVE using consensus-based analytic guidelines rather than time-to-first fall as the primary endpoint, the objective was to examine the effectiveness of the Whitehorse NoFalls trial on all falls, falls resulting in injury and falls requiring medical care to be sought. DESIGN, SETTING AND PARTICIPANTS the study was a community-based randomised controlled trial, with 1,090 participants assigned to one of eight groups, these being a combination of one or more of exercise, vision and or home hazard reduction or alternatively assignment to the control group. METHODS using negative binomial regression, the incidence of all falls, falls resulting in injury and those requiring medical care in the intervention groups were examined. Falls were reported using a monthly return calendar. RESULTS exercise alone and in combination with vision and/or home hazard reduction was associated with fewer falls. For falls resulting in injury and the subset requiring medical care, the vision plus exercise intervention was associated with fewer falls. CONCLUSIONS the findings confirm the effectiveness of exercise in preventing falls among community-dwelling older adults and supports contention that multi-component interventions do not prevent more falls than a single intervention. The results highlight the effectiveness of vision plus exercise in preventing more serious falls, a finding which warrants further consideration.