Falls are the leading cause of injury-related deaths in older persons and a major cause of morbidity, leading to disability and institutionalization. Preliminary data suggest that these problems may be disproportionately great in low-income African American elderly persons. Yet most interventions, having been developed for European American elders, are neither culturally based nor proven effective in African American populations. The objective of this two-phase proposal is to pilot test and develop a feasible home-based intervention to prevent functional decline and repeated falls among elderly inner-city African Americans who have suffered a fall. A multi-factorial risk abatement strategy will focus on major risk factors for falls, including problems with gait, mobility, balance, use of inappropriate medications, impaired vision and hearing, and environmental hazards. Phase I involves: 1) developing the protocol, including culturally competent educational approaches; 2) testing the protocol in a controlled environment with 60 participants; and 3) evaluating the reliability of the performance of specially trained community interventionists working with nurses. In Phase II, we will assess the feasibility of carrying out the multi-factorial intervention in the community and evaluate the impact of the intervention on fall risk factor abatement and functional decline through a randomized controlled trial. Two hundred elderly persons discharged from participating urban emergency departments after treatment of a fall will be randomly assigned to intervention or control groups. The control group will be counseled regarding a """"""""usual care"""""""" walking program. The intervention group will have a home hazard evaluation, counseling interventions for fall risk factors, and participate in an exercise program three times weekly. Standardized outcome evaluations will be blinded to group status and will assess gait, balance, strength, vision, hearing, use of medication and home hazards. The results of this study will be used to create a final intervention proposal to evaluate the interventions' effectiveness in preventing falls and disability. Our ultimate goal is to develop an effective system of public health outreach and follow-up preventive care among low-income elderly African Americans who have suffered a fall.
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