Continued Effects of A Falls Prevention Program

Hornbrook, Mark

Abstract

The primary aim of this renewal of the Study of Accidental Falls in the Elderly (SAFE) is to estimate the continuity effects of a comprehensive environmental and behavioral falls prevention program for older persons. This proposal would extend the follow- up period of SAFE for an additional 12 months and provide for additional analyses of intervention effects and of the antecedents and consequences of falls. This would ensure 36 months of continuous follow-up of all SAFE participants. The outcomes of interest are incidence of self-reported falls, falls requiring medical care and falls requiring hospitalization, as well as overall medical care cost of falls-related injuries and associated morbidities. The research questions are: (1) Are the intervention effects decaying, cumulating, constant, or delayed over time? (2) What is the association between extent of participation in the intervention and the outcomes? (3) What is the sensitivity of the estimates of effectiveness and cost-effectiveness to under- reporting of falls and other errors of measurement? (4) What is the relationship between aging and the incidence, type, and severity of injury falls? and, (5) What are the environmental and behavioral factors associated with specific types of falls and what types of fall are being prevented, if any? Nearly 3,000 persons aged 68 and over will continue under the SAFE follow-up regimen, which involves telephone and mail surveys and abstracts of medical records to obtain data on falls, medical care use, and general health status. Participants are required to report every fall, and quarterly telephone follow-up is conducted to detect unreported falls. Cross-validation with medical records is also carried out to identify unreported falls. All SAFE participants are members of Kaiser Permanente (KP), a large prepaid group practice health maintenance organization. KP maintains a single, centralized medical record system for all members. This extension will provide a clearer picture of the longer-run effects of falls prevention efforts and will enable better use of a large data set on falls among elderly.