The objectives of this project are to develop, implement, and evaluate a moderate-intensity group behavioral approach to falls prevention among older persons who are at risk of falling. The intervention represents a refinement and extension of a previous falls prevention protocol which focused on behavioral and environmental changes for the general community- dwelling elderly population. The Study of Accidental Falls in the Elderly (SAFE) demonstrated the ability to recruit and engage older persons in a health behavior program targeted to falls. SAFE produced significant changes in environmental and behavioral risk factors for intervention participants and reduced overall fall and hospitalization rates. This new project will narrow the target population to fallers aged 65 and over (instead of being open to the general aged population) and will increase the total number of intervention sessions. The research design calls for mass screening to stratify older persons into three fall risks groups--high, medium, and low--and recruiting, assessing, and randomizing 1,100 persons in the medium risk group into placebo control and intervention conditions. The intervention protocol contains four major rehabilitative and adaptive elements: moderate endurance-building exercise (walking) to increase overall functional health status; physical conditioning to increase coordination and muscle strength in lower limbs; identification and correction of environmental safety hazards; and use of ideokinetic facilitation (guided mental imagery) to teach adaptive responses to mental stress, distraction, and falls. Sessions will be co-led by a behaviorist and a physical therapist and will be attended by groups of 30 participants. Participants in the intervention group will receive 12 weekly sessions followed by 18 monthly sessions. The research setting is a large prepaid group practice HMO. Clinical risk assessment will include joint flexibility, strength, ADLs, IADLs, cognitive function, depression, and morbidities. Intermediate outcomes will include attendance rates, participant satisfaction, exercise frequency, home modifications, and objective measures of lower limb strength, gait,, and balance. Final outcomes will be assessed by self- reported falls and medical care use for fall-related injuries.
