Balance, Postural Control, and Falls in Older AdultsPage 9 of 11

7. Interdisciplinary Interventions to Prevent Falls

A vast array of strategies and interventions are available to healthcare providers to reduce falls in their older adult clients. These include strength and balance training, and modifying the home or workplace. The number of falls can also be decreased by reviewing or changing medications that are known to increase the risk of falls in older adults.

There are two overarching considerations in planning a fall prevention program. First, fall prevention measures must be individualized—there is no "one size fits all" method to preventing falls. A successful program must include a combination of environmental measures (such as nonslip floors or ensuring patients are within nurses' line of sight), clinical interventions (such as minimizing medications that cause delirium), care process interventions (such as using a standardized risk assessment tool), cultural interventions (emphasizing that fall prevention is a multidisciplinary responsibility), and technological/logistical interventions (such as bed alarms or lowering the bed height). The program should explicitly tackle the underlying assumption held by many health care providers that falls are inevitable and not necessarily preventable (Patient Safety Network, 2019)

A number of studies have shown the benefits of interdisciplinary interventions to reduce the risk of falls in community-dwelling older adults, a practice that is becoming commonplace. A breakthrough 1994 study by Yale researcher Mary Tinetti used a combination of intervention strategies based on an assessment of each participant’s fall risk factors. Tinetti assigned assessment responsibilities to a nurse practitioner and a physical therapist (see Table 3).

Source: Burns et al., 2022.

Table 3. Yale FICSIT
(Frailty and Injuries: Cooperative Studies of Intervention Techniques)

Risk Factor


Assessed by a nurse practitioner:

Postural hypotension

  • Behavioral modifications such as elevating the head of the bed and using ankle pumps
  • Changes in medications

Use of sedative-hypnotic medication

  • Education
  • Discontinued medications
  • Non-pharmacological alternatives

Use of 4+ prescription medication

  • Reviewed medications with primary physician
  • Final decision on changes made by physician

Inability to transfer safely to bathtub or toilet

  • Training in transfer skills
  • Home modifications (installing grab bars, raising toilet seat)

Environmental hazards

  • Home modifications (removing rugs, installing rails)

Assessed by a physical therapist:

Gait impairments

  • Gait training
  • Use of assistive devices
  • Balance training
  • Strength exercise

Impairments in transfer skills or balance

  • Training in transfer skills
  • Home modifications
  • Progressive balance exercises

Impairment in leg or arm strength, range of motion

  • Progressive strength exercises
  • Exercises performed 10–20 min per day

Key elements of the study involved linking the screening and assessments to the interventions. At the end of three months, participants were about 30% less likely to fall compared with people who did not receive the interventions (Burns et al., 2022).

7.1 Exercise-Based Interventions

The benefits of exercise have long been recognized. The USPSTF concludes with high certainty that exercise or physical therapy has moderate net benefit in preventing falls in older adults (USPSTF, 2018). Exercise programs have many positive effects including improved strength and gait speed, reduction in falls, improved balance, and increased bone mineral density.

A review of 18 studies of exercise or physical therapy in community-dwelling older adults found a statistically significant reduction in risk for falling (USPSTF, 2018). The benefit was greater in high-risk than in low-risk populations. The studies included approximately 3500 adults who were mostly older than 75 years and primarily non-Hispanic white women. Most studied populations were deemed high-risk on the basis of several factors, including history of falling, gait and balance impairments, chronic disease status, and use of psychotropic medications. Exercise or physical therapy trials included various components that can be summarized into 3 major categories: gait, balance, or functional training (including a study on tai chi); strength or resistance exercise; and general exercise. Treatment intensity ranged from 2 to 80 hours (USPSTF, 2018).

A 2010 CDC report reviewed 22 exercise-based, home modification, and multi-faceted interventions for the prevention of falls. We will review several programs in each of those categories. To be included in the CDC review, evidence-based fall prevention intervention studies had to meet the following criteria:

  • Published in the peer-reviewed literature
  • Included community-dwelling adults aged 65 and older
  • Used a randomized controlled study design
  • Measured falls as a primary outcome (did not include intervention studies using other outcomes, such as balance improvement or reduced fear of falling)
  • Demonstrated statistically significant positive results in reducing older adult falls (Burns et al., 2022)

7.11 Stay Active, Stay Fit

This Australian study used weekly structured group sessions of moderate-intensity exercise, held in community settings, with additional exercises performed at home. Participants were 163 individuals at risk for falling because of lower limb weakness, poor balance, or slow reaction time. All were aged 67 or older and lived in the community. About two-thirds of participants were female.

Participants were divided into two groups: a control group and an exercise intervention group. The exercise group participated in 23 exercise classes over a 1-year period and completed exercises at home. The exercises were designed by a physical therapist to address physical fall risk factors: balance and coordination, strength, reaction time, and aerobic capacity. Each class began with 5 to 10 minutes of warmup that included stretching of the major lower limb muscle groups and 10 minutes of cool-down that included gentle stretching, relaxation, and controlled-breathing practice. Each class featured music chosen by the participants. The classes included the following types of exercises:

  • Balance and coordination exercises, including modified Tai Chi exercises
  • Practice in stepping and in changing direction, dance steps, and catching and throwing a ball
  • Strengthening exercises, including exercises that used the participant’s weight (eg, sit-to-stand, wall press-ups) and resistance-band exercises that worked both upper and lower limbs
  • Aerobic exercises, including fast-walking practice with changes in pace and direction (Burns et al., 2022)

As the classes progressed, the complexity and speed of the exercises and the resistance of the bands were steadily increased. Participants also took part in a home exercise program using content from the exercise class and recorded their participation in a home exercise diary (Burns et al., 2022).


At retest, the exercise group performed significantly better than the controls in 3 of 6 balance measures: (1) postural sway in standing with eyes open, (2) postural sway in standing with eyes closed, and (3) coordinated stability. The groups did not differ at retest in measures of strength, reaction time, or walking speed. However, within the 12-month trial period, the rate of falls in the intervention group was 40% lower than that of the control group.

7.12 The Otago Exercise Program

This intervention involved four randomized-controlled trials and one controlled multi-center trial. It used an individually tailored program of muscle-strengthening and balance-retraining exercises of increasing difficulty, combined with a walking program. This extensively tested fall prevention program is now used worldwide.

The program was conducted in participants’ homes and was intended for people who did not want to attend, or could not reach, a group exercise program. The program was delivered by either a PT experienced in prescribing exercises for older adults or a nurse who was given special training and received ongoing supervision from a PT.

A physical therapist or nurse visited each participant four times at home over the first 2 months and visited again for a booster session at 6 months. Participants were telephoned once a month during the months when no visits were scheduled. The first home visit lasted an hour; all subsequent visits took about half an hour. During the visits, the PT or nurse prescribed a set of in-home exercises (selected at appropriate and increasing levels of difficulty) and a walking plan (Burns et al., 2022).

The exercises included:

  • Strengthening exercises for lower leg muscle groups using ankle cuff weights
  • Balance and stability exercises such as standing with one foot in front of the other and walking on the toes
  • Active range of motion exercises such as neck rotation and hip and knee extensions (Burns et al., 2022)

Exercise programs were individually tailored and each participant received instructions and an illustration of each exercise. Participants were encouraged to complete the exercises three times a week and to walk outside the home at least two times a week. The exercises took about 30 minutes to complete. In three trials, the exercise program was prescribed for 1 year and in one trial was extended to 2 years (Burns et al., 2022).


Overall, the fall rate was reduced by 35% among program participants compared with those who did not take part, and it was equally effective for men and women. Participants aged 80 years and older who had fallen in the previous year showed the greatest benefit (Burns et al., 2022).

7.13 Tai Chi: Moving for Better Balance

This Portland, Oregon study compared the effectiveness of a 6-month program of Tai Chi classes with a program of stretching exercises. Participants were inactive seniors aged 70 years or older. Three-quarters were female. All participants lived in the community (Burns et al., 2022).

The program included 24 Tai Chi forms that emphasized weight shifting, postural alignment, and coordinated movements. Synchronized breathing aligned with Tai Chi movements was integrated into the movement routine. Each session included instructions in new movements as well as review of movements from previous sessions.

Each practice session incorporated musical accompaniment and each hour-long session included:

  • A 5- to 10-minute warmup period
  • Practice of Tai Chi movements
  • A 5- to 10-minute cool-down period (Burns et al., 2022)

Practicing at home was encouraged and monitored using a home-practice log. One-hour classes were held three times a week for 26 weeks, followed by a 6-month period in which there were no organized classes (Burns et al., 2022).


Participants in the Tai Chi classes had fewer falls and fewer fall injuries, and their risk of falling was decreased 55%.

7.14 Australian Group Exercise Program

This study evaluated a 12-month group exercise program for frail older adults. The program was tailored to each participant’s abilities. Ages ranged from 62 to 95, although nearly all were 70 years or older. Most study participants were female. Participants lived in retirement villages and most were independent (Burns et al., 2022).

The program consisted of four 3-month terms. The first term included understanding movement, how the body works, training principles, and basic exercise principles. This was followed by progressive strength training and increasingly challenging balance exercises, using equipment to maintain interest. In each term, the exercise sessions built on the skills acquired in the previous term (Burns et al., 2022).

Each hour-long class had three segments:

  • A 5- to 15-minute warmup period that included chair-based activities, stretching large muscle groups, and, later in the program, slow to moderate walking
  • A 35- to 40-minute conditioning period that included aerobic exercises, strengthening exercises, and activities to improve balance, hand-eye and foot-eye coordination, and flexibility. As the program progressed, the number of repetitions of each exercise increased, beginning with 4 repetitions at week 2 and reaching 30 by week 10. Thirty repetitions were maintained for rest of the program.
  • A 10-minute cool-down period that included muscle relaxation, controlled breathing, and guided imagery (Burns et al., 2022)

One-hour classes were held twice a week for 12 months. The program consisted of four successive 3-month terms (Burns et al., 2022).


Overall, the fall rate was 22% lower among people who took part in the program, and 31% lower among participants who had fallen in the previous year, compared with those who were not in the program.

7.15 Veterans Affairs Group Exercise Program

This study evaluated a structured group exercise program for fall-prone older men. All participants were aged 70 or older and lived in the community. All were males who had at least one of these fall risk factors: leg weakness, impaired gait, mobility, or balance, and had fallen two or more times in the previous 6 months. The study calculated the fall rate as the number of falls per hour of physical activity (Burns et al, 2022).

The program was conducted at a Veterans Affairs ambulatory care center. Strength training included hip flexion, extension, abduction, and adduction; knee flexion and extension; squats, dorsiflexion, and plantar flexion. Over the first 4 weeks, participants increased each exercise from one to three sets of 12 repetitions. Resistance levels also were increased progressively. The rate of progression was modified for subjects with physical limitations (Burns et al., 2022).

Endurance training used bicycles, treadmills, and indoor walking sessions. Endurance training alternated between cycling (once a week), using a treadmill (twice a week), and indoor walking that included a walking loop as well as two flights of stairs (twice a week). Heart rates were monitored to ensure that participants did not exceed 70% of their heart rate reserve (Burns et al., 2022).

Balance training used a rocking balance board, balance beam, obstacle course, and group activities such as balloon volleyball and horseshoes. Balance training sessions were held twice a week and increased in difficulty over the 12-week program (Burns et al., 2022).


During the 3-month program, participants were two-thirds less likely to fall compared with those who did not take part in the program (Burns et al., 2022).

7.16 Simplified Tai Chi

This study compared a 15-week program of Tai Chi classes that used ten simplified movements with a balance training program. All participants were 70 years or older and lived in the community. Most study participants were female (Burns et al., 2022).

Participants were taught a simplified version of Tai Chi. The 108 existing Tai Chi forms were synthesized into a series of 10 composite forms that could be completed during the 15-week period. The composite forms emphasized all elements of movement that generally become limited with age (Burns et al., 2022).

Exercises systematically progressed in difficulty. The progression of movements led to gradually reducing the base of standing support until, in the most advanced form, a person was standing on one leg. This progression also included increasing the ability to rotate the body and trunk as well as performing reciprocal arm movements. These exercises were led during the group sessions; however, individuals were encouraged to practice these forms on their own, outside of the group setting (Burns et al., 2022).

The 15-week program included:

  • Twice weekly 25-minute group sessions
  • Weekly 45-minute individual contact time with the instructor
  • Twice daily 15-minute individual practice sessions at home without an instructor (Burns et al., 2022)

After 4 months, the risk of falling more than once among participants in the Tai Chi classes was almost half that of people in the comparison group. Participants reported that after the study they were better able to stop themselves from falling by using their environment and appropriate body maneuvers. After the study ended, almost half the participants chose to continue meeting informally to practice Tai Chi.

Online Resource

Video Link: Tai Chi for Older Adults (6 min, 6 sec)

7.2 Home Modification Interventions

Modifying the home to improve safety and reduce the risk of falls is extremely effective. The first step is to remove hazards and clutter and educate the client about fall risks in the home. The next step is to recommend assistive devices and equipment and additions to the home such as grab bars or transfer poles that can be installed in high risk areas. Here are two examples of successful home modification programs.

7.21 Home Visits by an Occupational Therapist

This Australian study used an occupational therapist (OT) who visited participants 65 years and older in their homes, identified environmental hazards and unsafe behaviors, and recommended home modifications and behavior changes.

The OT visited each participant’s home and conducted an assessment using the standardized Westmead Home Safety Assessment form. The OT identified environmental hazards such as slippery floors, poor lighting, and rugs with curled edges, and discussed with the participant how to correct these hazards. The OT also assessed each participant’s abilities and behaviors, and how each functioned in his or her home environment. Specific unsafe behaviors were identified such as wearing loose shoes, leaving clutter in high-traffic areas, and using furniture to reach high places. The OT discussed with the participants ways to avoid these unsafe behaviors (Burns et al., 2022).

Two weeks after the initial home visit the OT telephoned each participant to ask whether they had made the modifications and to encourage them to adopt the recommended behavioral changes (Burns et al., 2022).


Fall rates were reduced by one-third but only among men and women who had experienced one or more falls in the year before the study (Burns et al., 2022).

7.22 Falls-HIT (Home Intervention Team) Program

This German intervention provided home visits to identify environmental hazards that can increase the risk of falling, provided advice about possible changes, offered assistance with home modifications, and provided training in using safety devices and mobility aids.

Participants were frail community-dwelling older adults who had been hospitalized for conditions unrelated to a fall and then discharged to home. Participants showed functional decline, especially in mobility. All were 65 years or older and lived in the community and three-quarters were female (Burns et al, 2022).

The intervention team consisted of a physical therapist, occupational therapist, three nurses, a social worker, and a secretary. The first home visit was conducted while the participant was still hospitalized. Two team members, an occupational therapist with either a nurse or a physical therapist, depending on patient’s anticipated needs, conducted a home assessment. They identified home hazards using a standardized home safety checklist and determined what safety equipment a participant needed (Burns et al., 2022).

During two to three subsequent home visits, an occupational therapist or nurse met with the participant to:

  • Discuss home hazards
  • Recommend home modifications
  • Facilitate necessary modifications
  • Teach participants how to use safety devices and mobility aids when necessary (Burns et al., 2022)

The fall rate for participants was reduced 31%. The intervention was most effective among those who had experienced two or more falls in the previous year; the fall rate for these participants was reduced 37% (Burns et al., 2022).

7.3 Multifaceted Interventions

AGS/BGS guidelines stress the importance of interventions that target risk factors identified during the initial risk assessment. In a review of programs that target multiple risk factors, most of the interventions can be described under the broad headings of exercise and physical activity, medical assessment and management, medication adjustment, environmental modification, and education. These components represent distinct areas of expertise and clinical practice and are often administered by several clinicians from various disciplines, presenting challenges of coordination (AGS/BGS, 2009).

The components most commonly included in multifaceted interventions are:

  • Adaptation or modification of home environment
  • Withdrawal or minimization of psychoactive medications
  • Withdrawal or minimization of other medications
  • Management of postural hypotension
  • Management of foot problems and footwear
  • Exercise, particularly balance, strength, and gait training (AGS/BGS, 2009)

Multifaceted intervention should also include an education component complementing and addressing issues specific to the intervention being provided, tailored to individual cognitive function and language. It should also include an exercise program incorporating balance, gait, and strength training. Flexibility and endurance training should also be offered, but not as sole components of the program. The health professional or team conducting the fall risk assessment should directly implement the interventions or should ensure that the interventions are carried out by other qualified healthcare professionals (AGS/BGS, 2009). We will review several programs that stress multifaceted interventions in the following section.

7.31 Stepping On

This Australian study used a series of small group sessions to teach fall prevention strategies to community-dwelling older adults. Participants were individuals who had fallen in the previous year or who were concerned about falling. All were 70 years or older and lived in the community. Most study participants were female (Burns et al., 2022).

The program addressed multiple fall risk factors: improving lower limb balance and strength, improving environmental and behavioral safety in both the home and community, and encouraging visual and medical screenings to check for low vision and possible medication problems. Each session covered a different aspect to reducing fall risk:

  • Session 1: Risk appraisal and introducing balance and strength exercises
  • Session 2: Review and practice exercises and how to move safely in the home
  • Session 3: Hazards in and around the home and how to remove or reduce them
  • Session 4: How to move safely in the community and safe footwear and clothing
  • Session 5: Poor vision and fall risk and the benefits of vitamin D, calcium, and hip protectors
  • Session 6: Medication management, review of exercises, and more strategies for moving safely in the community
  • Session 7: Review of topics covered in program (Burns et al., 2022)

The program included seven weekly 2-hour program sessions, a 1- to 1.5-hour home visit by an occupational therapist, and—6 weeks after the final session—a 1-hour booster session. The follow-up home visit included review of fall prevention strategies, assistance with home adaptations, and modifications, if needed. A 3-month booster session included review of achievements and how to maintain motivation (Burns et al., 2022).

A team of content experts, trained by the OT and guided by the Stepping On manual, participated in the study. Duties were divided as follows:

  • Physical therapist: introduced exercises and led a segment on moving about safely.
  • Occupational therapist: led segments on home safety, community safety, behavioral methods for better sleep, and hip protectors.
  • Older adult volunteer from the Roads and Traffic Authority: spoke on pedestrian safety.
  • Retired volunteer nurse from the Medicine Information Project: discussed how to manage medications.
  • Mobility officer from the Guide Dogs: spoke on coping with low vision. (Burns et al., 2022)

The fall rate among participants was reduced about 30% compared with those who did not receive the intervention. The intervention was especially effective for men. The fall rate among male participants was reduced almost two-thirds.

7.32 PROFET (Prevention of Falls in the Elderly Trial)

This British intervention provided assessments for fall risk with referrals to relevant services and an occupational therapy home hazard assessment with recommendations for home modifications. Participants were older adults who had been treated for a fall in a hospital emergency department. All were aged 65 years and older and lived in the community. Two-thirds of participants were female (Burns et al., 2022).

An outpatient medical assessment was conducted soon after the fall that was treated in the emergency room. It included assessments of visual acuity, postural hypotension, balance, cognition, depression, and medication problems. The results were used to identify and address problems that could contribute to fall risk. Participants received referrals to relevant services, based on identified risk factors (Burns et al., 2022).

The home assessment was conducted during a single visit. The occupational therapist (OT) identified environmental hazards in the home, such as uneven outdoor surfaces, loose rugs, and unsuitable footwear. Based on findings, the OT provided advice and education regarding safety within the home, made safety modifications to the home with the participant’s consent, and provided minor safety equipment. The OT made social service referrals for participants who required hand rails, other technical aids, adaptive devices such as grab bars and raised toilet seats, and additional support services. The average length of the medical assessment was 45 minutes. The average length of the home assessment was 60 minutes (Burns et al., 2022).


After 12 months, those in the intervention group were 60% less likely to fall once and 67% less likely to fall repeatedly (at least three times), compared with those who did not receive the intervention.

7.33 The NoFalls Intervention

This Australian study looked at the effectiveness of group-based exercise in preventing falls when used alone or in combination with vision improvement and home hazard reduction. The interventions focused on increasing strength and balance, improving poor vision, and reducing home hazards. All participants were aged 70 and older and lived in the community. Sixty percent were female (Burns et al., 2022).

The exercise program was delivered in community settings such as exercise rooms in fitness centers and community health centers. The vision intervention was delivered via usual services available in the community. Participants went to their optometrist or ophthalmologist if they had one. If any further action was required, it was facilitated using normal services such as hospitals for cataract surgery, optometrists for new glasses, and general practitioners or ophthalmologists for medication if required. The home hazard intervention was conducted in participants’ homes (Burns et al., 2022).

The exercise intervention consisted of weekly 1-hour classes plus daily home exercises. Classes were designed by a physical therapist to improve flexibility, leg strength, and balance. About one-third of the exercises were devoted to balance improvement. Exercises were adjusted for participants with limitations. Music was played during the sessions. Leaders provided a social time with coffee and tea after each session to talk informally about exercise improvements and opportunities (Burns et al., 2022).

The vision intervention included referral to an appropriate eye care provider if a participant’s vision fell below predetermined criteria during the baseline assessments for visual acuity, contrast sensitivity, depth perception, and field of view. Criteria for referral included more than four lines difference between the line of smallest letters read correctly on the high and low contrast sections of the vision chart or any loss of field of view (Burns et al., 2022).

A referral was recommended if:

  • A potential visual deficit was identified and the participant was not already receiving treatment, or
  • If a deficit had been identified previously but the participant had not received treatment during the previous 12 months. The intervention consisted of the participant receiving the recommended treatment by an appropriate specialist

The home hazard assessment consisted of a walk-through with a checklist for those rooms used in a normal week. The checklist included a comprehensive section defining the various areas of the house and specific hazards. The checklist was divided into rooms or areas of the house—access points (main entry door, back door), hallways, stairwells, dining room, living room, den, bedrooms, and wet areas (kitchen, bathroom, laundry rooms). Within each of these areas, the focus was on steps and stairs, floor surfaces, lighting, and some key furniture items or fixtures such as a favorite chair or bathroom fixtures (Burns et al., 2022).

After the assessment, the results were discussed with the participant and potential interventions noted on the checklist were suggested. If the participant agreed to the intervention, it was determined who would carry it out. Hazards could be removed or modified by the participants, their families, the City of Whitehorse home maintenance program, or some other person. Study staff visited the participants’ homes and provided quotes for the materials needed for the suggested modifications; labor was provided free of charge (Burns et al., 2022).

The duration of the study was as follows:

  • Exercise: Weekly 1-hour group classes for 15 weeks and 25 minutes of daily home exercises.
  • Vision improvement: Duration depended on the specific intervention (such as cataract surgery or new glasses).
  • Home hazard reduction: Duration depended on the length of time the home modifications were left in place by the participant.

The group-based exercise program was the most potent single intervention. When used alone, it reduced the fall rate by 20%. Falls were reduced further when vision improvement or home hazard reduction was combined with exercise. The most effective combination was the group-based exercise with both vision improvement and home hazard reduction. Participants who received all three components were one-third less likely to fall (Burns et al., 2022).

7.34 The SAFE Health Behavior and Exercise Intervention

The Study of Accidental Falls in the Elderly (SAFE) health behavior intervention, conducted in Washington and Oregon, was a program of four group classes on how to prevent falls. The classes addressed environmental, behavioral, and physical risk factors and included exercise with instructions and supervised practice. The home safety portion included a home inspection by a BA-level home assessor with guidance and assistance in reducing fall hazards. All were participants were 65 years or older and lived in the community. About 60% of participants were female (Burns et al., 2022).

The SAFE health behavior intervention consisted of four 1.5- hour group classes that used a comprehensive approach to reducing fall risks. Classes addressed environmental, behavioral, and physical risk factors. Classes included:

  • A slide presentation on common household risks.
  • Discussions of behavioral risks such as walking on ice or using a chair to reach high places.
  • A self-appraisal of home hazards using a specially designed form.
  • Small group sessions during which participants worked together to develop action plans.

Each class session also had an exercise component that included a brief demonstration of fall prevention exercises and about 20 minutes of supervised practice. Participants received a manual describing the exercises and were encouraged to begin walking at least three times a week. The exercises were chosen to:

  • Actively involve all parts of the body
  • Maintain full range of motion of all joints
  • Strengthen muscles
  • Improve posture
  • Improve balance

During the home safety inspection, the assessor inspected the participant’s home and identified fall hazards using a standard protocol. The assessor encouraged the participant to remove or repair the hazards identified during this initial visit. The participant was also given fact sheets on how to obtain technical and financial assistance for making repairs and modifications to the home (Burns et al., 2022).

After the four classes were completed, the assessor returned to the participant’s home to check on the progress of repairs and to offer financial and technical assistance, if needed, as well as discounts on safety equipment. The full duration of the study included two home visits, each lasting about 15 minutes, and four weekly 1.5-hour classes (including 20 minutes of supervised exercise) over a 1-month period (Burns et al., 2022).


Overall, participants were 15% less likely to fall compared with those who did not receive the intervention. Male participants showed the greatest benefit.

7.35 Yale FICSIT

This Yale FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques) study used a tailored combination of intervention strategies based on an assessment of each participant’s fall risk factors. Participants were members of a health maintenance organization. All were 70 years or older and lived in the community. Most participants were female (Burns et al., 2022).

Individualized interventions were delivered to each of the participants in their homes. The content varied based on the fall risk factors identified. Possible intervention components included medication adjustment, recommendations for behavioral change, education and training, home-based physical therapy, and a home-based progressive balance and strengthening exercise program. The selection of interventions was guided by decision rules and priorities. No participant received more than three balance and strength training programs (Burns et al., 2022).

The assessments were directly linked to the interventions. The minimum risk factor interventions included:

  • Postural blood pressure and behavioral recommendations
  • Medication review and reduction (especially psychoactive medications
  • Balance, strength, and gait assessments and interventions
  • Environmental assessment and modification

The progressive balance and strength exercise program included both supervised and at-home (unsupervised) components (Burns et al., 2022).


Participants were about 30% less likely to fall compared with people who did not receive the intervention.

7.36 A Multifactorial Program

This Seattle study tested a moderate-intensity intervention that used tailored strategies based on assessment of each participant’s risk factors. All participants were 65 years and older and lived in the community, and about 60% of participants were female (Burns et al., 2022).

Participants received the assessments and interventions from a nurse at a local health maintenance organization (HMO) center. Participants conducted a home assessment or had it done by a family member or volunteer. The assessments consisted of simple screening tests for six risk factors. The intervention content varied based on the individual’s risk factors (see Table 4).

Source: Burns et al., 2022.

Table 4: Risk Factors and Interventions

Risk Factor


Inadequate exercise

  • Participated in a 2-hr exercise orientation class testing fitness.
  • Given exercise instruction.
  • Encouraged to begin a program of brisk walking.

Excessive alcohol use

  • Referred to an alcohol treatment program if alcoholism suspected.
  • Given instructional booklet with strategies for limiting use.

Home hazards

  • Assessed home safety using a home safety checklist.

Use of psychoactive drugs

  • Reviewed medications using a pharmacist and sent written recommendations to primary care provider.

Impaired hearing

  • Evaluated for hearing aid.
  • Provided with behavioral intervention classes for participants with uncorrectable deficits

Impaired vision

  • Corrected when possible.
  • Received information about available community resources if vision impairments were uncorrectable.

After 1 year, participants were 10% less likely to fall and 5% less likely to have an injurious fall, compared with people who received usual medical care.

Back Next