1

A CDC Compendium of 

Effective Fall Interventions:

What Works for Community-Dwelling Older Adults

Exercise-based Interventions

Home Modification Interventions

Multifaceted Interventions

2nd Edition

A CDC Compendium of 

Effective Fall Interventions:

What Works for 

Community-Dwelling Older Adults 

2nd Edition

by

Judy A. Stevens, PhD

Division of Unintentional Injury Prevention

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention (CDC)

Atlanta, Georgia

2010
This document is a publication of the 

National Center for Injury Prevention and Control 

of the Centers for Disease Control and Prevention

Centers for Disease Control and Prevention

Thomas R. Frieden, MD, MPH, Director

National Center for Injury Prevention and Control

Linda C. Degutis, DrPH, MSN, Director

Division of Unintentional Injury Prevention

Grant Baldwin, PhD, MPH, Director

Home and Recreation Injury Prevention Team

Rita Noonan, PhD, Team Leader

Author

Judy A. Stevens, PhD
Acknowledgements for First Edition

We acknowledge and appreciate the contributions of Dr. Christine Branche 

who provided encouragement and unwavering support of this project; Dr. 

Patricia D. Nolan and Mr. DavidRamsey who developed the Compendium

data base; and Ms. Lisa Jeanette who produced the initial draft. 

Acknowledgements for Second Edition

We acknowledge and appreciate the contributions of Ms. Bonny Bloodgood 

and Ms. Sondra Dietz for their persistence in collecting data and drafting 

the second edition; and Dr. Rita Noonan, Dr. David Sleet and Dr. Michael 

Ballesteros who provided thoughtful and constructive suggestions.

A Special Acknowledgement

To Dr. Ellen Sogolow, my co-author on the first edition, in appreciation 

of her foresight and leadership in developing the Compendium, a document 

that has been instrumental in promoting the dissemination and implementation 

of effective evidence-based fall interventions for older adults. 

Suggested Citation: Stevens JA. A CDC Compendium of Effective Fall Interventions: 

What Works for Community-Dwelling Older Adults. 2nd ed. Atlanta, GA: 

Centers for Disease Control and Prevention, National Center for Injury Prevention 

and Control, 2010.

Disclaimer: Reference herein to any specific commercial products, programs, or services by trade name, trademark, 

manufacturer, or otherwise, does not necessarily constitute or imply its endorsement, recommendation, or favoring by 

the United States Government. The views and opinions of authors expressed herein do not necessarily state or reflect 

those of the United States Government and shall not be used for advertising or product endorsement purposes.
Preface 

The first edition of the CDC Compendium of Effective Fall Interventions (2008) 

was developed to give public health practitioners and aging services providers 

detailed information about interventions that were scientifically proven to 

reduce falls in older adults. The first edition included 14 studies of effective 

falls interventions that were published before 2005. The second edition 

maintains the original format—study summaries, intervention descriptions, 

and summary tables—and provides this information for 8 additional fall 

intervention studies published between 2005 and 2009. 

The 22 interventions included in this second edition address a variety of 

audiences. Some are suitable for the very old (e.g., The Otago Exercise 

Programme), some are appropriate for specific populations such as the visually 

impaired (e.g., The VIP Trial), and others are designed for specific situations 

such as walking on ice and snow (e.g., Yaktrax Walker). The Compendium

will provide public health organizations and aging services providers with the 

information they need to identify effective fall interventions that are most 

appropriate for their communities’ particular needs, resources, and population.

to the Second Edition

® 
Contents

Introduction ..........................................................................................1 

Exercise-based Interventions

Stay Safe, Stay Active (Barnett, et al.)................................................................. 6

The Otago Exercise Programme (Campbell, et al. and Robertson, et al. )..........10

Erlangen Fitness Intervention (Freiberger, et al.) ...............................................14

Tai Chi: Moving for Better Balance (Li, et al.) ................................................. 16

Australian Group Exercise Program (Lord, et al.) ..............................................18

Yaktrax Walker (McKiernan)............................................................................20

Veterans Affairs Group Exercise Program (Rubenstein, et al.)............................22

Falls Management Exercise (FaME) Intervention (Skelton, et al.) .....................24

Central Sydney Tai Chi Trial (Voukelatos, et al.)...............................................28

Simplified Tai Chi (Wolf, et al.) ....................................................................... 30

Home Modification Interventions

The VIP Trial (Campbell, et al.)........................................................................34 

Home Visits by an Occupational Therapist (Cumming, et al.)..........................36

Falls-HIT (Home Intervention Team) Program (Nikolaus, et al.)..................... 38

Multifaceted Interventions

Stepping On (Clemson, et al.) ......................................................................... 42

PROFET (Prevention of Falls in the Elderly Trial) (Close, et al.) ..................... 46

Accident & Emergency Fallers (Davison, et al.) ................................................48

The NoFalls Intervention (Day, et al.).............................................................. 52

The SAFE Health Behavior and Exercise Intervention (Hornbrook, et al.)........56

Multifactorial Fall Prevention Program (Salminen, et al.)..................................60

The Winchester Falls Project (Spice, et al.)........................................................64

Yale FICSIT (Frailty and Injuries: Cooperative Studies of Intervention 

 Techniques) (Tinetti, et al.).......................................................................... 68

A Multifactorial Program (Wagner, et al.) .........................................................72

® 
Appendix A Intervention Study Selection Process.....................................................75

Appendix B Bibliography of Compendium Studies....................................................81

Appendix C Tables ...................................................................................................89

Table 1 Overall Population Characteristics......................................................90

Table 2 Study Characteristics ..........................................................................92

Table 3 Intervention Characteristics..............................................................102

Appendix D Original Intervention Materials..........................................................107

Appendix D-1 Barnett Materials ....................................................................109

Appendix D-2 Skelton Materials....................................................................121

Appendix D-3 Voukelatos Materials...............................................................125

Appendix D-4 Wolf Materials........................................................................129

Appendix D-5 Close Materials.......................................................................133

Appendix D-6 Spice Materials........................................................................145
1

Introduction

Older adults value their independence and a fall can 

significantly limit their ability to remain self-sufficient. 

More than one-third of people aged 65 and older fall 

each year, and those who fall once are two to three times 

more likely to fall again. Fall injuries are responsible 

for significant disability, loss of independence, and 

reduced quality of life. In 2000, direct medical costs 

for fall injuries totaled $19 billion. However, we know 

that falls are not an inevitable result of aging. In recent 

years, systematic reviews of fall intervention studies have 

established that prevention interventions can reduce falls.

 

Purpose

The Centers for Disease Control and Prevention 

(CDC) developed the CDC Compendium of Effective 

Fall Interventions to help public health practitioners 

use the best scientific evidence to effectively address the 

problem of falls. The Compendium includes 22 specific 

interventions for community-dwelling older adults that 

have rigorous scientific evidence of effectiveness, and 

provides relevant information about these interventions 

to public health practitioners, aging service providers, and 

others who wish to implement fall prevention programs.

More than one-third 

of people aged 65 

and older fall each 

year, and those who 

fall once are two 

to three times more 

likely to fall again.
2

 Process

CDC gathered information about science-based fall prevention intervention studies 

that met the following criteria:

•	 Published in the peer-reviewed literature

•	 Included community-dwelling adults aged 65 or 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 

This selection process was used by CDC in the first edition of the Compendium to 

identify 14 studies of effective fall interventions published before December 31, 

2004. Another literature review was conducted in 2010 that identified an additional 

8 interventions published from January 1, 2005 to December 31, 2009; these are 

included in this second edition.

See Appendix A for details about the selection process.

Content

The Compendium categorizes interventions into 3 groups: exercise-based, home

modification, and multifaceted interventions. Information about each

intervention was obtained from the published study and by directly contacting 

the principal investigator. Each is presented using a standardized format that

includes a short summary of the research study and results as well as a longer section 

describing relevant details about the intervention. The intervention description 

includes information about the purpose, program setting, content, number of 

sessions, duration, provider, provider’s training, key elements, available intervention 

materials, and contact information for the study’s principal investigator. 

The Compendium also contains appendices. These include figures illustrating the

intervention study selection process; a bibliography of the research studies; tables 

comparing the participating populations, study characteristics, and intervention

characteristics of the 22 studies; and supplemental materials, such as assessment 

instruments and evaluation materials, provided by the principal investigators.


Stay Safe, Stay Active (Barnett, et al.) ................................................................................... 6

The Otago Exercise Programme (Campbell, et al. and Robertson, et al. ) ............................10

Erlangen Fitness Intervention (Freiberger, et al.)..................................................................14

Tai Chi: Moving for Better Balance (Li, et al.).................................................................... 16

Australian Group Exercise Program (Lord, et al.).................................................................18

Yaktrax® Walker (McKiernan)..............................................................................................20

Veterans Affairs Group Exercise Program (Rubenstein, et al.) ..............................................22

Falls Management Exercise (FaME) Intervention (Skelton, et al.)........................................24

Central Sydney Tai Chi Trial (Voukelatos, et al.) .................................................................28

Simplified Tai Chi (Wolf, et al.).......................................................................................... 30

Exercise-based

 Interventions
6

Stay Safe, Stay Active

This study used weekly structured group sessions of moderate-intensity 

exercise, held in community settings, with additional exercises performed 

at home. Participants were 40 percent less likely to fall and one-third 

less likely to suffer a fall-related injury compared with those who did not 

receive the intervention.

Population: Participants were individuals at risk for falling because 

of lower limb weakness, poor balance, and/or slow reaction time. All 

were aged 67 or older and lived in the community. About two-thirds of 

participants were female. 

Geographic Locale: Southwest Sydney, Australia 

Focus: Improve balance and coordination, muscle strength, reaction time, 

and aerobic capacity. 

Program Setting: Classes were conducted in local indoor lawn bowling 

and sports clubs that hosted community programs for various sports and 

exercise activities, comparable to United States. community exercise, 

sports, and recreation facilities. Many lawn bowling and sports clubs also 

included other indoor attractions such as restaurants, meeting facilities, 

and movies. 

Content: The classes 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 warm-up 

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 included 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 (e.g., 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

Barnett,

et al.
Exercise-based

Interventions

7

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.

Duration: A total of 37 1-hour classes were conducted once a week over a 

1-year period.

Delivered by: Nationally accredited exercise instructors who had been trained to conduct

this exercise program by a licensed physical therapist (accredited by Australia’s National 

Association for Gentle Exercise). The study used currently accredited exercise leaders who 

already had a good understanding of the exercise principles. 

Before classes began, regular meetings were held with the exercise leaders to discuss the 

content and how the classes would be run, giving leaders ownership in the program. 

Training included approximately 6 hours of additional meetings, discussion, and practice 

sessions before beginning the program. During the classes, instructors were visited by the 

physical therapist for support once each term.

Minimum Level of Training Needed: Information was not provided by the 

principal investigator.

Key Elements: 

•	 This study used health practitioners to assess and recruit participants. General 

practitioners are in an ideal position to both identify older people at risk of falls and 

to support their participation in an exercise program when appropriate.

•	 The program used existing services and facilities in the community, so it is likely to be 

sustainable and transferable to other settings.

Available Materials: In addition to the guidance received during the exercise 

sessions, participants received: 

•	 A home exercise program based on class content*

•	 A “hot tips” sheet listing practical strategies for avoiding falls such as where to place 

hands and feet if a loss of balance occurs*

* See Appendix D-1. 
8

Study Citation: Barnett A, Smith B, Lord S, Williams M, Baumand A. 

Community-based group exercise improves balance and reduces falls in 

at-risk older people: A randomized controlled trial. Age and Ageing. 2003 

Jul;32(4):407-14.
Exercise-based

Interventions

9

Contact

Practitioners interested in using this intervention may contact the principal 

investigator for more information:

Anne Barnett, MPH

Physiotherapy Department

Bankstown Hospital, Locked Mailbag 1600

Bankstown NSW 2200, Australia

Tel: +61 (9) 722 7154

Fax: +61 (9) 722 7125

E-mail: anne.barnett@swsahs.nsw.gov.au
10

The Otago Exercise Programme

This intervention, tested in 4 randomized controlled trials and 1 controlled 

multi-center trial, was an individually tailored program of musclestrengthening and balance-retraining exercises of increasing difficulty, 

combined with a walking program. This extensively tested fall prevention 

program is now used worldwide.

Overall, the fall rate was reduced by 35 percent among program 

participants compared with those who did not take part. The program was 

equally effective for men and women. Participants aged 80 years and older 

who had fallen in the previous year showed the greatest benefit. 

Population: Participants were aged 65 to 97 years and lived in 

the community. 

Geographic Locale: Dunedin, New Zealan. 

Focus: Improve strength and balance with a simple, easy-to-implement, 

and affordable home-based exercise program. 

Program Setting: 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 or recreation facility. 

Content: A physical therapist (PT) or nurse visited each participant 

4 times at home over the first 2 months (at weeks 1, 2, 4, and 8) and 

visited again for a booster session at 6 months. To maintain motivation, 

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. 

Campbell,

et al. and

Robertson,

et al.
Exercise-based

Interventions

11

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

Participant safety was ensured by tailoring the exercise program and by giving participants 

instructions and an illustration for each exercise. 

Duration: The exercises took about 30 minutes. Participants were encouraged to 

complete the exercises 3 times a week and to walk outside the home at least 2 

times a week. Exercises then were continued on an ongoing basis. In 3 trials, the exercise 

program was prescribed for 1 year and in 1 trial was extended to 2 years.

Delivered by: 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.

Minimum Level of Training Needed: PTs can deliver the program immediately 

after reading the manual. Nurses can be trained to deliver the program after a 2-day 

training program and with ongoing supervision by a PT. 

Key Elements: PTs should understand the research evidence on which the program 

is based and avoid adding or subtracting exercises from the set used in the trials, as this 

particular combination of exercises worked to reduce falls.

Available Materials: The Otago Exercise Programme instruction guide, which 

describes the program exercises, is available to health professionals at 

www.acc.co.nz/PRD_EXT_CSMP/idcplg?IdcService=GET_

FILE&dID=8311&dDocName=PRD_CTRB118334&allowInterrupt=1.
12

Study Citation: 

Primary studies

Campbell AJ, Robertson MC, Gardner MM, Norton RN, Tilyard 

MW, Buchner DM. Randomised controlled trial of a general practice 

programme of home based exercise to prevent falls in elderly women. 

British Medical Journal. 1997 Oct 25;315(7115):1065-9. 

Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM. 

Falls prevention over 2 years: A randomized controlled trial in women 80 

years and older. Age and Ageing. 1999 Oct;28(6):513-8.

Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM. 

Psychotropic medication withdrawal and a home-based exercise program 

to prevent falls: A randomized controlled trial. Journal of the American 

Geriatrics Society. 1999 Jul;47(7):850-3.

Campbell AJ, Robertson MC, La Grow SJ, Kerse NM, Sanderson GF, 

Jacobs RJ, Sharp DM, Hale LA. Randomised controlled trial of prevention 

of falls in people aged ≥75 with severe visual impairment: The VIP trial. 

British Medical Journal. 2005 Oct 8;331(7520):817-20.

Robertson MC, Devlin N, Gardner MM, Campbell AJ. Effectiveness and 

economic evaluation of a nurse delivered home exercise programme to 

prevent falls. 1: Randomised controlled trial. British Medical Journal. 2001 

Mar 24;322(7288):697-701.

Robertson MC, Gardner MM, Devlin N, McGee R, Campbell AJ. 

Effectiveness and economic evaluation of a nurse delivered home exercise 

programme to prevent falls. 2: Controlled trial in multiple centres.

British Medical Journal. 2001 Mar 24;322(7288):701-4.

Supplemental articles

Gardner MM, Buchner DM, Robertson MC, Campbell AJ. Practical 

implementation of an exercise-based falls prevention programme. 

Age and Ageing. 2001 Jan;30(1):77-83.

Robertson MC, Campbell AJ, Gardner MM, Devlin N. Preventing injuries 

in older people by preventing falls: A meta-analysis of individual-level 

data. Journal of the American Geriatrics Society. 2002 May;50(5):905-11.
Exercise-based

Interventions

13

Contact

Practitioners interested in using this intervention may contact the principal 

investigator for more information:

M. Clare Robertson, PhD

Research Associate Professor

Department of Medicine, Dunedin School of Medicine

University of Otago, P.O. Box 913

Dunedin 9054, New Zealand

Tel: +64 (3) 474 7007 extension 8508

Fax: +64 (3) 474 7641

E-mail: clare.robertson@otago.ac.nz
14

Erlangen Fitness Intervention

This study examined 2 interventions to reduce falls: a psychomotor 

intervention that focused on body awareness, body experience, and 

coordination; and a fitness intervention that focused on functional skills, 

strength, endurance, and flexibility. Both interventions included group 

classes, home-based exercises, and physical activity recommendations. 

Only the fitness intervention was effective in reducing falls. Compared to 

the control group, participants in the fitness group experienced 23 percent 

fewer falls. 

Population: The participants were community-dwelling, physically 

active people in very good health, aged 70 or older. Slightly more than half 

were male.

Geographic Locale: Erlangen, Germany

Focus: Improve functional skills, strength, endurance, and flexibility.

Program Setting: The group classes were conducted at the University 

of Erlangen-Nuremberg, Institute of Sport Science, and the home-based 

portion was carried out in participants’ homes. 

Content: This program consisted of group exercise classes, home-based 

exercises, and recommendations for increasing physical activity levels such 

as daily walking or biking. 

Each session lasted 1 hour. Approximately one-third of the time was spent 

on each of the components:

•	 Strength and flexibility training (including the use of dumbbells, ankle 

weights, weight-bearing exercises, and joint flexibility)

•	 Balance and motor coordination training (including standing balance, 

dynamic weight transfers, stepping strategies, motor control when 

performing activities of daily living, motor control under time pressure 

and sensory awareness)

•	 Endurance training (including normal walking and Nordic walking)

Group discussions were conducted at the beginning and end of each 

session to outline the goals of the program and to review progress. 

Duration: One-hour classes were held twice a week for 16 weeks. In 

addition, participants were instructed to perform selected exercises at home 

on a daily basis between sessions and after the program ended.

Freiberger,

et al.
Exercise-based

Interventions

15

Delivered by: The program was supervised by 2 trainers, preferably a man and a woman, 

who had backgrounds in sports science. This training is similar to that received by physical 

education teachers. It included knowledge of physical education, kinesiology, motor control, 

and motor learning. Trainers also had experience working with older persons, which they 

generally gained during the course of their academic studies. 

Minimum Level of Training Needed: Trainers need to have a background in 

physical therapy, psychology, sports science, or as a personal trainer. Trainers also need 

to have experience working with older adults and attend a 2-day training session, or 

to attend a comprehensive 4-day training if they do not have experience working with 

older adults. Training should include age-related changes in physical, cognitive and social 

dimensions (e.g., changes in muscle mass, loss of strength and power); fear of falling and 

how to address it; how to perform the strength, balance, and gait training exercises; and 

an introduction to public health theories and models, such as the Health Belief Model.

Key Elements:

•	 Strength, endurance, and functional skill exercises, including balance and gait 

training, should increase in intensity over the duration of the program.

•	 Trainers must attend the program training. 

Available Materials: A course manual has been published in German (Freiberger E, 

Schöne D. Sturzprophylaxe im Alter. Deutscher Aerzteverlag: Köln). In addition, there is a 

German web site with information about fall prevention and trainers’ education at 

www.standfestimalter.de. 

Study Citation: Freiberger E, Menz HB, Abu-Omar K, Rütten A. Preventing falls in 

physically active community-dwelling older people: A comparison of two intervention 

techniques. Gerontology. 2007 Aug;53(5):298-305. 

Supplemental article

Freiberger E, Menz HB. Characteristics of falls in physically active community-dwelling 

older people. Zeitschrift für Gerontologie und Geriatrie. 2006 Aug;39(4):261-7.

Contact

Practitioners interested in using this intervention may contact the principal 

investigator for more information: 

Dr. Ellen Freiberger

Institut für Sportwissenschaft und Sport

Friedrich-Alexander-Universität Erlangen-Nürnberg

Gebbertstrasse 123b, DE-91058, Erlangen, Germany

Tel: +49 9131 852 5464 

Fax: +49 9131 852 5002

E-mail: ellen.freiberger@sport.uni-erlangen.de 
16

Tai Chi: Moving for Better Balance

This study compared the effectiveness of a 6-month program of Tai Chi 

classes with a program of stretching exercises. Participants in the Tai Chi 

classes had fewer falls and fewer fall injuries, and their risk of falling was 

decreased 55 percent. 

Population: Participants were inactive seniors aged 70 or older. Threequarters were female. All participants lived in the community. 

Geographic Locale: Portland, Oregon, United State. 

Focus. Improve balance and physical performance with Tai Chi classes 

designed for older adults.

Program Setting: The Tai Chi programs were conducted in community 

settings such as local senior centers and adult activity centers.

Content: 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. 

Each hour-long session included:

•	 A 5- to 10-minute warm-up period

•	 Practice of Tai Chi movements

•	 A 5- to 10-minute cool-down period

Practicing at home was encouraged and monitored using a home-practice 

log.

Duration: One-hour classes were held 3 times a week for 26 weeks, 

followed by a 6-month period in which there were no organized classes. 

Delivered by: Experienced Tai Chi instructors who followed the classical 

Yang style, which emphasizes multidirectional weight shifting, body 

alignment, and coordinated movement of the arms, legs, and trunk. 

Li, 

et al.
Exercise-based

Interventions

17

Minimum Level of Training Needed: Instructors should be familiar with the 

fundamental principles of Tai Chi and the major postures and movements, be able 

to follow the training protocol, and have experience teaching physical activity to 

older adults.

Key Elements:

•	 Program settings can include facilities such as senior centers, adult activity centers, 

and community centers. 

•	 An average class size of 15 is ideal for effective learning and teaching.

•	 For this program to be successful, participants should attend Tai Chi classes at least 2 

times a week and participate actively in class. 

•	 Tai Chi can also be used in rehabilitative settings where the emphasis is on retraining 

balance in older adults. 

Available Materials: The Tai Chi: Moving for Better Balance program package, 

specifically designed for community-dwelling older adults and senior service providers, is 

available from Dr. Fuzhong Li. The package contains an implementation plan, training 

manuals, and class materials on videotape and/or DVD.

Study Citation: Li F, Harmer P, Fisher KJ, McAuley E, Chaumeton N, Eckstrom E, 

Wilson NL. Tai Chi and fall reductions in older adults: A randomized controlled trial.

Journal of Gerontology. 2005 Feb;60A(2):187-94.

Contact

Practitioners interested in using this intervention may contact the principal 

investigator for more information:

Fuzhong Li, PhD

Oregon Research Institute

1715 Franklin Boulevard

Eugene, OR 97403, United States

Tel: 541-484-2123

E-mail: fuzhongl@ori.org
18

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. Overall, the 

fall rate was 22 percent lower among people who took part in the program, 

and 31 percent lower among participants who had fallen in the previous 

year, compared with those who were not in the program.

Population: 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. 

Geographic Locale: Sydney and Wollongong, Australia

Focus: Increase participants’ strength, coordination, balance and gait, 

and increase their ability to carry out activities of daily living such as rising 

from a chair and climbing stairs. 

Program Setting: Programs were conducted in common rooms in 

residential care community centers and senior centers within the 

retirement villages.

Content: The group classes included weight-bearing exercises and 

balance activities that were challenging but not so difficult as to discourage 

participation or cause any adverse events. The program emphasized social 

interaction and enjoyment. 

The program consisted of 4 successive 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.

Each hour-long class had 3 segments:

•	 A 5- to 15-minute warm-up 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

Lord, 

et al.
Exercise-based

Interventions

19

•	 A 10-minute cool-down period that included muscle relaxation, controlled breathing, 

and guided imagery

Duration: One-hour classes were held twice a week for 12 months. The program 

consisted of 4 successive 3-month terms. 

Delivered by: Six exercise instructors were trained to deliver the program. All had 

previously completed a training course conducted by the Australian Council for Health, 

Physical Education, and Recreation on leading exercise programs for frail, older people. 

The project coordinator regularly observed the instructors to provide support and to 

monitor program fidelity and consistency. 

Everyone involved in implementing the program received specific 1-day training and met 

regularly to discuss issues and training updates. 

Minimum Level of Training Needed: Instructors should have taken an exercise 

instructor course as well as a specific course on teaching exercise to older adults.

Key Elements: Information was not provided by the principal investigator.

Available Materials: No intervention materials were available at the time of publication.

Study Citation: Lord SR, Castell S, Corcoran J, Dayhew J, Matters B, Shan A, 

Williams P. The effect of group exercise on physical functioning and falls in frail older 

people living in retirement villages: A randomized, controlled trial. Journal of the American 

Geriatrics Society. 2003 Dec;51(12):1685-92.

Contact

Practitioners interested in using this intervention may contact the principal 

investigator for more information:

Stephen R. Lord, PhD

Neuroscience Research Australia

Barker Street, Randwick,

Sydney NSW 2031, Australia

Tel: +61 (2) 9399 1061 

Fax: +61 (2) 9399 1005

E-mail: s.lord@neura.edu.au
20

McKiernan Yaktrax® Walker 

This study tested the effectiveness of the 

Yaktrax® Walker, a lightweight traction device 

that fits over shoes, to prevent falls among 

older adults when walking outdoors on ice 

and snow. 

During the winter months, participants in the 

Yaktrax® intervention group were half as likely 

to slip and about 60 percent less likely to fall 

compared to the group that wore their usual 

winter footwear. Participants in the intervention group also experienced significantly fewer minor fall-related injuries. 

Population: Participants were community-dwelling adults aged 65 or 

older who had fallen at least once in the previous year. About 60 percent 

were female. 

Geographic Locale: Rural central and northern Wisconsin, 

United States

Focus: Using a traction device that fits on shoes to improve stability when 

walking on ice and snow. 

Program Setting: Participants used the Yaktrax® Walker on their own in 

the community.

Content: Participants were given a Yaktrax® Walker that was sized to fit 

the external length of their usual winter footwear. Participants had to be 

able to put on the Yaktrax® Walker correctly. 

After reviewing the Yaktrax® Walker instruction manual with participants, 

the research study coordinator spent approximately 30 minutes training the 

participant and then had the participant practice putting on the Yaktrax® 

Walker.

Participants were told to only wear the device outdoors when there was ice 

or snow. They were instructed that the Yaktrax® Walker should never be 

worn indoors or on smooth outdoor non-ice surfaces. 

Duration: This study took place during the winter of 2003–04.

Delivered by: Research study coordinator.

Reprinted with permission of the Yaktrax® 

Walker. Yaktrax® is a Registered Trademark 

of Implus Footcare LLC.
Exercise-based

Interventions

21

Minimum Level of Training Needed: Instructors should read the manual and 

practice putting the Yaktrax® Walker on themselves and others.

Key Elements:

•	 People must be able to safely put on and take off the Yaktrax® Walker or leave the

device on a dedicated pair of shoes or boots that are only worn out of doors.

•	 Shoes should be measured to assure proper fit of Yaktrax® Walker.

•	 Yaktrax® Walker must not be worn indoors.

•	 Yaktrax® Walker should be inspected for breakage and replaced if broken.

Available Materials: Instructions that accompany the device are sufficient for consumer 

use.

Study Citation: McKiernan FE. A simple gait-stabilizing device reduces outdoor falls 

and non-serious injurious falls in fall-prone older people during the winter. Journal of the 

American Geriatrics Society. 2005 Jun;53(6):943-7. 

Contact

Practitioners interested in using this intervention may contact the principal 

investigator for more information: 

Fergus Eoin McKiernan, MD

Center for Bone Diseases

Marshfield Clinic

1000 North Oak Avenue

Marshfield, WI 54449, United States

E-mail: mckiernan.fergus@marshfieldclinic.org 
22

Veterans Affairs Group Exercise 

Program

This study evaluated a structured group exercise program for fall-prone 

older men. During the 3-month program, participants were two-thirds 

less likely to fall compared with those who did not take part in the program.

Note: This study calculated the fall rate as the number of falls per hour of 

physical activity.

Population: All participants were aged 70 or older and lived in the 

community. All were males who had at least 1 of these fall risk factors: leg 

weakness; impaired gait, mobility, and/or balance; and had fallen 2 or more 

times in the previous 6 months. 

Geographic Locale: Los Angeles, California, United States

Focus. Increase strength and endurance and improve mobility and balance 

using a low- to moderate-intensity group exercise program. 

Program Setting: The program was conducted at a Veterans Affairs 

ambulatory care center.

Content:

•	 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 1 to 3 sets of 12 repetitions. Resistance levels also were 

increased progressively. The rate of progression was modified for 

subjects with physical limitations.

•	 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 2 flights of stairs (twice a week). Heart rates 

were monitored to ensure that participants did not exceed 70 percent of 

their heart rate reserve.

•	 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.

Rubenstein, 

et al.
Exercise-based

Interventions

23

Duration: Three 11⁄2-hour sessions a week for 12 weeks. 

Delivered by: Exercise physiology graduate students with training from experienced 

exercise physiologists or physical therapists. 

Minimum Level of Training Needed: Facilitators should have approximately 2 weeks

of on-the-job training by an experienced exercise physiologist or physical therapist.

Key Elements:

•	 Using a group format and providing a wide variety of exercise activities

•	 Focusing on strength, balance, and endurance

•	 Providing personal encouragement and reinforcement

Available Materials: No materials were available at time of publication.

Study Citation: Rubenstein LZ, Josephson KR, Trueblood PR, Loy S, Harker JO, 

Pietruszka FM, Robbins, AS. Effects of a group exercise program on strength, mobility, 

and falls among fall-prone elderly men. Journal of Gerontology: Medical Sciences. 2000 

Jun;55A(6):M317-21.

Contact

Practitioners interested in using this intervention may contact the principal 

investigator for more information:

Laurence Z. Rubenstein, MD, MPH

VA Medical Center, GRECC (11e)

16111 Plummer St.

Sepulveda, CA 91343, United States

Tel: 818-895-9311

Fax: 818-891-8181

E-mail: laurence.rubenstein@va.gov
24

Skelton, 

et al.

Falls Management Exercise (FaME) 

Intervention 

This study examined the effectiveness of an individualized, tailored group 

and home-based exercise intervention designed to improve participants’ 

dynamic balance and core and leg strength, and to recover their ability to 

get down to and up from the floor.

After 36 weeks, the fall rate in the exercise group was reduced by one-third. 

Over the entire study, which included a 50-week follow-up period, the fall 

rate was reduced by 54 percent.

Population: Participants were women aged 65 or older, living 

independently, who had fallen 3 or more times in the previous year. 

Geographic Locale: London, United Kingdom

Focus: Improve balance and strength. 

Program Setting: Group classes were conducted at 4 locations in 

London in Community Leisure Centers (gym facilities that have rooms for 

exercise classes). Home exercises were performed in participants’ homes.

Content: Before starting the program, participants were assessed for 

asymmetry in strength or balance and specific problems with strength, 

balance, and flexibility. Five basic functional tests were used:

•	 Shoulder flexibility

•	 Hamstring flexibility

•	 Timed up and go

•	 180 degree turn

•	 Functional reach

Participants also received a health screening and were evaluated for fear 

of falling (FES-I), fracture risk (Black score), quality of life (SF12), and 

confidence in maintaining balance (ConfBal).

Falls Management Exercise (FaME) group classes are based on the Otago 

Exercise Programme, which includes exercises for endurance and flexibility 

as well as floor exercises. The exercises meet the American College of Sports 

Medicine guidelines for adults over age 65. 

Class exercises were tailored to the abilities of the group and home exercises 

were tailored to each participant’s needs and abilities. All exercises became 
Exercise-based

Interventions

25

more challenging (that is, increased in intensity or difficulty) as the program progressed. 

For example, classes used individualized resistance bands and progressively reduced 

levels of support (seated and supported options moving to unsupported options). Home 

exercises addressed asymmetry in strength or balance by prescribing additional repetitions 

or sets for the weaker side.

Class exercises focused on:

•	 Improving first static then dynamic balance

•	 Muscle and bone strength (e.g., Thera-Bands, free weights, low-impact side stepping

 and standing squats, etc.)

•	 Endurance (e.g., marching, side stepping)

•	 Flexibility of 5 major muscle groups

•	 Gait (e.g., side and backward walking)

•	 Functional skills (e.g., sit to stand)

•	 How to avoid falling (e.g., compensatory stepping)

•	 Functional floor exercises (e.g., crawling, rolling, back extensions, and side leg lifts)

Note: These exercises were introduced after at least 8 weeks of preparatory physical 

therapy to restore the skills needed to get down to and up off the floor. 

The home exercise program consisted of:

•	 Warm-up

•	 10-minute endurance session

•	 Otago exercises along with additional resistance-band strengthening exercises

•	 Developmental flexibility exercises

•	 Cool-down

Participants wore hip protectors during the exercise sessions in group classes and at home 

to reduce the risk of hip fractures. They were not encouraged to wear them at other times.

Duration:

•	 The pre-exercise assessment lasted about 40 minutes. 

•	 One-hour group classes were held once a week for 36 weeks.

•	 30 minutes of home exercises were done twice a week.

Delivered by: Postural Stability Instructors. These are qualified “exercise for the older 

person” instructors, physical therapists, and occupational therapists who have taken the 

5-day training course, “Exercise for the Prevention of Falls and Injuries in Frailer Older 

People.” See standards and requirements in Appendix D-2, Form D514.
26

Minimum Level of Training Needed: The United Kingdom has 

national education standards governing the training content for exercise 

instructors working with special populations, including older people. Further 

information can be found at www.skillsactive.com/training/standards. 

Standards for adapting an exercise program for older adults can be found in 

Appendix D-2, Form D467.

After instructors are trained to work with older people, they can train 

as Postural Stability Instructors, focusing on older people at high risk of 

falling. Physical therapists and occupational therapists do not have to 

become an exercise instructor in order to take this training.

The 5-day training course to become a Postural Stability Instructor is 

considered postgraduate-level training. It involves 54 contact hours of 

theory and practical delivery and 100 noncontact hours. The qualification 

is based on successfully completing a 40-minute practical exam, a case 

study on a faller, and a theoretical paper. 

Additional information about the course content can be found at 

www.laterlifetraining.co.uk/page5.html.

The United Kingdom Chartered Society of Physiotherapists 

endorses the Postural Stability Instructor training course. Additional 

information can be found at www.csp.org.uk/director/members/

careersandprofessionaldevelopment/courses/otherendorsedprogrammes/

laterlifetraining.cfm. 

Key Elements: 

•	 To be successful, the exercise program should last at least 36 weeks.

•	 It should include a minimum of 2 hours per week of combined group 

and home exercises.

•	 Exercise must be progressive, continually increasing in intensity, 

resistance, weight, and challenging balance.

•	 Exercises must be tailored to each individual’s needs and abilities, both 

in group classes and at home. 

It is desirable but not essential to include floor work to reduce fear of 

falling and improve falls self efficacy. 

Available Materials: The participants’ home exercise booklet is 

available at www.ageuk.org.uk/Documents/EN-GB/ID8950%20

Strength%20And%20Balance%20Book.pdf?dtrk=true. 

Information about the accredited Postural Stability Instructor course in the 

United Kingdom is available at www.laterlifetraining.co.uk.
Exercise-based

Interventions

27

The training manual for the Postural Stability Instructor course can be purchased from 

www.laterlifetraining.co.uk.

Study Citation: Skelton D, Dinan S, Campbell M, Rutherford O. Tailored group 

exercise (Falls Management Exercise—FaME) reduces falls in community-dwelling older 

frequent fallers (an RCT). Age and Ageing. 2005 Nov;34(6):636-9. 

Supplemental articles

Skelton DA, Dinan SM. Exercise for falls management: Rationale for an exercise 

program aimed at reducing postural instability. Physiotherapy Theory and Practice. 

1999 Jan;15(2):105-20. Available at: www.laterlifetraining.co.uk/documents/

ExerciseFallsManage.PDF.

Iliffe A, Kendrick D, Morris R, Skelton D, Gage H, Dinan S, Stevens Z, Pearl M, 

Masud T. Multi-centre cluster randomised trial comparing a community group exercise 

programme with home based exercise with usual care for people aged 65 and over in 

primary care: Protocol of the ProAct 65+ trial. Trials. 2010 Jan;11(1):6-10.

Skelton DA, Stranzinger K, Dinan SM, Rutherford O. BMD improvements following 

FaME (falls management exercise) in frequently falling women age 65 and over: An RCT. 

Journal of Aging and Physical Activity. 2008 Jul;16(Suppl):S89-90.

Skelton DA. The Postural Stability Instructor: Qualification in the United Kingdom 

for effective falls prevention exercise. Journal of Aging and Physical Activity. 2004 

Jul;12(3):375-6.

Skelton DA. Effects of physical activity on postural stability. Age and Ageing. 2001 

Nov;30(Suppl 4):33-9.

Contact

Practitioners interested in using this intervention may contact the principal 

investigator for more information:

Dr. Dawn Skelton

Reader in Ageing and Health

School of Health, HealthQWest

A236 Govan Mbeki Building 

Glasgow Caledonian University 

Cowcaddens Road, 

Glasgow G4 0BA, United Kingdom

Tel: +44 (0) 141 331 8792

E-mail: dawn.skelton@manchester.ac.uk 
28

Voukelatos, 

et al.

Central Sydney Tai Chi Trial 

This study evaluated the effectiveness of a community-based Tai Chi 

program to reduce falls among people aged 60 or older. One-hour 

classes were offered once a week for 16 weeks in community settings by 

experienced instructors who taught their regular programs using several 

styles of Tai Chi. 

After the 24-weekfollow-up period, the fall rate among Tai Chi participants 

was one-third lower and the rate of multiple falls was 46 percent lower 

than the rates for participants who did not take Tai Chi.

Population: Participants were healthy people aged 60 or older who lived 

in the community. About 84 percent were female. 

Geographic Locale: Sydney, Australia

Focus: Improve balance and reduce falls.

Program Setting: Tai Chi classes were conducted at community 

locations such as town halls and senior centers. Locations were chosen 

based on accessibility (e.g., accessible by public transportation, room 

accessible without climbing stairs), geographic diversity, and options for 

no- or low-cost sustainability after the study was completed. 

Content: The majority of classes used modified Sun-style Tai Chi 

although a small proportion used Yang-style Tai Chi or a mixture of several 

styles. Detailed information about Tai Chi styles was not collected.

Instructors followed a set of guidelines that focused on teaching physical 

activity to older people and contained suggestions about how to 

incorporate key elements, such as relaxation, into the Tai Chi program. 

Some classes had the option to buy a video and/or booklet about the type 

of Tai Chi they were learning.

Duration: One-hour per week for 16 weeks.

Delivered by: Experienced Tai Chi instructors or instructors experienced 

in teaching physical activity to older people.

Minimum Level of Training Needed: Instructors must have at 

least 5 years experience as a Tai Chi instructor or have experience teaching 

physical activity to older people and attend an intensive weekend 

workshop about the basic principles of Tai Chi.
Exercise-based

Interventions

29

Key Elements: 

•	 Limit class size to 12 people to maximize the attention each participant can get from

 the instructor.

•	 Incorporate relaxation and lowered center of gravity exercises into each class.

•	 It is important that participants maintain an upright (straight) posture at all times 

to reduce the risk of falling. Forms of Tai Chi that require participants to squat 

while moving or to get into positions that are not totally upright should be modified 

appropriately.

•	 Instructors need to be aware of participants’ comfort levels as well as any medical or

 physical conditions that may limit their ability to perform certain Tai Chi movements.

•	 Tai Chi movements should be introduced gradually so that participants are not 

 exposed to too many new movements at once.

Available Materials: 

•	 Tai Chi Principles for Falls Prevention in Older People*

•	 Guidelines for Instructors Working with Older People* 

*See Appendix D-3.

Study Citation: Voukelatos A, Cumming RG, Lord SR, Rissel C. A randomized, 

controlled trial of Tai Chi for the prevention of falls: The Central Sydney Tai Chi trial. 

Journal of the American Geriatrics Society. 2007 Aug;55(8):1185-91. 

Supplemental article

Voukelatos A. The Central Sydney Tai Chi trial: A randomized controlled trial 

investigating the effectiveness of Tai Chi in reducing falls in older people. PhD thesis, 

University of Sydney, 2010.

Contact

Practitioners interested in using this intervention may contact the principal 

investigator for more information:

Alexander Voukelatos, PhD

Sydney Southwest Area Health Promotion Service

Level 9 (North), KGV building

Missenden Road, Camperdown 

New South Wales 2050, Australia

E-mail: avouk@email.cs.nsw.gov.au
30

Simplified Tai Chi

This study compared a 15-week program of Tai Chi classes that

used 10 simplified movements, with a balance training program. 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.

Population: All were 70 years or older and lived in the community. 

Most study participants were female. 

Geographic Locale: Atlanta, Georgia, United States

Focus: Improve strength, balance, walking speed, and other functional 

measures among seniors using Tai Chi.

Program Setting: The program used facilities in a residential 

retirement community.

Content: Participants were taught a simplified version of Tai Chi. The 

108 existing Tai Chi forms were synthesized into a series of 10 composite 

forms (see Appendix D-4) that could be completed during the 15-week 

period. The composite forms emphasized all elements of movement that 

generally become limited with age. 

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.

Example of a simplified Tai Chi form:

Wolf, 

et al.
Exercise-based

Interventions

31

Duration: 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

Delivered by: A Tai Chi Quan grand master with 50 years of experience instructed the 

classes and met individually with participants. A nurse/coordinator maintained contact 

with participants to ensure their participation. 

Minimum Level of Training Needed: Information was not provided by the 

principal investigator.

Key Elements: This program needs to be led by a very experienced Tai Chi grand 

master. No elements should be changed in order to replicate these results among seniors 

who are similar to study participants.

Available Materials: Illustrations of the 10 Tai Chi exercises are found in 

Appendix D-4.

Study Citation: Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T. 

Reducing frailty and falls in older persons: An investigation of Tai Chi and computerized 

balance training. Journal of the American Geriatrics Society. 1996 May;44(5):489-97.

Supplemental article

Wolf SL, Coogler C, Xu T. Exploring the basis for Tai Chi Chuan as a therapeutic exercise 

approach. Archives of Physical Medicine and Rehabilitation. 1997 Aug;78(8):886-92.

Contact

Practitioners interested in using this intervention may contact the principal 

investigator for more information:

Steven L. Wolf, PhD, PT, FAPTA

Department of Rehabilitation Medicine

Emory University School of Medicine

1441 Clifton Road NE

Atlanta, GA 30322, United States

Tel: 404-712-4801

Fax: 404-712-5895

E-mail: swolf@emory.edu

The VIP Trial (Campbell, et al.) ..........................................................................................34 

Home Visits by an Occupational Therapist (Cumming, et al.).............................................36

Falls-HIT (Home Intervention Team) Program (Nikolaus, et al.)....................................... 38

Home Modification

 Interventions
34

The VIP Trial 

This study looked at the effectiveness of 2 interventions to reduce falls and 

fall injuries in older people with poor vision. The home safety program 

consisted of a home hazard assessment by an occupational therapist 

followed by home modifications and recommendations for behavior 

change. The home exercise program consisted of a combination of strength 

and balance exercises (the Otago Exercise Programme modified for people 

with poor vision) plus vitamin D supplements. 

Only the home safety program was effective in reducing falls. The home 

safety group had 61 percent fewer falls and 44 percent fewer injuries 

compared to those who received social visits.

Population: Participants were community-dwelling seniors aged 75 or 

older with poor vision. Two-thirds of the participants were female.

Geographic Locale: Dunedin and Auckland, New Zealand

Focus. Assess and reduce home hazards and encourage changes in 

behavior. 

Program Setting: The program took place in participants’ homes.

Content: An occupational therapist conducted a home safety assessment 

and made suggestions for modifications. The assessment consisted of a 

walk-through of the participant’s home using a checklist to identify hazards 

as well as a discussion about items, behavior, or lack of equipment that 

could lead to falls. The occupational therapist and participant then agreed 

on which recommendations to implement. 

The occupational therapist helped the participant obtain any necessary 

equipment and oversaw payment for the home modifications. Home 

modifications and equipment costing more than NZ$200 were funded by 

the local Board of Health and items costing less than this were funded by 

the participant or from research funds. The occupational therapist made a 

follow-up visit if equipment needed to be installed. 

Duration: The intervention consisted of 1 or 2 home visits. The first visit 

lasted about 2 hours. If the occupational therapist needed to approve new 

equipment, they made a second visit 2 to 3 weeks later. The second visit 

lasted about 45 minutes. 

Delivered by: Occupational therapists who attended a 2-day training 

course.

Campbell,

et al.
Home 

Modification

Interventions

35

Minimum Level of Training Needed: One half-day training is necessary for 

occupational therapists to become familiar with the specific focus on falls prevention in 

people with poor vision. 

Key Elements: 

•	 The occupational therapist’s advice rather than the environmental changes was key.

•	 A trained and experienced occupational therapist is critical to the success of this 

intervention.

Available Materials: The Westmead Home Safety Assessment checklist is available but not 

the modified version used in the VIP trial.

Clemson L. Home fall hazards: A guide to identifying fall hazards in the homes of elderly 

people and an accompaniment to the assessment tool, the Westmead Home Safety Assessment 

(WeHSA). West Brunswick, Victoria: Co-ordinates Publications, 1997.

Study Citation: Campbell AJ, Robertson MC, La Grow SJ, Kerse NM, Sanderson 

GF, Jacobs RJ. Randomised controlled trial of prevention of falls in people aged 

≥75 with severe visual impairment: The VIP trial. British Medical Journal. 2005 Oct 

8;331(7520):817-25. 

Supplemental article

La Grow SJ, Robertson MC, Campbell AJ, Clarke GA, Kerse NM. Reducing hazard 

related falls in people 75 years and older with significant visual impairment: How did a 

successful program work? Injury Prevention. 2006 Oct;12(5):296-301.

Contact

Practitioners interested in using this intervention may contact the principal 

investigator for more information:

A. John Campbell, MD

Department of Medical and Surgical Sciences

Dunedin School of Medicine

Dunedin, New Zealand

E-mail: john.campbell@otago.ac.nz
36

Home Visits by an Occupational 

Therapist

This intervention used an occupational therapist (OT) who visited 

participants in their homes, identified environmental hazards and unsafe 

behaviors, and recommended home modifications and behavior changes. 

Fall rates were reduced by one-third but only among men and women who 

had experienced 1 or more falls in the year before the study. 

Population: All participants were 65 or older and lived in the 

community. More than half of the participants were female.

Geographic Locale: Sydney, Australia 

Focus: Assess and reduce home hazards.

Program Setting: The program was conducted in participants’ homes.

Content: The OT visited each participant’s home and conducted an 

assessment using the standardized Westmead Home Safety Assessment form 

(see Available Materials below). 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. 

Based on standard occupational therapy principles, the therapist 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.

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. 

Cumming,

et al.
Home 

Modification

Interventions

37

Duration: One-hour home visit with a follow-up telephone call 2 weeks later. Total 

contact time was approximately 2 hours.

Delivered by: An occupational therapist with 2 years experience. 

Minimum Level of Training Needed: A degree in occupational therapy is 

the minimum qualification needed to conduct the home assessments, develop the 

recommendations, and supervise the home modifications. 

Key Elements: 

•	 Using an experienced occupational therapist is critical.

•	 These researchers emphasized that this study should not be used to justify widespread, 

untargeted home modification programs implemented by people who do not have 

skills in caring for older people.

Available Materials: Information on the falls prevention kit, which includes the 

Westmead Home Safety Assessment form and a booklet that gives background information 

on falls and hazards can be purchased from the following company:

Co-ordinates Therapy Services

PO Box 59, West Brunswick

Victoria 3055, Australia

Tel: +61 (3) 9380 1127

Fax: +61 (3) 8080 5996

E-mail: jenny@therapybookshop.com

Study Citation: Cumming RG, Thomas M, Szonyi M, Salkeld G, O’Neill E, 

Westburg C, Frampton G. Home visits by an occupational therapist for assessment and 

modification of environmental hazards: A randomized trial of falls prevention. Journal of 

the American Geriatrics Society. 1999 Dec;47(12):1397-1402.

Contact

Practitioners interested in using this intervention may contact the principal 

investigator for more information:

Robert G. Cumming, PhD

School of Public Health, Building A27

University of Sydney

Sydney NSW 2006, Australia

Tel: +61 (2) 9036 6407

Fax: +61 (2) 9351 5049

E-mail: robert.cumming@sydney.edu.au
38

Falls-HIT (Home Intervention Team) 

Program

This 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. The fall rate for participants was 

reduced 31 percent. The intervention was most effective among those who 

had experienced 2 or more falls in the previous year; the fall rate for these 

participants was reduced 37 percent.

Population: 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 or older and lived in the community. 

Three-quarters were female. 

Geographic Locale: Mid-sized town, Southern Germany 

Focus: Assess and reduce fall hazards in participants’ homes.

Program Setting: Intervention team members contacted patients once 

or twice while they were hospitalized to explain the program. The program 

took place in participants’ homes.

Content: 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. 

During 2 to 3 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 

Nikolaus,

et al.
Home 

Modification

Interventions

39

Duration: The program consisted of 2 or more home visits, each lasting about 

11/2 hours. After the participant was discharged from the hospital, 3 home visits typically 

were needed to provide advice on recommended home modifications and to teach the 

participant how to use safety devices and mobility aids. On average, the total individual 

contact time was 8 hours.

Delivered by: The home intervention team was composed of a physical therapist, 

occupational therapist, 3 nurses, a social worker, and a secretary. Occupational therapists 

generally worked with all participants. Depending on individual need, either a physical 

therapist or nurse also helped the participant. The social worker was available to provide 

information about ambulatory services and to help participants complete applications for 

additional money from the mandatory care insurance. 

Minimum Level of Training Needed: Information was not provided by the 

principal investigator. 

Key Elements: Participants met all intervention team members at the hospital before 

they were discharged, which facilitated follow-up.

Available Materials: A standardized home safety checklist is available in German only.

Study Citation: Nikolaus T, Bach M. Preventing falls in community-dwelling frail 

older people using a home intervention team (HIT): Results from the randomized 

falls-HIT trial. Journal of the American Geriatrics Society. 2003 Mar;51(3):300-5.

Contact

Practitioners interested in using this intervention may contact the principal 

investigator for more information:

Thorsten Nikolaus, MD 

Medical Director/CEO

Bethesda Geriatric Clinic and Professor of Geriatric Medicine

University of Ulm

Zollernring 26, 89073 Ulm, Germany

Tel: +49 731 187 185

Fax: +49 731 187 389

E-mail: thorsten.nikolaus@bethesda-ulm.de

Stepping On (Clemson, et al.)............................................................................................ 42

PROFET (Prevention of Falls in the Elderly Trial) (Close, et al.)........................................ 46

Accident & Emergency Fallers (Davison, et al.)...................................................................48

The NoFalls Intervention (Day, et al.) ................................................................................ 52

The SAFE Health Behavior and Exercise Intervention (Hornbrook, et al.) ..........................56

Multifactorial Fall Prevention Program (Salminen, et al.) ....................................................60

The Winchester Falls Project (Spice, et al.) ..........................................................................64

Yale FICSIT (Frailty and Injuries: Cooperative Studies of Intervention 

 Techniques) (Tinetti, et al.) ............................................................................................ 68

A Multifactorial Program (Wagner, et al.)............................................................................72

Multifaceted

Interventions
42

Stepping On

This study used a series of small group sessions to teach fall prevention 

strategies to community-dwelling older adults. The fall rate among 

participants was reduced about 30 percent 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.

Population: Participants were individuals who had fallen in the previous 

year or who were concerned about falling. All were 70 or older and lived in 

the community. Most study participants were female. 

Geographic Locale: Sydney, Australia 

Focus: Improve self-efficacy, empower participants to make better 

decisions and learn about fall prevention techniques, and make 

behavioral changes. 

Program Setting: Initial sessions were conducted in easily accessible 

community settings. Refreshments were provided before and after the 

sessions to give participants an opportunity to talk to each other and with 

the facilitators and content experts. Follow-up visits took place in the 

participants’ homes. 

Content: 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; introducing balance and strength exercises

•	 Session 2: Review and practice exercises; 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; safe footwear 

and clothing

•	 Session 5: Poor vision and fall risk; the benefits of vitamin D, calcium, 

and hip protectors

Clemson,

et al.
Multifaceted

Interventions

43

•	 Session 6: Medication management; review of exercises; more strategies for moving 

safely in the community

•	 Session 7: Review of topics covered in program

•	 Follow-up home visit: Review fall prevention strategies; assist with home adaptations 

and modifications, if needed

•	 Three-month booster session: Review achievements and how to maintain motivation

Duration: 

•	 Seven weekly 2-hour program sessions

•	 A 1- to 11⁄2-hour home visit, 6 weeks after the final session

•	 A 1-hour booster session 3 months after the final session

Delivered by: An occupational therapist (OT) facilitated the program and conducted 

the home visits. 

A team of content experts, trained by the OT and guided by the Stepping On manual, 

led the sessions. These included:

•	 A physical therapist who introduced the exercises and led a segment on moving 

about safely.

•	 An OT who led segments on home safety, community safety, behavioral methods to 

sleeping better, and hip protectors.

•	 An older adult volunteer from the Roads and Traffic Authority who spoke on 

pedestrian safety.

•	 A retired volunteer nurse from the Medicine Information Project who discussed how 

to manage medications.

•	 A mobility officer from the Guide Dogs who spoke on coping with low vision (The 

Stepping On manual has a topics section that outlines the information required to run 

this session).

Minimum Level of Training Needed: The program should be facilitated by a 

health professional with experience both in group work and in working with older adults 

in community settings. 

This program requires a physical therapist, an OT, a person trained in road safety for 

older drivers who can discuss pedestrian safety, a low vision expert, and a nurse or 

community pharmacist who can discuss medications. Other potentially useful content 

experts include a podiatrist or perhaps a nutritionist. All content experts need to receive 

training in fall prevention. 
44

Key Elements: Using content experts is critical. It is also important to 

let each expert know what is expected of them, to provide feedback, and to 

make sure each focuses on fall prevention. 

The Stepping On manual is essential for all program facilitators and 

provides a step-by-step guide to running the 7-week group program. It 

outlines topic areas and provides the background information for each 

content expert. 

Chapters include: 

•	 Essential background information for understanding the conceptual 

underpinning of the program and the group process

•	 Valuable content information for all the key fall prevention areas that 

can be used to train local experts participating in the program

•	 A guide to useful resources

•	 Handouts for group participants

•	 Ideas on recruitment and evaluation

Work is ongoing to develop training workshops and certification for 

Stepping On program leaders. 

Available Materials: The program manual Stepping On: Building 

Confidence and Reducing Falls. A Community-Based Program for Older People

by Dr. Lindy Clemson is available at 

Freiberg Press Inc.

PO Box 612

Cedar Falls, IA 50613, United States

E-mail: bfreiberg@cfu.net

Study Citation: Clemson L, Cumming RG, Kendig H, Swann M, 

Heard R, Taylor K. The effectiveness of a community-based program for 

reducing the incidence of falls in the elderly: A randomized trial. Journal of 

the American Geriatrics Society. 2004 Sep;52(9):1487-94.
Multifaceted

Interventions

45

Contact

Practitioners interested in using this intervention may contact the principal 

investigator for more information:

Lindy Clemson, PhD

Associate Professor in Ageing, Head of Discipline (Occupational Therapy)

Faculty of Health Sciences, The University of Sydney

Cumberland Campus, PO Box 170 

Lidcombe 1825, Australia

Tel: +61 (2) 9351 9372

Fax: +61 (2) 9351 9166

E-mail: lindy.clemson@sydney.edu.au
46

PROFET (Prevention of Falls in the 

Elderly Trial) 

This intervention provided medical assessments for fall risk factors with 

referrals to relevant services and an occupational therapy home hazard 

assessment with recommendations for home modifications. After 12 months,

those in the intervention group were 60 percent less likely to fall once and 

67 percent less likely to fall repeatedly (at least 3 times), compared with 

those who did not receive the intervention.

Population: Participants were seniors who had been treated for a fall in a 

hospital emergency department. All were aged 65 or older and lived in the 

community. Two-thirds of participants were female. 

Geographic Locale: London, United Kingdom 

Focus: Identify medical risk factors and home hazards, and provide referrals

and/or recommendations to reduce fall risk and improve home safety. 

Program Setting: The medical assessment took place in an outpatient 

hospital clinic. The occupational therapy assessment took place in 

participants’ homes. 

Content: The 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, as appropriate, based on identified risk factors. 

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. 

Duration: The average length of the medical assessment was 45 minutes. 

The average length of the home assessment was 60 minutes.

Delivered by: A physician specializing in geriatrics conducted the 

medical assessment. An OT delivered the home hazard assessment. 

Close,

et al.
Multifaceted

Interventions

47

Minimum Level of Training Needed: This program could be implemented by:

•	 Appropriately trained geriatricians

•	 General practitioners with a strong interest in older adult health

•	 Trained physical therapists or nurses with the support of a general practitioner in case 

medication modification, referrals to specialists, or other medical services were required

Key Elements: For medication review and modification, a medical specialist rather 

than a general practitioner is recommended. 

Available Materials:

•	 Folstein mini-mental state examination (see Supplemental articles)

•	 Modified Geriatric Depression Scale (see Supplemental articles)

•	 Snellen vision assessment chart

•	 Medical assessment form*—the form used in the outpatient hospital clinic setting 

•	 Accident and emergency assessment tool*—the instrument used in the emergency 

department to identify people at high risk of falling and those who should be referred 

for a comprehensive geriatric assessment

•	 Environmental hazards checklist*—the checklist used to guide the home assessment

* See Appendix D-5.

Study Citation: Close J, Ellis M, Hooper R, Glucksman E, Jackson S, Swift C. 

Prevention of Falls in the Elderly Trial (PROFET): A randomised controlled trial. 

Lancet.1999 Jan 9;353(9147):93-7.

Supplemental articles

Folstein MF, Folstein SE, McHugh PR. “Mini-mental state.” A practical method for 

grading the cognitive state of patients for the clinician. Journal of Psychiatric Research.

1975 Nov;12(3):189-98.

Sheikh J, Yesavage J. Geriatric Depression Scale (GDS): Recent evidence and 

development of a shorter version. Clinical Gerontology. 1986;5(1/2):165-72. 

Contact

Practitioners interested in using this intervention may contact the principal 

investigator for more information: 

Jacqueline Close, MD

Neuroscience Research Australia

Barker Street, Randwick

Sydney NSW 2031, Australia

Tel: +61 (2) 9399 1055

Fax: +61 (2) 9399 1005

E-mail: j.close@neura.edu.au
48

Accident & Emergency Fallers 

This multifaceted intervention was designed for people who fell repeatedly. 

Participants received a medical fall risk assessment by a geriatrician at 

the hospital and had in-home assessments by physical and occupational 

therapists. Each participant received an individualized intervention 

designed to reduce their fall risk factors. 

After 12 months, the fall rate in the intervention group was 36 percent 

lower than the rate in the comparison group. 

Population: Participants were men and women aged 65 or older. All had 

experienced at least 1 fall in the past year and also had been treated in the 

emergency department for another fall or fall injury. About three-quarters 

of participants were female. 

Geographic Locale: Newcastle, United Kingdon

Focus: Identify and modify each participant’s fall risk factors. 

Program Setting: The medical assessment was conducted in a hospital 

and the physical therapy and home assessments were conducted in 

participants’ homes. 

Content: After taking a medical and fall history, a physician conducted 

a full clinical examination that included vision, medication review, a 

neurological examination, and a cardiovascular assessment. Postural blood 

pressure was assessed and laboratory tests and an electrocardiogram were 

performed. 

Interventions for identified fall risk factors followed recognized treatment 

recommendations. Each participant was referred to relevant specialists as 

needed, such as to an optometrist for vision correction or cataract removal; 

given advice or medication to reduce orthostatic hypotension; and had 

medications associated with falls stopped, reduced, or modified.

The physical therapist evaluated each participant’s gait and balance and, if 

necessary, provided gait re-education and the functional training program 

used in the Yale FICSIT (Frailty and Injuries: Co-operative Studies of 

Intervention Studies) study (See Koch, et al. and Tinetti, et al. under 

Supplemental articles). The main intervention was exercise to strengthen 

the proximal leg muscles and ankle dorsiflexion muscles. If needed, 

Davison, 

et al.
Multifaceted

Interventions

49

participants were given assistive devices, had their footwear modified or replaced, and 

were referred to a podiatrist.

An occupational therapist used a room-by-room environmental fall hazard checklist, 

the User Safety and Environmental Risks (USER) checklist, to identify potential hazards 

throughout the home including the kitchen, bathroom, bedroom, and stairs (See 

Hagedorn, et al. under Supplemental articles). Specific areas included the position and 

condition of furniture, cabinets and shelving heights, loose rugs and tripping hazards, 

grab bars and handrails, toilet height, and lighting (including the use of night lights).

Environmental interventions followed published criteria (See Tideiksaar under 

Supplemental articles) and included advice about reducing home hazards as well as 

suggestions for specific home modifications.

Duration: On average, participants visited the hospital twice for the medical 

intervention. The initial hospital assessment took 1 hour and the medical intervention 

visit was 20 minutes. Participants received 2 physical therapy intervention visits; the 

initial physical therapy assessment took 45 minutes and the intervention lasted 15 

minutes. The occupational therapy visit took 45 minutes and the follow-up visit about 1 

month later lasted 20 minutes.

Delivered by: A physician performed the medical assessments and made appropriate 

referrals to specialists; a physical therapist conducted the gait and balance assessment and 

re-education; and an occupational therapist conducted the home hazard assessment and 

recommended home modifications. 

Minimum Level of Training Needed: This intervention requires a variety of highly 

trained health care professionals. Complex individualized interventions of this type 

cannot be implemented by individuals with lower levels of training. 

Key Elements: Multifactorial assessments and interventions conducted by highly 

trained individuals in each of the 3 disciplines. 

Available Materials: No additional materials are available.

Study Citation: Davison J, Bond J, Dawson P, Steen IN, Kenny RA. Patients with 

recurrent falls attending accident and emergency benefit from multifactorial intervention: 

A randomised controlled trial. Age and Ageing. 2005 Mar;34(2):162-8.

Supplemental articles

Koch M, Gottschalk M, Baker DI, Palumbo S, Tinetti ME. An impairment and disability 

assessment and treatment protocol for community-living elderly persons. Physical Therapy. 

1994 Apr;74(4):286-94.
50

Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett, P, Gottschalk M, 

Koch ML, Trainor K, Horwitz RI. A multifactorial intervention to reduce 

the risk of falling among elderly people living in the community. New 

England Journal of Medicine. 1994 Sept 29;331(13):821-7.

Hagedorn R, McLafferty S, Russell D. The User Safety and Environmental 

Risk Checklist (USER). In: Anonymous falls: Screening and risk assessment 

for older people in the community. Worthing Priority Care NHS Trust. 

1998:48-57.

Tideiksaar R. Preventing falls: Home hazard checklists to help older 

patients protect themselves. Geriatrics. 1986 May;41(5):26-8.
Multifaceted

Interventions

51

Contact

Practitioners interested in using this intervention may contact the principal 

investigator for more information: 

Dr. John Davison

Falls and Syncope Service and Institute for Ageing & Health

Royal Victoria Infirmary

Newcastle upon Tyne NEI 4LP, United Kingdom

Fax: (+44) 191 222 5638

E-mail: john.davison@ncl.ac.uk 
52

The NoFalls Intervention

This study looked at the effectiveness of group-based exercise in preventing 

falls when used alone or in combination with vision improvement and/or 

home hazard reduction. The intervention components focused on 

increasing strength and balance, improving poor vision, and reducing 

home hazards. 

The group-based exercise was the most potent single intervention; when 

used alone, it reduced the fall rate by 20 percent. 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 3 components were 

one-third less likely to fall.

Population: All participants were aged 70 and older and lived in the 

community. Sixty percent were female. 

Geographic Locale: City of Whitehorse, Melbourne, Australia 

Focus: Increase strength and balance, improve poor vision, and 

reduce home hazards. 

Program Setting: 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.

Day, 

et al.
Multifaceted

Interventions

53

Content: 

Exercise: 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.

Vision improvement: 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 4 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. 

A referral was recommended if:

(1) A potential visual deficit was identified and the participant was not already 

receiving treatment, or 

(2) 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.

Home hazard reduction: The home hazard assessment consisted of a walk-through 

using a checklist for those rooms used in a normal week. The checklist included a 

comprehensive section defining the different 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, etc.), 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. 

After the assessment, the results were discussed with the participant and potential 

interventions described in 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 participant, their family, 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. 
54

Duration: 

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.

Delivered by: 

Exercise: Classes were led by trainers who were accredited to lead exercise 

classes for older adults, and were trained in the NoFalls program by the 

physical therapist who designed the program.

Vision improvement: Initial assessment was conducted by nurses with up 

to a half-day training required on the vision assessment. Detailed vision 

assessment was conducted by each participant’s usual eye care provider, 

general practitioner, local optometrist, or ophthalmologist.

Home hazard reduction: Home assessments were conducted by research 

nurses who followed the study protocol for assessment with 1 day of 

training required on the home hazard assessment. Modifications were 

undertaken by participants, their family or a private contractor, or by the 

City of Whitehorse home maintenance program.

Minimum Level of Training Needed: Exercise: Requires a basic level 

of exercise leadership training such as that received by a physical therapist 

or certified fitness instructor. 

Vision and home hazard assessments: Nurses or other allied health 

professionals with the appropriate training. 

Key Elements: Although the most effective single component was 

the NoFalls exercise program, the complete program should be followed 

because partial implementation may not reduce falls.
Multifaceted

Interventions

55

Available Materials: The NoFalls exercise program manual, which was developed 

for trained professionals, is available free of charge in electronic format at 

www.monash.edu.au/muarc/projects/nofalls/.

These researchers have not made the home assessment protocol available because this 

intervention component by itself was not effective. 

Study Citation: Day L, Fildes B, Gordon I, Fitzharris M, Flamer M, Lord S. 

Randomised factorial trial of falls prevention among older people living in their own 

homes. British Medical Journal. 2002 Jul 20;325(7356):128-33.

Contact

Practitioners interested in using this intervention may contact the principal 

investigator for more information:

Lesley Day, PhD, MPH

Accident Research Centre

Building 70, Monash University

Wellington Road

Clayton Victoria 3800, Australia

Tel: +61 (3) 9905 1811

Fax: +61 (3) 9905 1809

E-mail: NoFalls.enquire@general.monash.edu.au
56

The SAFE Health Behavior and 

Exercise Intervention 

The Study of Accidental Falls in the Elderly (SAFE) health behavior intervention was a program of 4 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 with guidance and assistance in 

reducing fall hazards.

Overall, participants were 15 percent less likely to fall compared with 

those who did not receive the intervention. Male participants showed 

the greatest benefit.

Population: All were participants were 65 or older and lived in the 

community. About 60 percent of participants were female. 

Geographic Locale: Portland, Oregon, and Vancouver, Washington, 

United States 

Focus: Reduce risky behaviors, improve physical fitness through exercise, 

and reduce fall hazards in the home.

Program Setting: No information was available on where risk 

education and group exercise classes took place. Home safety inspections 

were conducted in participants’ homes.

Content: The SAFE health behavior intervention consisted of 4 11⁄2-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

Hornbrook,

et al.
Multifaceted

Interventions

57

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 

3 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 his or her home. 

After the 4 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.

Duration: 

•	 Two home visits, each lasting about 15 minutes

•	 Four weekly 11⁄2-hour classes (including 20 minutes of supervised exercise) over a 

1-month period

Delivered by: 

•	 The home inspection was performed by a BA-level home assessor who was trained during

a 2-day program that included practice assessments of elderly volunteers’ homes.

•	 The fall prevention program and exercise sessions were delivered by MA-level lifestyle 

change experts with various backgrounds including health behavior change and sports 

training. Each group meeting was conducted by a team consisting of a lifestyle change 

expert and a physical therapist. 

Minimum Level of Training Needed: Information was not provided by the 

principal investigator.
58

Key Elements: Information was not provided by the principal 

investigator.

Available Materials: No intervention materials were available for 

distribution at the time of publication. Please contact the principal 

investigator for information on how to obtain the exercise manual.

Study Citation: Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, 

Greenlick MR, Ory MG. Preventing falls among community-dwelling 

older persons: Results from a randomized trial. The Gerontologist. 1994 

Feb;34(1):16-23.
Multifaceted

Interventions

59

Contact

Practitioners interested in using this intervention may contact the principal 

investigator for more information:

Mark C. Hornbrook, PhD

Chief Scientist

The Center for Health Research, NW/HI/SE

Kaiser Permanente Northwest

3800 North Interstate Avenue

Portland, OR 97227-1110, United States

Tel: 503-335-6746

Fax: 503-335-2428

E-mail: mark.c.hornbrook@kpchr.org
60

Multifactorial Fall Prevention 

Program 

This multifaceted fall intervention consisted of a geriatric fall risk 

assessment with counseling and guidance in fall prevention; home hazards 

assessment and modification; group and home-based exercise; group 

lectures on topics related to fall prevention; and monthly participation in a 

psychosocial group. 

The intervention did not reduce falls overall. However, falls were decreased 

41 percent in participants who had experienced 3 or more falls in the 

previous year and 50 percent in participants with more symptoms of 

depression. 

Population: Participants were seniors aged 65 or older who lived in the 

community or in housing that provided occasional assistance, had no or 

little cognitive impairment, and had experienced at least 1 fall in the past 

year. Eighty-four percent of participants were female.

Geographic Locale: Pori, Finland 

Focus: Assess and address each participant’s specific fall risk factors, 

improve physical fitness, provide information and counseling on fall 

prevention, assess and modify home hazards, and provide psychological 

support.

Program Setting: The fall risk assessment, counseling, and group 

exercise classes were conducted in the Pori Health Center or at home for 

those participants living in assisted housing. Lectures and psychosocial 

groups were held in a senior center. The home-based exercises and home 

assessment were carried out in participants’ homes. 

Content: A geriatrician assessed each participant for medical factors that 

could increase their risk of falling such as disorders affecting balance and 

gait, the use of psychoactive medications, depression, and poor eyesight. 

If needed, referrals were made to an ophthalmologist for vision correction 

and to the primary care physician for follow-up on recommended 

medication changes. All participants who were not already taking calcium 

and vitamin D supplements were prescribed 500 mg calcium and 400 IU 

of vitamin D per day.

Salminen,

et al.
Multifaceted

Interventions

61

A public health nurse provided oral and written information about reducing personal fall 

risk factors as well as facts about safe environments, healthy diets, calcium and vitamin D 

supplements, and the use of hip protectors. 

Trained nursing students conducted home hazard assessments using a detailed form. 

Participants were given oral and written instructions for safety modifications. A follow-up 

of the home modifications was made 1 year later. 

A physical therapist led a group exercise class every 2 weeks. This included:

•	 5 minutes of warm-up 

•	 15 minutes of balance, coordination, and weight-shifting exercises. Each exercise was 

performed for 45 seconds followed by 30 seconds of rest. 

•	 20 minutes of circuit training for muscle strength. Two to 4 circuits were performed 

with 3 to 5 minutes of rest between circuits.

•	 5 to 10 minutes of cool-down

The intensity of the exercises was increased progressively over time, based on the physical 

therapist’s judgment of each person’s fitness level. 

Participants also performed similar exercises at home 3 times a week. Participants received 

written information on performing home exercises based on the physical therapist’s 

judgment of their physical condition.

Once a month, a lecture was given by a health professional on various topics including 

causes of falling, fall prevention, medications that can increase fall risk, nutrition, 

exercise, and home hazards.

Also once a month, participants attended a psychosocial group that provided recreational 

activities (e.g., discussing various topics such as news headlines, a musical performance, 

memory disorders, or exercise; reading poetry) and psychological support. 

Duration: 

•	 45-minute fall risk assessment 

•	 45-minute home hazard assessment

•	 45-minute information and counseling session 

•	 45- to 50-minute group exercise class once every 2 weeks plus 25 minutes of exercise

 at home 3 times per week 

•	 1-hour health lecture once a month

•	 1-hour psychosocial group session once a month 

Delivered by: A geriatrician conducted the fall risk assessment; a trained public 

health nurse provided information and counseling on fall prevention; trained nursing 

students conducted the home hazards assessment and psychosocial group sessions; a 
62

physical therapist facilitated the group exercise sessions; and various health 

professionals (e.g., geriatricians, public health nurses, physical therapists, 

dieticians, podiatrists) gave lectures on topics related to falling. 

Minimum Level of Training Needed: Risk assessments can be 

conducted by a trained nurse with referrals, if needed, to a general 

practitioner who specializes in geriatrics. Exercise groups can be supervised 

by a well-trained volunteer or physical therapy student.

Key Elements:

•	 Individual risk factor assessment, treatment, and/or referral by a 

physician

•	 Exercise classes led by a trained physical therapist or physical therapy

 student, combined with at-home exercises tailored to each participant

•	 Exercise intensity must increase progressively over time

•	 Monthly lectures by various health professionals on topics related to

 falling, followed by a question and answer period 

•	 Individual guidance on fall prevention

•	 Home hazards assessment and written safety recommendations

•	 Monthly psychosocial group sessions

Available Materials: Materials are available only in Finnish.

Study Citation: Salminen MJ, Vahlberg TJ, Salonoja MT, Aarnio PTT, 

Kivelä SL. Effect of a risk-based multifactorial fall prevention program 

on the incidence of falls. Journal of the American Geriatrics Society. 2009 

Apr;57(4):612-9. 

Supplemental articles

Sjösten NM, Salonoja M, Piirtola M, Vahlberg T, Isoaho R, Hyttinen H, 

Aarnio P, Kivelä SL. A multifactorial fall prevention programme in homedwelling elderly people: A randomized-controlled trial. Public Health. 2007 

Apr;121(4):308-18.

Sjösten NM, Salonoja M, Piirtola M, Vahlberg TJ, Isoaho R, Hyttinen 

HK, Aarnio PT, Kivelä SL. A multifactorial fall prevention programme in 

the community-dwelling aged: Predictors of adherence. European Journal of 

Public Health. 2007 Oct;17(5):464-70.
Multifaceted

Interventions

63

Vaapio S, Salminen M, Vahlberg T, Isoaho R, Aarnio P, Kivelä S-L. Effects of risk-based 

multifactorial fall prevention on health-related quality of life among the communitydwelling aged: A randomized controlled trial. Health and Quality of Life Outcomes. 2007 

Apr;5:20-7. 

Salminen M, Vahlberg T, Sihvonen S, Piirtola M, Isoaho R, Aarnio P, Kivelä SL. Effects 

of risk-based multifactorial fall prevention on maximal isometric muscle strength 

in community-dwelling aged: A randomized controlled trial. Aging Clinical and 

Experimental Research. 2008 Oct;20(5):487-93. 

Salminen M, Vahlberg T, Sihvonen S, Sjösten N, Piirtola M, Isoaho R, Aarnio P, 

Kivelä SL. Effects of risk-based multifactorial fall prevention on postural balance in the 

community-dwelling aged: A randomized controlled trial. Archives of Gerontology and 

Geriatrics. 2009 Jan-Feb;48(1):22-7. 

Contact

Practitioners interested in using this intervention may contact the principal 

investigator for more information:

Marika J. Salminen, PhD

Family Medicine

Lemminkäisenkatu 1

FI-20014

University of Turku

Turku, Finland

E-mail: majosa@utu.fi
64

The Winchester Falls Project

This study evaluated the effectiveness of 2 fall interventions. The primary 

care intervention consisted of fall risk assessments by nurses followed 

by referrals to other professionals. The secondary care intervention 

involved multidisciplinary fall risk assessments (by a doctor, nurse, 

physical therapist, and occupational therapist), followed by appropriate 

interventions and follow-up if necessary. Only the secondary care 

intervention was effective in reducing falls. 

Compared to the group who received usual care, participants in the 

secondary care multidisciplinary intervention were half as likely to fall, a 

third less likely to sustain a fall-related fracture, and 55 percent less likely 

to die in the year following the intervention. 

Population: Participants were community-dwelling adults aged 65 or 

older who had sustained 2 or more falls in the previous year. About threequarters were female.

Geographic Locale: Mid Hampshire, United Kingdom

Focus: Assess fall risk factors and provide individualized interventions.

Program Setting: Baseline assessments were conducted in a 

multidisciplinary clinic with referrals for interventions and follow-up if 

necessary. 

Content: Participants received a standardized assessment for fall risk factors 

that included psychoactive medications; visual impairment; neurological, 

musculoskeletal, and/or cardiovascular problems; poor mobility; postural 

hypotension; improper footwear; environmental hazards; and alcohol use. 

Individualized interventions included medication changes; physical therapy 

interventions such as strength, balance, and gait training; occupational therapy 

interventions such as corrective shoes, adaptive equipment, and home visits 

to reduce fall hazards; nursing interventions such as monitoring postural 

hypotension; and social services interventions such as increasing home help. 

Spice,

et al.
Multifaceted

Interventions

65

Risk Factor Intervention

Assessed by a doctor:

General medical history and 

examination 

Refer to appropriate specialists

Medications Stop medications when possible; add medication 

where appropriate; make recommendations to 

primary care physician; reduce or stop psychoactive 

medications

Visual impairment Recommend optician if one has not been seen in 

2 years or if there is a change in vision; refer to 

ophthalmologist when appropriate (e.g., cataracts) 

Alcohol use Advise to reduce or stop

Assessed by a nurse:

Postural hypotension Refer to primary care nurse for monitoring 

Review of continence Refer to community nurse 

Assessed by a physical therapist:

Poor mobility Physical therapy interventions such as strength, 

balance, and gait training; exercise instruction; 

provide mobility aids

Assessed by an occupational therapist:

Improper footwear Information on footwear; refer for orthotics or 

corrective shoes

Environmental hazards In-home visit; suggest adaptive equipment; 

recommend grab bars; refer to local organizations 

specializing in home safety assessments for security 

advice, and to install window or door locks, security 

lights, smoke alarms etc., if necessary

Personal and domestic 

activities of daily living

Daily living advice; refer to social services for 

assistance
66

Duration: Fall risk assessments took about 2 hours. The amount and 

duration of the follow-up interventions varied by the type of interventions 

received. 

Delivered by: Assessments and individualized interventions were 

implemented by doctors, nurses, physical therapists, and occupational 

therapists.

Minimum Level of Training Needed: This intervention requires 

a variety of highly trained health care professionals. Preparation for 

conducting the baseline assessments requires a half-day training session. 

Key Elements: Doctors, nurses, physical therapists, and occupational 

therapists used a structured in-depth assessment instrument. 

Available Materials: Structured assessment instrument*

*See Appendix D-6.

Study Citation: Spice CL, Morotti W, George S, Dent THS, Rose 

J, Harris S, Gordon CJ. The Winchester falls project: A randomised 

controlled trial of secondary prevention of falls in older people. Age and 

Aging. 2009 Jan;38(1):33-40. 
Multifaceted

Interventions

67

Contact

Practitioners interested in using this intervention may contact the principal 

investigator for more information:

Dr. Claire Spice

Department of Medicine for Older People

Portsmouth Hospitals NHS Trust

Queen Alexandra Hospital

Southwick Hill, Cosham PO6 3LY, United Kingdom

E-mail: claire.spice@porthosp.nhs.uk
68

Yale FICSIT (Frailty and Injuries: 

Cooperative Studies of 

Intervention Techniques) 

This study used a tailored combination of intervention strategies based 

on an assessment of each participant’s fall risk factors. Participants were 

about 30 percent less likely to fall compared with people who did not 

receive the intervention. 

Population: Participants were members of a health maintenance 

organization. All were 70 or older and lived in the community. 

Most participants were female. 

Geographic Locale: Farmington, Connecticut, United States 

Focus: Identify and modify each participant’s risk factors.

Program Setting: The intervention was delivered to participants in 

their homes. 

Content: This program provided an individualized intervention for each 

participant. 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 3 balance and 

strength training programs.

Tinetti,

et al.
Multifaceted

Interventions

69

Risk Factor Intervention

Assessed by a nurse practitioner:

Postural hypotension Behavioral recommendations such as elevating 

the head of the bed and using ankle pumps; made 

changes in medications

Use of sedative-hypnotic 

medication

Education; discontinued medication; 

non-pharmacological alternatives

Use of 4+ prescription 

medications

Reviewed medications with primary physician;

the final decision on medication changes was 

made by the primary physician

Inability to transfer safely to 

bathtub or toilet

Training in transfer skills; home modifications 

(e.g., installing grab bars and a raised toilet seat)

Environmental hazards Home modifications (e.g., removing rugs and 

installing railings)

Assessed by a physical therapist:

Gait impairments Gait training; use of assistive devices; balance and/

or strengthening exercises

Impairments in transfer skills 

or balance

Training in transfer skills; home modifications; 

balance exercises (progressing through 4 levels of 

difficulty)

Impairment in leg or arm 

strength or in range of motion

Progressive strengthening exercises with resistance 

bands and putty, increasing resistance after 

participant could complete 10 repetitions; exercises 

were performed for 15-20 minutes twice a day
70

Duration: The intervention was conducted over a 3-month period. The 

amount and duration of contacts varied by the type of interventions received.

Delivered by: A nurse practitioner and physical therapist (PT) 

conducted the risk factor assessments. Medication adjustments were 

undertaken in cooperation with the participant’s primary physician who 

made the final decision on medication changes. The PT conducted all 

physical therapy and supervised exercise sessions. 

Minimum Level of Training Needed: The assessment requires at 

least a well trained paraprofessional such as a PT assistant or licensed 

practical nurse (LPN). The intervention needs at least a BA-level nurse. 

The physical therapy portion requires a physical or occupational therapist, 

or a physical or occupational therapy assistant with supervision by a 

physical or occupational therapist. 

Key Elements: The assessments need to be clearly linked to the 

intervention components. The minimum risk factor interventions include (1) 

postural blood pressure and behavioral recommendations; (2) medication

review and reduction (especially psychoactive medications); (3) balance, 

strength, and gait assessments and interventions; and (4) environmental 

assessment and modification. 

It is essential that the progressive balance and strength exercise program 

includes both supervised and at-home (unsupervised) components.

Available Materials: Intervention materials including risk factor 

assessments and treatment worksheets, medication reduction strategies, 

balance exercises, home safety checklists, and information sheets can be 

requested through the intervention web site www.fallprevention.org.
Multifaceted

Interventions

71

Study Citation: Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P, Gottschalk 

M, Koch ML, Trainor K, Horwitz RI. A multifactorial intervention to reduce the risk of 

falling among elderly people living in the community. New England Journal of Medicine. 

1994 Sept 29;331(13):821-7. 

Supplemental articles

Koch M, Gottschalk M, Baker DI, Palumbo S, Tinetti ME. An impairment and disability 

assessment and treatment protocol for community-living elderly persons. Physical Therapy.

1994 Apr;74(4):286-94.

Tinetti ME, Baker DI, Garrett PA, Gottschalk M, Koch ML, Horwitz RI. Yale FICSIT: 

Risk factor abatement strategy for fall prevention. Journal of the American Geriatrics 

Society. 1993 Mar;41(3):315-320.

Contact

Practitioners interested in using this intervention may contact the principal 

investigator for more information:

Mary Tinetti, MD

Department of Epidemiology and Public Health

Yale University School of Medicine

Internal Medicine-Geriatrics

PO Box 208025

New Haven, CT 06520-8025, United States

Tel: 203-688-5238

Fax: 203-688-4209

E-mail: mary.tinetti@yale.edu
72

A Multifactorial Program

This study tested a moderate-intensity intervention that used tailored 

strategies based on assessments of each participant’s risk factors. After 

1 year, participants were 10 percent less likely to fall and 5 percent less 

likely to have an injurious fall, compared with people who received usual 

medical care. 

Population: All participants were 65 or older and lived in the 

community. About 60 percent of participants were female. 

Geographic Locale: Seattle, Washington, United States 

Focus: Reduce disability and/or falls by: improving physical fitness, 

modifying excessive alcohol use, improving home safety, reducing 

psychoactive medication use, and improving hearing and vision.

Program Setting: Participants received the assessments and 

interventions from a nurse at local health maintenance organization 

(HMO) centers. Participants conducted a home assessment or had it done 

by a family member or volunteer. 

Content: The assessments consisted of simple screening tests for 6 risk 

factors. The intervention content varied based on the individual’s risk factors. 

Wagner,

et al.

Risk Factor Intervention

Inadequate exercise Participated in a 2-hour exercise orientation class testing fitness, given exercise 

instruction, and encouraged to begin a program of brisk walking

Use of psychoactive 

drugs 

Reviewed medications using a pharmacist and sent written recommendations 

to the participant’s primary care provider 

Impaired vision Corrected when possible. Participants with uncorrectable visual impairments 

received information about available community resources

Impaired hearing Had a hearing aid evaluation. Program provided behavioral intervention 

classes for participants with uncorrectable deficits

Excessive alcohol use Referred to an alcohol treatment program if alcoholism was suspected, or 

given an instructional booklet that provided strategies for limiting use

Home hazards Assessed home safety using an instructional home safety checklist
Multifaceted

Interventions

73

Duration: The initial visit consisted of a 1- to 11⁄2-hour interview. The length 

and number of subsequent sessions varied by the type of interventions selected for 

each participant.

Delivered by: The program was delivered by a single nurse educator who received brief 

training by the research team. There was no formal curriculum because only 1 nurse was 

involved. Either trained volunteers or participants’ family members completed the home 

safety assessment using the provided checklist.

Minimum Level of Training Needed: Information was not provided by the 

principal investigator. 

Key Elements: The nurse’s follow-up phone contacts and home visits may have had 

positive effects on participants’ health that were independent of the interventions for 

specific risk factors. 

Available Materials: No intervention materials were available for distribution at the 

time of publication.

Study Citation: Wagner EH, LaCroix AZ, Grothaus L, Leveille SG, Hecht J, Artz K, 

Odle K, Buchner DM. Preventing disability and falls in older adults: A population-based 

randomized trial. American Journal of Public Health. 1994 Nov;84(11):1800-6.

Contact

Practitioners interested in using this intervention may contact the principal 

investigator for more information:

Edward H. Wagner, MD, MPH

Group Health Research Institute 

1730 Minor Avenue, Ste. 1290

Seattle, WA 98101, United States

Tel: 206-287-2877

E-mail: wagner.e@ghc.org

75

Intervention Study 

Selection Process

Appendix A
76

Intervention Study Selection Process

In 2003, the RAND Corporation was commissioned by the Centers for 

Medicare and Medicaid Services (CMS) to review and analyze the existing 

research on fall prevention interventions. They conducted a comprehensive 

literature search and reviewed 826 intervention studies, of which 95 met the 

following selection criteria: (1) included adults aged ≥65 years; (2) used a randomized controlled trial or controlled clinical trial study design; (3) identified 

falls as an outcome; and (4) measured the number of falls at least 3 months 

after the start of the intervention. Of the 95 studies, 57 had falls as a primary 

outcome and 38 of the 57 reported either the number of subjects who fell at 

least once or the monthly rate of falling. RAND included these 38 studies 

in their meta-analyses to determine the effectiveness of fall prevention interventions (categorized as exercise, education, environmental modification, or 

multiple component interventions).* 

Beginning with the 38 studies RAND included in their meta-analysis (used 

by permission, L. Rubenstein, personal communication), CDC identified 

those that met the following inclusion criteria: (1) included communitydwelling adults aged ≥65 years; (2) used a randomized controlled study 

design; (3) measured falls as a primary outcome; and (4) demonstrated statistically significant positive results for at least 1 fall outcome (e.g., showed 

statistically fewer falls for intervention participants). As illustrated in Figure 

1, CDC excluded 1 study that focused on nursing home residents, 4 that 

did not include falls as a primary outcome, and 25 that did not demonstrate 

statistically significant, positive results. Of the remaining 8, 2 described the 

same study and were combined. Lastly, CDC identified 7 studies published 

after the RAND Report that met the established criteria. In total, the first 

edition of the Compendium included 14 studies published before December 

31, 2004. 

Updates in the Second Edition:

In 2009, CDC undertook to update the original Compendium. A comprehensive literature search of randomized controlled trials of fall interventions 

published between January 1, 2005 and December 31, 2009 identified 86 

studies. As Figure 2 illustrates, 2 interventions were excluded because they 

were already in the Compendium. Of the remaining 84 studies, CDC excluded 20 that were not randomized controlled trials, 15 that did not focus 

on community-dwelling adults aged ≥65 years, 27 that did not include falls 

as a primary outcome, and 14 that did not demonstrate statistically significant, positive results. In total, 8 studies published between January 2005 and 

December 2009 were added to the Compendium. 

* Available at www.cms.gov/PrevntionGenInfo/Downloads/Exercise%20Report.pdf
77

Appendix A

Figure 1. Flow chart showing the selection process for 

studies used in the first edition of the Compendium

826

Fall intervention

studies

95

Relevant & rigorous

studies

57

Falls as an

outcome

37

Community-dwelling

population

8

Met CDC criteria

38

Rand Report:

Data on subjects

who fell at least

once or the

monthly fall rate

14

Compendium

studies

7

Relevant, rigorous

& effective studies

published 2003-2004

1

Reported on

same study

25

Not statistically

significant

positive results

4

Falls not the

primary outcome

1

Nursing home

population
78

Figure 2. Flow chart showing the selection process for 

studies used in the second edition of the Compendium 

86

Fall intervention 

studies published 

2005–2009

84

Fall intervention 

studies 

64

Randomized 

controlled 

trial studies

8

Met CDC criteria

8

Studies added 

to updated 

Compendium

49

Community-dwelling

 population

14

Not statistically 

significant positive 

results

2

Interventions already 

in Compendium

20

Not randomized 

controlled trial studies

15 

Not community-

 dwelling population 

27

Falls not the 

primary outcome


81

Bibliography of

Compendium Studies

Appendix B
82

Bibliography of Compendium

Studies and Supplemental Articles

Barnett A, Smith B, Lord SR, Williams M, Baumand A. Communitybased group exercise improves balance and reduces falls in at-risk 

older people: A randomized controlled trial. Age and Ageing. 2003 

Jul;32(4):407-14.

*Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner 

DM. Psychotropic medication withdrawal and a home-based exercise 

program to prevent falls: A randomized controlled trial. Journal of the 

American Geriatrics Society. 1999 Jul;47(7):850-3. 

*Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner 

DM. Falls prevention over 2 years: A randomized controlled trial in 

women 80 years and older. Age and Ageing. 1999 Oct;28(6):513-8.

Campbell AJ, Robertson MC, Gardner MM, Norton RN, Tilyard 

MW, Buchner DM. Randomised controlled trial of a general practice 

programme of home based exercise to prevent falls in elderly women. 

British Medical Journal. 1997 Oct 25;315(7115):1065-9. 

Campbell AJ, Robertson MC, La Grow SJ, Kerse NM, Sanderson 

GF, Jacobs RJ, Sharp DM, Hale LA. Randomised controlled trial of 

prevention of falls in people aged ≥75 with severe visual impairment: 

The VIP trial. British Medical Journal. 2005 Oct 8;331(7520):817-20.

Clemson L, Cumming RG, Kendig H, Swann M, Heard R, Taylor 

K. The effectiveness of a community-based program for reducing the 

incidence of falls in the elderly: A randomized trial. Journal of the 

American Geriatrics Society. 2004 Sep;52(9):1487-94. 

Close J, Ellis M, Hooper R, Glucksman E, Jackson S, Swift C. 

Prevention of Falls in the Elderly Trial (PROFET): A randomized 

controlled trial. Lancet. 1999 Jan 9;353(9147):93-7.

Cumming RG, Thomas M, Szonyi G, Szonyi M, Salkeld G, O’Neill E, 

Westburg C, Frampton G. Home visits by an occupational therapist for 

assessment and modification of environmental hazards: A randomized 

trial of falls prevention. Journal of the American Geriatrics Society. 1999 

Dec;47(12):1397-1402.
83

Appendix B

Davison J, Bond J, Dawson P, Steen IN, Kenny RA. Patients with recurrent falls 

attending accident and emergency benefit from multifactorial intervention: A 

randomised controlled trial. Age and Ageing. 2005 Mar;34(2):162-8.

Day L, Fildes B, Gordon I, Fitzharris M, Flamer H, Lord S. Randomized factorial 

trial of falls prevention among older people living in their own homes. British Medical 

Journal. 2002 Jul 20;325(7356):128-33.

*Folstein MF, Folstein SE, McHugh PR. “Mini-mental state.” A practical method for 

grading the cognitive state of patients for the clinician. Journal of Psychiatric Research.

1975 Nov;12(3):189-98.

*Freiberger E, Menz HB. Characteristics of falls in physically active communitydwelling older people. Zeitschrift für Gerontologie und Geriatrie. 2006 Aug;39(4):

261-7.

Freiberger E, Menz HB, Abu-Omar K, Rütten A. Preventing falls in physically active 

community-dwelling older people: A comparison of two intervention techniques. 

Gerontology. 2007 Aug;53(5):298-305. 

*Gardner MM, Buchner DM, Robertson MC, Campbell AJ. Practical 

implementation of an exercise-based falls prevention programme. Age and Ageing.

2001 Jan;30(1):77-83.

*Hagedorn R, McLafferty S, Russell D. The User Safety and Environmental Risk 

Checklist (USER). In: Anonymous falls: Screening and risk assessment for older 

people in the community. Worthing Priority Care NHS Trust. 1998:48-57.

Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, Greenlick MR, Ory 

MG. Preventing falls among community-dwelling older persons: Results from a 

randomized trial. The Gerontologist. 1994 Feb;34(1):16-23.

*Iliffe A, Kendrick D, Morris R, Skelton D, Gage H, Dinan S, Stevens Z, Pearl 

M, Masud T. Multi-centre cluster randomised trial comparing a community group 

exercise programme with home based exercise with usual care for people aged 65 and 

over in primary care: Protocol of the ProAct 65+ trial. Trials. 2010 Jan;11(1):6-10.

*Koch M, Gottschalk M, Baker DI, Palumbo S, Tinetti ME. An impairment and 

disability assessment and treatment protocol for community-living elderly persons. 

Physical Therapy. 1994 Apr;74(4):286-94.

*La Grow SJ, Robertson MC, Campbell AJ, Clarke GA, Kerse NM. Reducing hazard 

related falls in people 75 years and older with significant visual impairment: How did 

a successful program work? Injury Prevention. 2006 Oct;12(5):296-301.

Li F, Harmer P, Fisher KJ, McAuley E, Chaumeton N, Eckstrom E, Wilson NL. 

Tai Chi and fall reductions in older adults: A randomized controlled trial. Journal of 

Gerontology: Medical Sciences. 2005 Feb;60A(2):187-94. 
84

Lord SR, Castell S, Corcoran J, Dayhew J, Matters B, Shan A, Williams 

P. The effect of group exercise on physical functioning and falls in frail 

older people living in retirement villages: A randomized, controlled 

trial. Journal of the American Geriatrics Society. 2003 Dec;51(12):

1685-92. 

McKiernan FE. A simple gait-stabilizing device reduces outdoor falls 

and non-serious injurious falls in fall-prone older people during the 

winter. Journal of the American Geriatrics Society. 2005 Jun;53(6):943-7. 

Nikolaus T, Bach M. Preventing falls in community-dwelling frail 

older people using a home intervention team (HIT): Results from the 

randomized falls-HIT trial. Journal of the American Geriatrics Society.

2003 Mar;51(3):300-5.

*Robertson MC, Campbell AJ, Gardner MM, Devlin N. Preventing 

injuries in older people by preventing falls: A meta-analysis of 

individual-level data. Journal of the American Geriatrics Society. 2002 

May;50(5):905-11.

*Robertson MC, Devlin N, Gardner MM, Campbell AJ. Effectiveness 

and economic evaluation of a nurse delivered home exercise programme 

to prevent falls. 1: Randomised controlled trial. British Medical Journal.

2001 Mar 24;322(7288):697-701.

*Robertson MC, Gardner MM, Devlin N, McGee R, Campbell AJ. 

Effectiveness and economic evaluation of a nurse delivered home 

exercise programme to prevent falls. 2: Controlled trial in multiple 

centres. British Medical Journal. 2001 Mar 24;322(7288):701-4.

Rubenstein LZ, Josephson KR, Trueblood PR, Loy S, Harker JO, 

Pietruszka FM, Robbins, AS. Effects of a group exercise program on 

strength, mobility, and falls among fall-prone elderly men. Journal of 

Gerontology: Medical Sciences. 2000 Jun;55A(6):M317-21.

Salminen MJ, Vahlberg TJ, Salonoja MT, Aarnio PTT, Kivelä SL. 

Effect of a risk-based multifactorial fall prevention program on the 

incidence of falls. Journal of the American Geriatrics Society. 2009 

Apr;57(4):612-9.

*Salminen M, Vahlberg T, Sihvonen S, Piirtola M, Isoaho R, Aarnio 

P, Kivelä SL. Effects of risk-based multifactorial fall prevention on 

maximal isometric muscle strength in community-dwelling aged: A 

randomized controlled trial. Aging Clinical and Experimental Research.

2008 Oct;20(5):487-93. 
85

*Salminen M, Vahlberg T, Sihvonen S, Sjösten N, Piirtola M, Isoaho R, Aarnio P, 

Kivelä SL. Effects of risk-based multifactorial fall prevention on postural balance in 

the community-dwelling aged: A randomized controlled trial. Archives of Gerontology 

and Geriatrics. 2009 Jan-Feb;48(1):22-7. 

*Sheik J, Yesavage J. Geriatric depression scale (GDS): Recent evidence and 

development of a shorter version. Clinical Gerontology: A Guide to Assessment and 

Intervention. New York: The Haworth Press, Inc. 1986:165-73. 

*Sjösten NM, Salonoja M, Piirtola M, Vahlberg T, Isoaho R, Hyttinen H, Aarnio 

P, Kivelä SL. A multifactorial fall prevention programme in home-dwelling elderly 

people: A randomized-controlled trial. Public Health. 2007 Apr;121(4):308-18.

*Sjösten NM, Salonoja M, Piirtola M, Vahlberg T, Isoaho R, Hyttinen H, Aarnio P, 

Kivelä SL. A multifactorial fall prevention programme in the community-dwelling 

aged: Predictors of adherence. European Journal of Public Health. 2007 Oct;17(5):

464-70.

*Skelton DA. Effects of physical activity on postural stability. Age and Ageing. 2001 

Nov;30(Suppl 4):33-9.

*Skelton DA. The Postural Stability Instructor: Qualification in the United Kingdom 

for effective falls prevention exercise. Journal of Aging and Physical Activity. 2004 

Jul;12(3);375-6.

*Skelton DA, Dinan SM. Exercise for falls management: Rationale for an exercise 

program aimed at reducing postural instability. Physiotherapy Theory and Practice. 

1999 Jan;15(2):105-20. Available at www.laterlifetraining.co.uk/documents/

ExerciseFallsManage.PDF.

Skelton D, Dinan S, Campbell M, Rutherford O. Tailored group exercise (Falls 

Management Exercise—FaME) reduces falls in community-dwelling older frequent 

fallers (an RCT). Age and Ageing. 2005 Nov;34(6):636-9. 

*Skelton DA, Stranzinger K, Dinan SM, Rutherford O. BMD improvements 

following FaME (falls management exercise) in frequently falling women age 65 and 

over: An RCT. Journal of Aging and Physical Activity. 2008 Jul;16(Suppl):S89-90.

Spice CL, Morotti W, George S, Dent THS, Rose J, Harris S, Gordon CJ. The 

Winchester falls project: A randomised controlled trial of secondary prevention of falls 

in older people. Age and Aging. 2009 Jan;38(1):33-40. 

*Tideiksaar R. Preventing falls: Home hazard checklists to help older patients protect 

themselves. Geriatrics. 1986 May;41(5):26-8.

*Tinetti ME, Baker DI, Garrett PA, Gottschalk M, Koch ML, Horwitz RI. Yale 

FICSIT: Risk factor abatement strategy for fall prevention. Journal of the American 

Geriatrics Society. 1993 Mar;41(3):315-20.

Appendix B
86

Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P, Gottschalk 

M, Koch ML, Trainor K, Horwitz RI. A multifactorial intervention to 

reduce the risk of falling among elderly people living in the community. 

New England Journal of Medicine. 1994 Sept 29;331(13):821-7. 

*Vaapio S, Salminen M, Vahlberg T, Isoaho R, Aarnio P, Kivelä S-L. 

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*Voukelatos A. The Central Sydney Tai Chi trial: A randomized 

controlled trial investigating the effectiveness of Tai Chi in reducing 

falls in older people. PhD thesis, University of Sydney, 2010.

Voukelatos A, Cumming RG, Lord SR, Rissel C. A randomized, 

controlled trial of Tai Chi for the prevention of falls: The Central 

Sydney Tai Chi trial. Journal of the American Geriatrics Society. 2007 

Aug;55(8):1185-91. 

Wagner EH, LaCroix AZ, Grothaus L, Leveille SG, Hecht J, Artz K, 

Odle K, Buchner DM. Preventing disability and falls in older adults: A 

population-based randomized trial. American Journal of Public Health.

1994 Nov;84(11):1800-6.

Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T. 

Reducing frailty and falls in older persons: An investigation of Tai Chi 

and computerized balance training. Journal of the American Geriatrics 

Society. 1996 May;44(5):489-97.

*Wolf SL, Coogler C, Xu T. Exploring the basis for Tai Chi Chuan 

as a therapeutic exercise approach. Archives of Physical Medicine and 

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*Supplemental article


89

Tables

Appendix C

Table 1 Overall Population Characteristics

Table 2 Study Characteristics

Table 3 Intervention Characteristics
90

Table 1. Overall Population Characteristics (1 of 2)

Study

No. 

Study 

Participants

Mean

 Age

% 

Female

Race/

Ethnicity

Socioeconomic 

Status Previous Falls Other Characteristics

Barnett 2003

163 75 67% 90% used English as 

primary language

Study conducted in low SES areas 

42% fell in past year 27% lived alone

Campbell 1997

233 84 100% Most were White 20% used community 

services

44% fell in past year

Campbell 2005

391 84 68% 99% European 

0.3% Maori0.5% Other

NA* 45% fell in past year 53% lived alone

10% received home health (personal care) services 84% age-related macular degeneration43% cataract3% diabetic retinopathy15% glaucoma

Clemson 2004

310 78 74% NA 52% had below average 

weekly income

65% fell in past year

Close 1999

397 78 68% NA NA 65% fell in past year 61% lived alone

Cumming 1999

530 77 57% 100% White NA 31% fell in past year 37% used a walking aid

Davison 2005

313 77 72% Most were White; none 

were Asian or Black

70% education <8th grade4% education >HS Participants included all social classes

100% fell in past year; average was 3 falls

Day 2002

1,090 76 60% 77% born in 

Australia

Study conducted in mainly middle class area

6% fell in past month 54% lived alone

47% married

Freiberger 2007

152 75 39% 100% White 33% education >HS 

Mean income $5,458

34% fell in past 6 months
91

Table 1. Overall Population Characteristics continued (2 of 2)

Study

No. 

Study 

Participants

Mean

 Age

% 

Female

Race/

Ethnicity

Socioeconomic 

Status Previous Falls Other Characteristics

Hornbrook 1994

3,182 73 62% 90% White 33% education >HS 15% fell in past year 37% lived alone

56% married

Li 2005

256 77 70% 90% White 92% education ≥HS

68% income <$35,000

37% fell in past 3 months 48% lived alone

Lord 2003

551 80 86% 100% White NA 34% fell in past year 22% in assisted living 

housing

McKiernan 2005

113 74 60% 100% White NA 100% fell in past year

Nikolaus 2003

360 82 73% 98% White NA 30% ≥2 falls in past year All showed functional decline, especially in mobility

Rubenstein 2000

59 75 0% 95% White 63% education >HS 56% fell in past 6 months 73% married

Salminen 2009

591 74 84% 100% White 27% education >6th grade 

72% completed 6th grade 2% education <6th grade All participants were retired

100% fell in past year41% fell once in past year

53% lived alone 45% married 

Skelton 2005

81 73 100% Most were White Most were retired healthcare workers w/ at least 

some HS education 

100% ≥3 falls in past year Took on average 4 medications

15% used canes

Spice 2009

375 82 74% Most were White NA 100% ≥2 falls in past year 59% lived alone

Tinetti 1994

301 78 69% NA 31% education >HS 43% fell in past year 44% married

Voukelatos 2007

702 69 84% Most were White 44% education ≥HS 34% fell in past year

Wagner 1994

1,559 73 59% 93% White 25% education >16 years

35% income <$15,000

33% fell in past year

Wolf 1996

200 76 81% Most were White 77% education >HS 36% fell in past year

* No information available
92

Table 2. Study Characteristics (1 of 10)

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Barnett 2003

Southwest Sydney, Australia Recruited while patients in general practice clinics or attending 

hospital-based physical therapy clinics

Age 65+ & >1 physical impairment associated w/ fall risk (lower limb weakness, poor balance, slow reaction time)

Cognitively impaired or had degenerative or medical conditions that precluded participating in an exercise program

Yes

Method of Recording Falls Length of Follow-up Fall Outcomes Results* Adverse 

Effects

Postal surveys sent to participants each month. If not received within 2 weeks, participant was interviewed by telephone. 

12 months Fall rate

Fall w/ injury

RR = 0.60 (0.36-0.99)RR = 0.66 (0.38-1.15)

None

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Campbell 1997

Dunedin, New Zealand Women registered with a general 

practice in Dunedin were invited by general practitioner to take part

Age 80+ & able to move around within their own home 

Cognitively impaired or receiving physical therapy

Yes

Method of Recording Falls Length of Follow-up Fall Outcomes Results* Adverse 

Effects

Participants given 12 pre-addressed & stamped monthly fall calendar postcards. If one was not received, participant was interviewed by telephone.

12 months Fall rate

First fallFirst fall w/ injury

RR = 0.67 (p<0.05)HR = 0.81 (0.56-1.16)HR = 0.61 (0.39-0.97)

None

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Campbell 2005

Dunedin & Auckland, New Zealand Participants identified from the Royal New Zealand Foundation 

of the Blind, university & hospital low vision clinics, & private ophthalmology practices

Age 75+, poor vision (visual acuity 6/24 or worse) Unable to walk around own resi- dence, currently receiving physical 

therapy, or unable to understand study requirements

Yes

Method of Recording Falls Length of Follow-up Fall Outcomes Results* Adverse 

Effects

Pre-paid, addressed, tear-off monthly postcard calendars. Independent assessors called participants to record circumstances of falls & any resulting injuries.

12 months Number of falls 

Number of fall injuries 

IRR = 0.39 (0.24-0.62)IRR = 0.56 (0.36-0.87)

None
93

Table 2. Study Characteristics continued (2 of 10)

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Clemson 2004

Sydney, Australia Community residents recruited 

through referrals, advertisements, & community organizations

Age 70+, had a fall in past year or fear of falling, & spoke English

Cognitively impaired or homebound No

Method of Recording Falls Length of Follow-up Fall Outcomes Results* Adverse 

Effects

Participants mailed in a preaddressed, stamped calendar each month.

14 months Fall rate, overall

Fall rate, malesFall rate, females

RR = 0.69 (0.50-0.96)RR = 0.32 (0.17-0.59)RR = 0.96 (0.50-1.85)

None

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Close 1999

London, United Kingdom Community residents treated in 

an ED for a fall, sent letters & contacted by telephone

Age 65+, ambulatory, & had been treated for a fall

Cognitively impaired & had no regular caregiver, or spoke little or no English

Yes

Method of Recording Falls Length of Follow-up Fall Outcomes Results* Adverse 

Effects

Postal questionnaires were sent to participants every 4 months.

12 months Number of falls

Fall riskRisk of ≥3 falls

183 vs. 510 (p<0.002)OR = 0.39 (0.23-0.60)OR = 0.33 (0.16-0.68)

None

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Cumming 1999

Sydney, Australia Recruited while hospital patients 

or from among people attending outpatient clinics or a local senior center

Age 65+ & ambulatory Cognitively impaired & not living 

with someone who could give informed consent & report falls, or planned to have a home assessment by an occupational therapist

No

Method of Recording Falls Length of Follow-up Fall Outcomes Results* Adverse 

Effects

Monthly falls calendar was completed daily & returned by mail each month. If not received within 10 days, participant was interviewed by telephone.

12 months Fall rate for participants w/ no 

falls at baselineFall rate for participants w/ falls at baseline

RR = 1.03 (0.75-1.41)RR = 0.64 (0.50-0.83)

None
94

Table 2. Study Characteristics continued (3 of 10)

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Davison 2005

Newcastle, United Kingdom Community seniors treated in EDs 

for a fall were mailed a questionnaire to determine their fall history. Repeat fallers were recruited by telephone.

Age 65+, treated in ED for a fall or fall injury, & had a fall in past year

Cognitively impaired, had >1 previous episode of syncope, immobile, blind, aphasic, or had a clear medical explanation for their fall

Yes

Method of Recording Falls Length of Follow-up Fall Outcomes Results* Adverse 

Effects

Participants completed weekly fall diaries that they returned every month for 12 months. After 1 year, all participants’ hospital records were reviewed for falls.

12 months Number of falls

% fallersNumber of fallersHip fracturesOther fracturesFall-related ED visit Fall-related hospital admission

RR = 0.64 (0.46-0.90)RR = 0.95 (0.81-1.12)RR = 0.48 (0.04-5.29)RR = 0.53 (0.20-1.39)RR = 0.90 (0.55-1.47)RR = 0.80 (0.41-1.56)RR = 3.60 (0.10-7.60)

None

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Day 2002

Melbourne, Australia Identified from electoral roll & 

through general practitioners. Subjects were sent letters & then contacted by telephone.

Age 70+, owns or leases home & able to make home modifications

Planning to move within 2 years, recent physical activity with a balance component, unable to walk 10-20 m w/o rest, help, or angina, severe respiratory or cardiac disease, cognitively impaired, had made recent major home modifications, or did not have physician approval

No

Method of Recording Falls Length of Follow-up Fall Outcomes Results* Adverse 

Effects

Monthly calendar postcards completed daily & returned by mail. If not received within 5 working days after end of month, participant was interviewed by telephone. 

18 months Fall rates Exercise alone: 

RR = 0.82 (0.70-0.97)Exercise + vision:RR = 0.73 (0.58-0.91)Exercise + home mod:RR = 0.76 (0.60-0.95)Exercise + vision + home mod: RR = 0.67 (0.51-0.88)

None
95

Table 2. Study Characteristics continued (4 of 10)

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Freiberger 2007

Erlangen, Germany Recruited from a health insurance 

company membership database

Age ≥70, community-dwelling, & able to walk independently

Unable to walk independently or cognitively impaired

Yes

Method of Recording Falls Length of Follow-up Fall Outcomes Results* Adverse

 Effects

A fall calendar was returned each month. If not returned, participants received a follow-up telephone call. If a fall occurred, the participant was interviewed by telephone.

12 months Number of fallers

Number of multiple fallersFall rateTime to first fall

RR = 0.77 (0.60-0.97) RR = 0.87 (0.75-1.01)RR = 0.64 (0.38-1.06)337 ±9 days (fitness group) vs. 216 ±15 days (control)

None

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Hornbrook 1994

Portland, Oregon & Vancouver, Washington metro area, United States

Members of a Kaiser Permanente HMO were recruited by mail

Age 65+ & ambulatory Blind, deaf, housebound, nonEnglish speaking, severely mentally ill, terminally ill, not willing 

to travel or lived >20 mi. from research center

YesAlso “near falls”

Method of Recording Falls Length of Follow-up Fall Outcomes Results* Adverse 

Effects

Fall reported by postcard as soon as it occurred. Participant interviewed by telephone about circumstances & consequences. Monthly diaries monitored quarterly by mail or telephone for self-reported falls & associated injuries & medical care.

24 months Fall risk, overall

Fall risk, malesFall risk, males age 75+

OR = 0.85 (p<0.05)OR = 0.82 (p<0.05)OR = 0.53 (p<0.05)

None
96

Table 2. Study Characteristics continued (5 of 10)

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Li 2005

Portland, Oregon, United States Subjects enrolled in the Legacy 

Health System in Portland, OR were sent letters from their physicians encouraging them to participate

Age 70+, inactive, ambulatory, no chronic medical problems that would limit participation, had a physician’s clearance to participate

Cognitively impaired, in poor health, or had difficulty with language or transportation

Yes

Method of Recording Falls Length of Follow-up Fall Outcomes Results* Adverse 

Effects

Falls recorded daily in a fall calendar that was collected by a research assistant.

12 months Fall rate

Multiple fall rate

RR = 0.35 (p<0.001)RR = 0.45 (0.30-0.70)

None

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Lord 2003

Sydney & Wollongong, Australia Residents of self-care & intermediate-care retirement villages 

attended information sessions & then were approached individually

Age 62+ Cognitively impaired, had a medical condition that prevented participation in an exercise program, 

or already attended exercise classes of equivalent intensity

Yes

Method of Recording Falls Length of Follow-up Fall Outcomes Results* Adverse 

Effects

Completed monthly questionnaires. If not received within a week after end of month, received home visits or telephone calls. Nursing staff at each intermediate-care site also kept a falls record book.

12 months Fall rate

Fall rate for participants w/ no falls at baselineFall rate for participants w/ falls at baseline

RR = 0.78 (0.62-0.99)RR = 0.88 (0.65-1.20)RR = 0.69 (0.48-0.99)

None
97

Table 2. Study Characteristics continued (6 of 10)

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

McKiernan 2005

Rural central & northern Wisconsin, United States

Recruited using a database of people who had fallen in the past year & had been treated in a clinic or ED, one direct mailing or an announcement in local print media

Age 65+, community-dwelling, had a fall in past year, ambulatory w/o a walking aid, capable of putting on Yaktrax® Walker & using 

it appropriately, able & willing to maintain a fall diary

Incapable of walking w/o a walking aid or unable to use Yaktrax Walker correctly 

Yes

Method of Recording Falls Length of Follow-up Fall Outcomes Results* Adverse 

Effects

Participants kept a fall diary which they submitted at the end of the study.

10,724 observation-days Outdoor slip

Outdoor fallOutdoor fall on day walked on snow or iceOutdoor injurious fallOutdoor injurious fall on day walked on snow or ice

RR = 0.50 (0.26-0.96)RR = 0.45 (0.23-0.85)RR = 0.42 (0.26-0.92)RR = 0.10 (0.02-0.53) RR = 0.13 (0.03-0.66)

None

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Nikolaus 2003

Mid-sized town, Southern Germany

Recruited while inpatients at a geriatric clinic

Lived at home before hospital admission, had multiple chronic conditions or functional deterioration, & were discharged to home

Severe cognitive impairment, terminal illness, or lived >15 km away

Yes

Method of Recording Falls Length of Follow-up Fall Outcomes Results* Adverse 

Effects

Kept a falls diary & also contacted monthly by phone.

12 months Fall rate

Fall rate for participants w/ ≤1 fall at baselineFall rate for participants w/ ≥2 falls at baseline

IRR = 0.69 (0.51-0.97)IRR = 0.91 (0.72-1.22)IRR = 0.63 (0.43-0.94)

None
98

Table 2. Study Characteristics continued (7 of 10)

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Rubenstein 2000

Los Angeles, California, United States

Male patients at VA Ambulatory Care Center recruited through flyers & telephone screening

Age 70+, ambulatory, had at least 1 of 4 risk factors (lower extremity weakness, impaired gait, impaired balance, or >1 fall in past 6 months)

Exercised regularly, had cardiac or pulmonary disease, a terminal illness, severe joint pain, dementia, medically unresponsive depression, or progressive neurologic disease

No

Method of Recording Falls Length of Follow-up Fall Outcomes Results* Adverse 

Effects

Questioned about falls & injuries every 2 weeks by phone or inperson during exercise class.

12 weeks (at end of intervention)

Activity-adjusted fall rate** RR = 0.37 (p=0.027) None

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Salminen 2009

Pori, Finland Announcements in local newspapers, pharmacies, health centers, 

hospitals, & private clinics; also through written invitations from health professionals

Age 65+, ≥1 fall in past year, little or no cognitive impairment (MMSE ≥17), living in community or in housing that provided occasional assistance

Cognitively impaired, unable to walk 10 m independently w/ or w/o walking aids

Yes

Method of Recording Falls Length of Follow-up Fall Outcomes Results* Adverse 

Effects

Participants mailed fall diaries monthly. If one was not received, participants were reminded by telephone. Participants also reported falls as they occurred by phone to research assistants.

12 months Fall rate for participants w/ ≥3 

falls in previous yearFall rate for participants w/ more symptoms of depression

IRR = 0.59 (0.38-0.91)IRR = 0.50 (0.28-0.88)

2 participants stopped while exercising because they felt unwell 3 falls w/o injury occurred during the exercise sessions
99

Table 2. Study Characteristics continued (8 of 10)

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Skelton 2005

London, United Kingdom Posters, local & national newspapers, local radio stations Female, age 65+, ≥3 falls in past year Acute rheumatoid arthritis, uncontrolled heart failure or 

hypertension, significant cognitive impairment, significant neurological disease or impairment, or previously diagnosed osteoporosis

Yes

Method of Recording Falls Length of Follow-up Fall Outcomes Results* Adverse 

Effects

Falls diaries were returned every 2 weeks by mail. Every fall was followed up by questionnaire & telephone to determine the circumstances & outcome.

20 months Number of falls

Number of injurious falls

IRR = 0.66 (0.49-0.90)IRR = 0.60 (0.33-1.07) 

None

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Spice 2009

Mid Hampshire, United Kingdom Fallers identified at 18 general 

practices using a standard fall definition 

Age 65+, ≥2 falls in past year Life expectancy <1 year, plans 

to move from area within 1 year, abbreviated mental test score <7, non-English speaking w/o available interpreter, or a nursing home resident

Yes

Method of Recording Falls Length of Follow-up Fall Outcomes Results* Adverse 

Effects

Participants kept a monthly fall diary that was returned at the end of each month & indicated how many times they had fallen.

12 months Number fell during follow-up 

Time to first fall

OR = 0.52 (0.35-0.79)HR = 0.72 (0.56-0.93)

None
100

Table 2. Study Characteristics continued (9 of 10)

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Tinetti 1994

Southern Connecticut, United States

Members of an HMO, contacted first by letter & then screened by telephone

Age 70+, ambulatory in own home, had at least 1 of 9 risk factors (postural hypotension, used sedatives, ≥4 medications, inability to transfer, gait impairment, loss of strength or range of motion, home hazards)

Cognitively impaired or had participated in vigorous sports or walking for exercise in previous month

No

Method of Recording Falls Length of Follow-up Fall Outcomes Results* Adverse 

Effects

A monthly falls calendar was returned by mail. If a calendar was not received or if it indicated any falls, participant was interviewed by telephone.

12 months Fall rate

Fall per person-week

RR = 0.76 (0.58-0.98)RR = 0.69 (0.52-0.90)

None

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Voukelatos 2007

Sydney, Australia Recruited through advertisements 

in local community newspapers

Age 60+, had not practiced Tai Chi in past 12 months

Degenerative neurological condition, dementia, severely debilitating stroke, severe arthritis, marked vision impairment, or unable to walk across a room unaided

Yes

Method of Recording Falls Length of Follow-up Fall Outcomes Results* Adverse 

Effects

Participants recorded falls daily & mailed calendars to study coordinator monthly. If one was not received within 2 weeks of the end of the month, the participant was contacted by telephone.

24 weeks Number of falls

 16 weeks follow-up 24 weeks follow-up

Participants w/ ≥2 falls after 24 weeks follow-up

IRR = 0.73 (0.50-1.07)IRR = 0.67 (0.47-0.94)RR = 0.54 (0.28-0.96) HR = 0.27 (0.12-0.59)

An instructor tried to help a participant into a movement & the participant twisted a ligament.
101

Table 2. Study Characteristics continued (10 of 10)

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Wagner 1994

Seattle, Washington, United States Random sample of HMO members 

sent an introductory letter followed by a mail questionnaire

Age 65+, ambulatory, & independent in ADLs Institutionalized or seriously ill Yes

Method of Recording Falls Length of Follow-up Fall Outcomes Results* Adverse 

Effects

Mailed questionnaires at baseline, at 1 & 2 years. If not returned, participants were interviewed by telephone. Falls were identified through self-report & hospital discharge files.

24 months Difference in % falling

Falls, Year 1Falls, Year 2Falls w/ injury, Year 1Falls w/ injury, Year 2

-9.3% (4.1-14.5)+2.2% n.s.-4.6% (p<0.01)+3.3% n.s.

None

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Wolf 1996

Atlanta, Georgia, United States Community seniors & residents 

of an independent living facility, recruited through advertisements & direct contact

Age 70+, ambulatory, willing to participate weekly for 15 week program & at 4-month follow-up

Severe cognitive impairment or debilitating condition such as metastatic cancer, Parkinson’s disease, stroke, or profound visual deficits

Yes

Method of Recording Falls Length of Follow-up Fall Outcomes Results* Adverse 

Effects

Monthly calendar or monthly phone calls from staff.

7-20 months Fall risk

≥1 falls w/ injury

RR = 0.53 (0.32-0.86) RR = 0.81 (0.33-2.02)

None

Results shown with 95% confidence intervals. *RR = Relative Rate, HR = Hazard Ratio, OR = Odds Ratio, IRR = Incidence Rate Ratio **per 1,000 hrs of activity
102

Table 3: Intervention Characteristics continued (1 of 4)

Study Focus Providers Structure Number of Sessions Provider Contact Time

Barnett 2003

Exercise program to improve balance, coordination, strength, reaction time, & aerobic capacity

Accredited exercise instructors trained to provide intervention

Group exercise classes 37 weekly 1-hour classes Classes: 37 hours

Campbell 1997

Improve strength & balance w/ simple home-based exercise program

Physical therapist or nurse One-on-one exercise training 

at home

1⁄2 hour exercise program 3 times a week1⁄2 hour walking 3 times a week

4 home visits: 1-hour each

Campbell 2005

Assess & reduce home hazards & encourage changes in behavior 

Occupational therapist One-on-one 1-2 home visits Initial home visit: 2 hours 

Follow-up visit: 45 minutes 

Clemson 2004

Learn fall prevention techniques, improve self-efficacy, & make behavioral changes

Occupational therapist & team of trained content experts

Small group classes 7 weekly 2-hour classes

1 home visit 6 weeks after the final class 1 booster session 3 months after the final class

Classes: 14 hoursHome visit: 1 to 11⁄2 hoursBooster: 11⁄2 hours

Close 1999

Identify medical risk factors & home hazards, provide referrals & recommendations to reduce fall risk, & improve home safety

Physician & occupational therapist

One-on-one 1 medical assessment 

1 home assessment 

Medical assessment: 45 minutesHome assessment: 1 hour

Cumming 1999

Assess & reduce home hazards

Occupational therapist One-on-one 1-hour home assessment & 

follow-up telephone call

Total about 2 hours
103

Table 3: Intervention Characteristics continued (2 of 4)

Study Focus Providers Structure Number of Sessions Provider Contact Time

Davison 2005

Identify & modify each participant’s fall risk factors Physicians, physical thera- pists, & occupational therapists Hospital-based medical exam & treatment followed by physical therapy & occupational therapy in-home 

assessments & risk factor reduction 

2 hospital sessions 2 physical therapy visits 1 occupational therapy visit w/ 1 follow-up visit 

Medical assessment: 1 hourMedical intervention: 20 minutesPhysical therapy assessment: 45 minutesPhysical therapy intervention: 15 minutes Occupational therapy assessment: 45 minutes Follow-up visit: 20 minutes 

Day 2002

Improve strength & balance, improve poor vision, & reduce home hazards

Exercise instructors accredited by State-recognized institute & trained for intervention

Group exercise classes 15 weekly 1-hour classes

Vision assessment & treatmentHome assessment & modification

Classes: 15 hoursVision management: NAHome modification: NA

Freiberger 2007

Improve functional skills, strength, endurance, & flexibility

Specially trained instructors with a background in sport science & experience working w/ older adults

Group classes w/ individual practice at home

1-hour class 2 times a week for 16 weeks 

Classes: 32 hours

Hornbrook 1994

Reduce risk behaviors, improve physical fitness, & reduce home hazards

BA-level assessor trained for intervention, health behaviorist, & physical therapist

Group exercise classes & home visits

4 weekly 11⁄2-hour classes (incl. 20 minutes group exercise)2 15-minute home visits

Classes: 6 hours Home visits: 1⁄2 hour

Li 2005

Improve balance & physical performance

Experienced Tai Chi instructors who followed the classical Yang style Group exercise classes 1-hour class 3 times a week for 26 weeks Classes: 78 hours

Lord 2003

Increase strength, coordination, balance & gait, & improve ADLs

Trained exercise instructors certified for leading programs for older adults

Group exercise classes 1-hour class 2 times a week 

for 12 months (4 3-month terms)

Classes: 96 hours
104

Table 3: Intervention Characteristics continued (3 of 4)

Study Focus Providers Structure Number of Sessions Provider Contact Time

McKiernan 2005

Using a traction device that fits on shoes to improve stability when walking on ice & snow

Research coordinator Participants used the device 

on their own

1 introductory session Introductory session: 1⁄2 hour

Nikolaus 2003

Assess & reduce home hazards

Home intervention team incl. 3 nurses, a physical therapist, an occupational therapist, a social worker, & a secretary

Home visits 2+ (usually 3-4) home visits, 

about 11⁄2 hours each visit

Home visits: 8 hours on average

Rubenstein 2000

Increase strength & endurance, improve mobility & balance

Exercise physiology graduate students with on-the-job training or experienced physical therapist

Group exercise classes 11⁄2-hour class 3 times a 

week for 12 weeks

Classes: 54 hours

Salminen 2009

Assess & address each participant’s specific fall risk factors, improve physical fitness, provide information & counseling on fall prevention, assess & modify home hazards, & provide psychological support

Geriatrician, trained public health nurse, trained nursing students, physical therapist, & various health professionals 

One-on-one combined w/ group classes

1 fall risk assessment1 counseling & information session1 home assessment12 1-hour health lectures12 1-hour psychosocial group sessions 45- to 50-minute group exercise classes every 2 weeks for 26 weeksHome exercises 3 times a week for 52 weeks

Risk assessment: 45 minutesCounseling: 45 minutesHome assessment: 45 minutesHealth lectures: 12 hours Psychosocial group sessions: 12 hoursExercise classes: 10-11 hours 
105

Table 3: Intervention Characteristics continued (4 of 4)

Study Focus Providers Structure Number of Sessions Provider Contact Time

Skelton 2005

Improve balance & strength Postural Stability Instructors Group exercise classes & 

home-based exercises

1 pre-exercise assessment36 weekly 1-hour group exercise classes1⁄2-hour home exercise sessions 2 times a week for 36 weeks

Pre-exercise assessment: 40 minutesClasses: 36 hours 

Spice 2009

Assess fall risk factors & provide individualized interventions

Doctor, nurse, physical therapist, & occupational therapist One-on-one assessment with follow-up interventions 1 fall risk assessment 

Length & number of subsequent sessions varied by type of intervention(s)

Risk assessment: 2 hoursIntervention: Varied 

Tinetti 1994

Identify & modify each participant’s fall risk factors Medication adjustments coordinated w/ participant’s 

primary physician; exercise sessions conducted by physical therapist

Varied by type of intervention Varied by type & number of 

interventions received

Varied 

Voukelatos 2007

Improve balance & reduce falls 

Community-based Tai Chi instructors

Group exercise classes 16 weekly 1-hour classes Classes: 16 hours

Wagner 1994

Reduce disability &/or falls by addressing 6 specific risk factors

Specially trained nurseeducator Home visit with follow-up behavioral intervention 1 initial interview 1 to 11⁄2 hours

Length & number of subsequent sessions varied by type of intervention(s)

Initial interview: 1 to 11⁄2 hoursIntervention: Varied

Wolf 1996

Improve strength, balance, walking speed, & physical functioning

Tai Chi master Group classes w/ individual 

practice at home 

25-minute group classes 2 times a week for 15 weeks 15-minute practice at home 2 times a week

Classes: 12 hours
106
107

Original Intervention Materials

Appendix D

Appendix D-1 Barnett Materials

Appendix D-2 Skelton Materials

Appendix D-3 Voukelatos Materials

Appendix D-4 Wolf Materials

Appendix D-5 Close Materials

Appendix D-6 Spice Materials

109

Appendix D-1

Barnett Materials
110
111
112
113
114
115
116
117

Well done you have now completed all the exercises.

If you have any questions or concerns regarding the 

exercise program please don’t hesitate to contact your 

gentle exercise leader or the project manager.
118
119
120
121

Appendix D-2

Skelton Materials
122

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





















































 



 

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

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

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



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  



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





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 

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

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

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Appendix D-3

Voukelatos Materials
126

Tai Chi Principles for Falls Prevention in Older People 

The following notes are suggestions for incorporation into a Tai Chi program specifically targeting 

falls prevention in older people. 

BALANCE – the key element to preventing a fall 

Balance has been shown to decrease with age; however, some aspects of balance can be enhanced 

through training. 

Key elements to incorporate into a Tai Chi program 

Relaxation Æ relaxes muscles Æ lowers center of gravity

Lowered center of gravity Æ increases load on lower limbs Æ over time increases sensation and 

awareness of lower limb movement. 

• Transfer of weight 

Shifting body weight from leg to leg through incremental movements. Start with a small range of 

movement and gradually build up to a wide, square base stance. 

• Muscle strength

Muscle bulk and therefore strength decrease with age. A bent knee stance and movement works to 

strengthen lower limb muscle (particularly the quadriceps muscles) (however, always work to an 

individual’s limitations. If a bent knee stance is too difficult, then do the movement without bent 

knees). 

• Instability

This involves issues such as increased body sway, low mobility, and postural instability. Increasing 

age is also associated with reduced sensation in lower limbs and is consequently associated with a 

loss of righting reflexes and an increase in body sway, which can lead to falls. 

o Gait: decreased stepping height and decreased stride length.

Women tend to have a narrow walking and standing base, closer foot placement, erect posture 

Æ difficult to step down from stools/benches. 

Men tend to have a small-stepped gait, wider walking and standing base, and stooped posture.

Tai Chi addresses gait problems by teaching “correct” movement of lower limbs. This is done 

by lifting lower limbs from the knee rather than the foot; lifting lower limbs without 

misaligning the pelvis; and teaching to place heel down first when moving forward (toes first 

when moving back). Also, teaching movement with appropriate weight transfer, posture, and 

slightly bent knees improves stride length 

o Posture: Tai Chi also teaches participants to maintain a relaxed posture with an elongated 

spine. 

• Coordination/Mobility: Tai Chi consists of a moving from one stance to another in a slow, 

coordinated, and smooth way. This trains students in improved mobility and increased body 

awareness. 

D-3, Voukelatos Materials, 1 of 2
127

Guidelines for Instructors Working with Older People 

• Important to maintain an upright (straight) posture at all times. 

• Incremental movement is needed in teaching older people. 

• Instructors need to be well aware of an individual’s comfort level and not go beyond that. 

• In bent knee stance, must remember to introduce bent knee gradually throughout the 16-week 

period while staying within comfort levels of individuals. 

• Remember to keep the center line of gravity as perpendicular as possible and center within the 

base stance. 

• Tai Chi leaders also have to be mindful of any medical or physical conditions students might 

have that would interfere with standard Tai Chi movements. For example, if a practitioner has 

had a hip replacement then the range of movements involving hips may be limited. 

D-3, Voukelatos Materials, 2 of 2

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Appendix D-4

Wolf Materials
130

D-4, Wolf Materials, 1 of 3
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D-4, Wolf Materials, 2 of 3
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D-4, Wolf Materials, 3 of 3
133

Appendix D-5

Close Materials
134

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D-5, Close Materials, 1 of 10
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D-5, Close Materials, 2 of 10
136

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D-5, Close Materials, 3 of 10
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145

Appendix D-6

Spice Materials
146

Winchester Falls Project – Structured Secondary Assessment Domains

Question 1 – Basic information 

Name: 

Address:

GP:

DOB: 

Date of assessment: 

Date of referral: 

Question 2 – Home 

House/flat/bungalow/sheltered/RH/NH/independent

Question 3 – Walks 

Independent/stick/frame 

Question 4 – Carers 

Independent/family/carers 

Question 5 – Bowels 

Independent/continent or continent with help or incontinent occasionally or incontinent or 

stoma 

Continence aids

Question 6 – Bladder

Independent/continent or continent with help or incontinent occasionally or incontinent or 

catheter

Continence aids

Question 7 – Falls history 

How many times has/she or he fallen before this last fall: once/2-5/>5 

Has the patient sustained an injury during any fall: yes/no 

If yes, which sort:

 Head injury: yes/no 

 Fracture/dislocation: yes/no (please specify) 

 Laceration requiring medical attention: yes/no 

 Bruising: yes/no 

 Others: yes/no (please specify) 

Definite slip/trip: yes/no 

Loss of consciousness: yes/no 

Associated dizziness/palpitations: yes/no 

Vertigo: yes/no 

Presyncope: yes/no 

 

D-6, Spice Materials, 1 of 6
147

Question 8 – Drug history 

List all medications (including over the counter and prescribed) 

Question 9 – Drugs 

Is the patient taking any of the following drugs: 

 Diuretics 

 Hypnotic/sedative 

 Antidepressant 

 Digoxin 

 Cardiovascular 

 Anti-parkinsonian 

Question 10 – Alcohol consumption 

CAGE score 

Total number of units/week 

Question 11 – Smoking 

Do you smoke: yes/no 

If yes: cigarettes/pipe/cigars 

Question 12 – Past medical history 

Heart disease 

Stroke/TIA 

Respiratory disease 

Hypertension

Diabetes 

Epilepsy 

Parkinson’s disease 

Visual problems: wears glasses and last eye check within 2 years 

Joint disease 

Other neurological disease 

Other diseases: 

Question 13 – Examination BP 

Weight

BP lying 

BP standing immediately 

BP at 1 minute 

BP at 3 minutes 

Question 14 – MTS 

Question 15 – Vision 

Visual acuity with glasses/pin hole: 

Right

Left

D-6, Spice Materials, 2 of 6
148

Question 16 – Pulse 

Question 17 – Rhythm 

Question 18 – Heart sounds 

Question 19 – Cranial nerves 

Range of eye movements 

Visual fields 

Fundi

Pupils 

Other findings 

Question 20 – Peripheral neurology 

Tone (right and left) 

Power (right and left) 

Reflexes (right and left) 

Sensation (right and left) 

Cerebellar (right and left) 

Question 21 – Chest examination 

Question 22 – Abdominal examination 

Question 23 – Other findings 

Question 24 – Mobility/gait 

Aid used and pattern 

Pattern 

Heel strike 

Stance

Stride

Other

Stairs

Question 25 – Joint range and muscle strength 

Joint range 

 Upper limbs 

 Cervical spine 

 Lower limbs 

 Lumbar spine 

Muscle strength

 Upper limbs 

 Cervical spine 

 Lower limbs 

 Lumbar spine 

Question 26 – Getting up from the floor 

Pattern: independently/assistance x 1/assistance x 2/unable 

Comment: 

Question 27 – Transfers 

D-6, Spice Materials, 3 of 6
149

 Lumbar spine 

Question 26 – Getting up from the floor 

Pattern: independently/assistance x 1/assistance x 2/unable 

Comment: 

Question 27 – Transfers 

Bed

Chair

Toilet

Bath (reported) 

Question 28 – Equipment 

Equipment already in situ 

Question 29 – Domestic activities of daily living (reported) 

Make a hot drink 

Prepare a meal 

Washing up 

Use cooker 

Cleaning 

Laundry

Shopping

Carrying and lifting 

Question 30 – Personal activities of daily living (reported) 

Wash and dry self 

Dress and undress 

Clothes fastenings 

Stockings and socks 

Shoes and slippers 

Personal care 

Question 31 – Timed unsupported steady stand 

Time in seconds for unsupported/single hand/ double hand stand 

Distance between heels 

Question 32 – 180 degree turn 

Number of steps 

Time in seconds 

Question 33 – Functional reach 

Done standing in dominant arm (measured in inches) 

D-6, Spice Materials, 4 of 6
150

Question 34 – 6 meter timed walk 

Time in seconds 

Number of steps 

Question 35 – Single leg stand 

Right leg 

Left leg 

Question 36 – Clothing and footwear hazards 

Clothing

Footwear

Chiropodist: yes/no 

Question 37 – Pain 

Pain: no pain/ongoing chronic pain/acute and intermittent pain/ongoing and acute 

Description

Question 38 – Problem list 

Question 39 – Action list 

Question 40 – Likely cause of fall 

Musculoskeletal

Cardiovascular

Environmental 

Medication 

Vision

Alcohol

Other

Combination 

Comments 

Question 41 – Risk factor for falls 

Medication 

Vision

Alcohol

Postural hypotension 

Footwear

Mobility 

Medical – neurological 

Medical – musculoskeletal 

Medical – cardiovascular 

Environmental 

Other

Combination 

Comment 

D-6, Spice Materials, 5 of 6
151

Question 42 – Planned investigations and/or interventions 

Question 43 – Follow-up arrangements/referrals 

Question 44 – Timings 

Doctor:

Physiotherapist: 

Nurse:

Occupational therapist: 

Other (please specify): 

D-6, Spice Materials, 6 of 6