A CDC Compendium of 

Effective Fall Interventions:

What Works for Community-Dwelling Older Adults 

i

A CDC Compendium of 

Effective Fall Interventions:

What Works for Community-Dwelling Older Adults

3rd Edition

by

Judy A. Stevens, PhD and Elizabeth Burns, MPH

Division of Unintentional Injury Prevention

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

Atlanta, Georgia

2015
ii

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

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

Debra Houry, MD, MPH, Director

Division of Unintentional Injury Prevention

Grant Baldwin, PhD, MPH, Director

Home, Recreation, and Transportation Branch

Ann Dellinger, PhD, MPH, Branch Chief

Home and Recreation Injury Prevention Team

Robin Lee, PhD, MPH, Team Lead

Authors

Judy A. Stevens, PhD and Elizabeth Burns, MPH

ACKNOWLEDGEMENTS

To Dr. Ellen Sogolow, 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 falls interventions for older adults. 

We acknowledge and appreciate the support of Dr. Christine Branche in the initial phase of 

this project; the important contributions of Dr. Patricia D. Nolan, Mr. David Ramsey, Ms. Lisa 

Jeannotte, Ms. Bonny Bloodgood, and Ms. Sondra Dietz in collecting and organizing these 

data; and the thoughtful review and constructive suggestions of Dr. David Sleet, Dr. Daphne 

Moffett, Dr. Michael Ballesteros, Dr. Rita Noonan, Dr. Grant Baldwin, Dr. Ann Dellinger, and Dr. 

Robin Lee.

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

What Works for Community-Dwelling Older Adults. 3rd ed. Atlanta, GA: Centers for Disease 

Control and Prevention, National Center for Injury Prevention and Control, 2015.

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.
iii

CONTENTS

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

Single Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Exercise 5

Stay Safe, Stay Active Barnett, et al. (2003) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

The Otago Exercise Program Campbell, et al. and Robertson, et al. 

(1997, 1999, 2001, 2005) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

LiFE (Lifestyle approach to reducing Falls through Exercise) 

Clemson, et al. (2012) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Erlangen Fitness Intervention Freiberger, et al. (2007) . . . . . . . . . . . . . . . . . . . . . 16

Senior Fitness and Prevention (SEFIP) Kemmler, et al. (2010) . . . . . . . . . . . . . . . . . 18

Adapted Physical Activity Program Kovacs, et al. (2013) . . . . . . . . . . . . . . . . . . . . 20

Tai Chi: Moving for Better Balance Li, et al. (2005) . . . . . . . . . . . . . . . . . . . . . . . 22

Australian Group Exercise Program Lord, et al. (2003) . . . . . . . . . . . . . . . . . . . . . 24

Yaktrax® Walker McKiernan (2005) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Veterans Affairs Group Exercise Program Rubenstein, et al. (2000) . . . . . . . . . . . . . 28

Falls Management Exercise (FaME) Intervention Skelton, et al. (2005) . . . . . . . . . . . 30

Music-Based Multitask Exercise Program Trombetti, et al. (2011) . . . . . . . . . . . . . . 34

Central Sydney Tai Chi Trial Voukelatos, et al. (2007) . . . . . . . . . . . . . . . . . . . . . . 36

Simplified Tai Chi Wolf, et al. (1996) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Multi-target Stepping Program Yamada, et al. (2013) . . . . . . . . . . . . . . . . . . . . . . 40

Table 1. Summary Table of Studies and Study Population . . . . . . . . . . . . . . . . . 44

Table 2. Study Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Table 3. Intervention Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Home Modification 55

The VIP Trial Campbell, et al. (2005) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Home Visits by an Occupational Therapist Cumming, et al. (1999) . . . . . . . . . . . . . . 58

Falls-HIT (Home Intervention Team) Program Nikolaus, et al. (2003) . . . . . . . . . . . . 60

Home Assessment and Modification Pighills, et al. (2011) . . . . . . . . . . . . . . . . . . . 62

Table 1. Summary Table of Studies and Study Population . . . . . . . . . . . . . . . . . 65

Table 2. Study Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Table 3. Intervention Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
iv

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Clinical 69

Three-Year Study of Vitamin D (Cholecalciferol) Plus Calcium 

Bischoff-Ferrari, et al. (2006) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

Psychotropic Medication Withdrawal Campbell, et al. (1999) . . . . . . . . . . . . . . . . 72

Active Vitamin D (Calcitriol) as a Falls Intervention Gallagher, et al. (2007) . . . . . . . . 74

VISIBLE (Visual Intervention Strategy Incorporating Bifocal 

and Long-distance Eyewear) Study Haran, et al. (2010) . . . . . . . . . . . . . . . . . . . . 76

Vitamin D to Prevent Falls After Hip Fracture Harwood, et al. (2004) . . . . . . . . . . . . 79

Cataract Surgery Harwood, et al. (2006) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Pacemaker Surgery Kenny, et al. (2001) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

Study of 1000 IU Vitamin D Daily for One Year Pfeifer, et al. (2009) . . . . . . . . . . . . . 85

Quality Use of Medicines Program Pit, et al. (2007) . . . . . . . . . . . . . . . . . . . . . . . 87

Podiatry & Exercise Intervention Spink, et al. (2011) . . . . . . . . . . . . . . . . . . . . . . 90

Table 1. Summary Table of Studies and Study Population Characteristics . . . . . . . . 94

Table 2. Study Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

Table 3 Intervention Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101

Multifaceted Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

Stepping On Clemson, et al. (2004) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

PROFET (Prevention of Falls in the Elderly Trial) Close, et al. (1999) . . . . . . . . . . . . .107

Accident & Emergency Fallers Davison, et al. (2005) . . . . . . . . . . . . . . . . . . . . . .109

The NoFalls Intervention Day, et al. (2002) . . . . . . . . . . . . . . . . . . . . . . . . . . . .112

The SAFE Health Behavior and Exercise Intervention Hornbrook, et al. (1994) . . . . . .115

Falls Team Prevention Program Logan, et al. (2010) . . . . . . . . . . . . . . . . . . . . . . 118

KAAOS (Falls and Osteoporosis Clinic) Palvanen, et al. (2014) . . . . . . . . . . . . . . . . 120

Multifactorial Fall Prevention Program Salminen, et al. (2009) . . . . . . . . . . . . . . . 124

Nijmegen Falls Prevention Program (NFPP) for adults with Osteoporosis 

Smulders, et al. (2010) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127

The Winchester Falls Project Spice, et al. (2009) . . . . . . . . . . . . . . . . . . . . . . . .130

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

Tinetti, et al. (1994) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133

A Multifactorial Program Wagner, et al. (1994) . . . . . . . . . . . . . . . . . . . . . . . . .136

Table 1. Summary Table of Studies and Study Population Characteristics . . . . . . . .139

Table 2. Study Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140

Table 3. Intervention Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .146
v

Table of Contents

Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .149

Appendix A: Intervention Study Selection Process 149

Appendix B: Bibliography of Compendium Studies and Supplemental Articles . . . . 153

Appendix C: Original Intervention Materials . . . . . . . . . . . . . . . . . . . . . . . . . 160

Appendix C-1 Barnett Materials Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . .161

Appendix C-2 Kovacs Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166

Appendix C-3 Voukelatos Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .167

Appendix C-4 Wolf Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .169

Appendix C-5 Haran Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .173

Appendix C-6 Pit Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .176

Appendix C-7 Spink Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179

Appendix C-8 Close Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .194

Appendix C-9 Spice Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201

1

Introduction

Introduction

Older adults value their independence and a fall can 

significantly reduce 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.1 Among older adults, falls are the leading cause of both 

fatal and nonfatal injuries2 and are responsible for significant 

disability, hospitalization, loss of independence, and reduced 

quality of life.3

 Most fractures among older adults are caused 

by falls.4 Falls also have a huge economic impact. Direct 

medical costs for fall injuries total $34 billion annually.5

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.6

Purpose

This report is intended to showcase specific interventions for 

which there is published evidence of the intervention’s ability 

to reduce falls among community-dwelling older adults. 

The compilation of this information can help public health 

practitioners, senior service providers, clinicians, and others 

who want to address falls in their community. 

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. 

1 Tromp AM, Pluijm SMF, Smit JH, et al. Fall-risk screening test: a prospective study on predictors for falls in communitydwelling elderly. Journal of Clinical Epidemiology 2001;54(8):837–844.

2 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based Injury 

Statistics Query and Reporting System (WISQARS) [online]. Accessed August 15, 2013.

3 Wolinsky F D, Fitzgerald J F, Stump T E. The effect of hip fracture on mortality, hospitalization, and functional status: 

a prospective study. American Journal of Public Health 1997.

4 Jager TE, Weiss HB, Coben JH, Pepe PE. Traumatic brain injuries evaluated in U.S. emergency departments, 1992–1994. 

Academic Emergency Medicine 2000;7(2):134–40.

5 Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and nonfatal falls among older adults. Injury Prevention

2006a;12:290–5.

6 Gillespie, LD, Robertson, MC, Gillespie, WH, Sherrington C, Gates S, Clemson LM, Lamb SE. Interventions for preventing 

falls in older people living in the community. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD007146. 

DOI: 10.1002/14651858.CD007146.pub3.
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Process

For this 3rd edition of the Compendium, CDC gathered information about fall prevention 

studies that met the following criteria: 

• Published in the peer-reviewed literature

• Included community-dwelling adults aged 60 and older

• Used a randomized controlled study design

• Was specifically designed to be a fall prevention intervention

• Measured falls or the proportion of fallers as an outcome 

• Demonstrated statistically significant positive results in reducing older adult falls

• Took place in a community or clinical setting

This selection methodology differed from previous versions in that the selected age criteria 

was changed from 65 and older to 60 and older. Interventions implemented in clinical settings 

also were included. A literature review was conducted in 2014 and identified 12 interventions 

published between January 1, 2009 and September 30, 2014. We also identified seven 

interventions published before 2009 that met the expanded criteria. 

See Appendix A for details about the selection process and methods used for the earlier editions.
3

Introd uction

Content

The Compendium classifies interventions into two 

main groups: single interventions and multifaceted 

interventions. 

Multifaceted interventions address multiple fall risk 

factors. Some multifaceted interventions include an 

assessment of each participant’s fall risk factors and 

provide an individually tailored intervention plan. 

Single interventions address a specific fall risk factor 

(e.g. treating gait and balance issues with physical 

therapy). Single interventions are further categorized as 

exercise, home modification, and clinical interventions. 

Twenty nine single interventions (15 exercise 

interventions, 4 home modification interventions, and 10 

clinical interventions) and 12 multifaceted interventions 

are included in the 3rd edition of the Compendium. 

Information about each intervention was obtained from 

the published study and by direct communication with the study’s principal investigator. Each 

is presented using a standardized format that includes a short summary of the intervention, 

study results, and a section describing additional details about the intervention. These include:

• Purpose

• Program setting

• Content

• Number of sessions

• Duration

• Type of provider

• Provider’s training

• Key elements

• Available materials

• Contact information for the principal investigator. 

At the end of each section are tables comparing the participating populations, study 

characteristics, and intervention characteristics.

The Compendium also contains appendices. These include figures illustrating the intervention 

selection process; a bibliography of the research interventions; and supplemental materials, 

such as assessment instruments.

15

Note: The color coding in this chart uses 

a different percentage of the section color 

(saturation) to assist color blind readers in 

viewing the differences between sections.

5

Single Interventions

Exercise

ToC3

SINGLE INTERVENTIONS

Exercise 

Stay Safe, Stay Active Barnett, et al. (2003) . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

The Otago Exercise Program Campbell, et al. and Robertson, et al. 

(1997, 1999, 2001, 2005) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

LiFE (Lifestyle approach to reducing Falls through Exercise) Clemson, et al. (2012) . . .12

Erlangen Fitness Intervention Freiberger, et al. (2007) . . . . . . . . . . . . . . . . . . . . 16

Senior Fitness and Prevention (SEFIP) Kemmler, et al. (2010) . . . . . . . . . . . . . . . . .18

Adapted Physical Activity Program Kovacs, et al. (2013) . . . . . . . . . . . . . . . . . . . 20

Tai Chi: Moving for Better Balance Li, et al. (2005) . . . . . . . . . . . . . . . . . . . . . . .22

Australian Group Exercise Program Lord, et al. (2003) . . . . . . . . . . . . . . . . . . . . .24

Yaktrax® Walker McKiernan (2005) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Veterans Affairs Group Exercise Program Rubenstein, et al. (2000) . . . . . . . . . . . . 28

Falls Management Exercise (FaME) Intervention Skelton, et al. (2005) . . . . . . . . . . .30

Music-Based Multitask Exercise Program Trombetti, et al. (2011) . . . . . . . . . . . . . .34

Central Sydney Tai Chi Trial Voukelatos, et al. (2007) . . . . . . . . . . . . . . . . . . . . . .36

Simplified Tai Chi Wolf, et al. (1996) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Multi-target Stepping Program Yamada, et al. (2013) . . . . . . . . . . . . . . . . . . . . .40

Table 1. Summary Table of Studies and Study Population . . . . . . . . . . . . . . . . . . 44

Table 2. Study Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Table 3. Intervention Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
6

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Stay Safe, Stay Active 

Barnett, et al. (2003) 

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 of 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 

community exercise, sports, and recreation facilities in the United States. 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 (PT) to address physical fall risk 

factors: balance and coordination, strength, reaction time, and aerobic capacity. Each class 

began with five to ten minutes of warm-up that included stretching of the major lower limb 

muscle groups and ten 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 

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 one-hour classes were conducted once a week over a one-year period. 
7

Single Interventions : Exer cise

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

this exercise program by a licensed PT (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 the leaders ownership in the program. 

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

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

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 C-1

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.

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 7155

Fax: +61 (9) 722 7125

E-mail: anne.barnett@swsahs.nsw.gov.au
8

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

The Otago Exercise Program 

Campbell, et al. and Robertson, et al. 

(1997, 1999, 2001, 2005) 

This program, tested in four randomized controlled trials and one controlled multi-center 

trial, was an individually tailored program of muscle-strengthening and balance-retraining 

exercises of increasing difficulty, combined with a walking program. This extensively tested fall 

prevention program is now used worldwide. 

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. 

Note: This study has been translated for use in the United States. See page 11 for more information.

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

Geographic Locale: Dunedin, New Zealand 

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. It 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 at home four times over 

the first two months (at weeks one, two, four, and eight) and again for a booster session at six 

months. To maintain motivation, participants received telephone calls once a month during 

the months when no visits were scheduled. 

The first home visit lasted one-hour and all subsequent visits took about half an hour. During 

each visit, the PT or nurse prescribed a set of in-home exercises (selected at appropriate and 

increasing levels of difficulty) and a walking plan. 

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. 
9

Single Interventions : Exer cise

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

the exercises three times a week and to walk outside the home at least two times a week. 

Exercises then were continued on an ongoing basis. In three trials, the exercise program was 

prescribed for one year and in one trial it was extended to two 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 two-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/

groups/external_providers/documents/publications_promotion/prd_ctrb118334.pdf.

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, 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. 
10

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

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. 

Contact 

Practitioners interested in using this intervention may contact the principal investigator for 

more information: 

M. Clare Robertson, PhD 

Research Honorary Associate Professor

Department of Medicine, Dunedin School of Medicine

University of Otago 

P.O. Box 913 Dunedin 9054, New Zealand 

E-mail: clare.robertson@otago.ac.nz
11

Single Interventions : Exer cise

U.S. Program Contact 

In 2011, CDC funded the translation of the Otago Exercise Program for dissemination and 

implementation in the U.S. 

As implemented in the U.S., the key features of the Otago Exercise Program are:

1. Delivered only by PTs or PT assistants. 

2. Provides a minimum of five visits over eight weeks with a follow-up visit at six months. 

3. Takes place in the older adult’s home or in an outpatient setting.

4. Encourages the PTs to find ways to help older adults adhere to the program. This may include 

encouraging the caregiver to exercise with the older adult or having participants perform their 

Otago exercises in a group setting.

To support adoption of the Otago Exercise Program, CDC has published an implementation guide 

for PTs and has partnered with other organizations to develop:

• An online training program for PTs. 

• Additional implementation resources (videos, handouts, etc.).

Available Materials: Tools to Implement the Otago Exercise Program in the U.S. are available at 

http://www.med.unc.edu/aging/cgec/exercise-program/tools-for-practice/.

Online training is available at: http://www.med.unc.edu/aging/cgec/exercise-program.

Practitioners interested in learning more may contact: 

Tiffany E. Shubert, MPT, PhD

Senior Research Scientist

Center for Health Promotion and Disease Prevention

UNC Chapel Hill

Phone: (919) 360-1970

Email: tshubert@med.unc.edu

Or visit the course website at: http://www.med.unc.edu/
12

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

LiFE (Lifestyle Approach to Reducing Falls 

Through Exercise) 

Clemson, et al. (2012)

This study evaluated the effectiveness of two exercise interventions to reduce falls: an 

integrated balance and strength training intervention that focused on embedding exercises 

into daily life (LiFE), and a structured balance and strength exercise program performed 

three times a week. 

Both interventions were tailored for participants and increased in difficulty during the 

intervention. Only the LiFE program was effective in reducing falls. Participants in the LiFE 

program experienced 31 percent fewer falls compared to the control group.

Population: Participants were community-dwelling adults aged 70 or older who had 

experienced two or more falls or one fall with a self-reported injury in the previous 12 

months. More than half were female. 

Geographic Location: Sydney, Australia

Focus: Integrate balance and strength training exercises into daily activities. 

Program Setting: Sessions were conducted in the participants’ homes. 

Content: This program consisted of five to seven in-home sessions where an implementer 

(a physical therapist [PT], occupational therapist [OT], or exercise physiologist) worked with 

each participant to add seven balance strategies (e.g., reducing base of support) and seven 

strength training strategies (e.g., bending knees) to their daily activities. The implementer 

worked with participants to upgrade the exercises over the course of the intervention. For 

instance, standing with one foot placed in front of the other (tandem stand) uses the balance 

strategy, “reduce base of support” and can be upgraded to standing on one foot as the 

participant becomes better at balancing.

The initial session lasted about 90 minutes; all subsequent sessions lasted 40–60 minutes.

• During Session One, the implementer: 

– Assessed the ability and daily activities of the participant.

– Chose and demonstrated one to two LiFE balance exercises and one to two LiFE 

strength exercises.

– Provided background on the principles behind challenging balance and 

strengthening muscles. 

– Worked with the participant to develop an Activity Plan for how, when, and where 

the exercises would be performed. 

– Provided the participant with the LiFE Participant manual that contains instructions 

and examples of LiFE balance and strength activities.
13

Single Interventions : Exer cise

• Encouraged the participant to plan and record where and when they would do 

each exercise.

• During Sessions two through five, the implementer: 

• Encouraged participants to suggest how they could perform LiFE exercises during daily 

activities and how they might upgrade these exercises (i.e., make them more challenging 

over time).

• Provided a new Activity Plan for each session that included current exercises, upgraded 

exercises, and two to four new exercises. 

• Reviewed and confirmed exercise techniques for safety.

• During two booster sessions, the implementer:

– Finished embedding the seven balance and seven strength LiFE strategies if they were 

not completed.

– Reviewed the participant’s current exercises and encouraged finding more opportunities 

to embed them in routines and to upgrade them. 

– Emphasized performing the exercises safety.

– Encouraged participant to continue doing these new exercises. 

Examples of LiFE Program exercises

Strategy Exercise Setting Upgraded exercise

Balance Training

Reduce base of support

Tandem stand

Tandem walking

Brushing teeth

Ironing

Walking down the 

hallway

Standing on one leg 

Move to the limits 

of sway

Lean to one side as far 

as possible 

Talking on the 

telephone

Hold longer

Reduce base of support

Strength Training

Bend your knees Squatting instead of 

bending your back

Putting laundry away in 

drawers

Putting a plate away in 

the kitchen cupboard

Emptying the 

dishwasher

Put the dishwashing 

liquid on a lower shelf
14

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Duration: Training sessions were held once a week for five weeks with two booster sessions 

if needed. Sessions lasted 40–90 minutes. The implementer encouraged participants to do 

the prescribed exercises as often as possible each day over the course of the 12-month 

intervention period.

Delivered By: This program was delivered by a PT, OT, or exercise physiologist. Each 

participant worked with only one member of the intervention team. However, all of the 

implementers met regularly to discuss any issues and to contribute suggestions and upgrades 

for all participants.

Minimum Level of Training Needed: A PT, OT, or exercise physiologist experienced with 

the LiFE approach. Those interested in implementing the intervention MUST read the trainer’s 

manual and do the LiFE program themselves before teaching it to older adults. The therapist 

should understand the importance of planning, prompts, and practice to reinforce learning 

new habits. 

LiFE does not prescribe a set number of times to do a LiFE activity. Rather it is focused on 

seeking opportunities to “do more.” The assessment and planning tools have been carefully 

designed to reflect this approach to behavior change.

Key Elements: 

• Understanding the principles underlying the balance and strength exercises.

• Planning when, where, and how to incorporate the exercises, including using prompts.

• Understanding how to upgrade the exercises.

• Having the participant practice the exercises safely so they feel challenged over time.

• Working with the participant to develop and embed LiFE exercises into daily activities.

Available Materials:

Clemson L, Fiatarone Singh M, Munro J. Lifestyle-Integrated Functional Exericse (LiFE) Program 

to reduce falls. Participant’s manual. Sydney: Sydney University Press; 2014.

Clemson L, Fiatarone Singh M, Munro J. Lifestyle-Integrated Functional Exericse (LiFE) Program 

to reduce falls. Trainer’s manual. Sydney: Sydney University Press; 2014.

The Daily Routine Chart, Life Assessment Tool, LiFE Balance and Strength Activity Planner’s and 

the Activity Plan are all freely downloadable from Sydney University Press: http://ses.library.

usyd.edu.au/handle/2123/10627.

Study Citation: Clemson L, Fiatarone Singh MA, Bundy A, Cumming RG, Manollaras K, 

O’Loughlin P, et al. Integration of balance and strength training into daily life activity to reduce 

rate of falls in older people (the LiFE study): randomised parallel trial. British Medical Journal

(Clinical Research Ed). 2012;345:e4547.
15

Single Interventions : Exer cise

Supplemental Article

Clemson L, Singh MF, Bundy A, Cumming RG, Weissel E, Munro J, Manollaras K, Black D. LiFE 

Pilot Study: A randomised trial of balance and strength training embedded in daily life activity 

to reduce falls in older adults. Australian Occupational Therapy Journal 2010;57(1):42–50.

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

E-mail: lindy.clemson@sydney.edu.au
16

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Erlangen Fitness Intervention 

Freiberger, et al. (2007)

This study examined two 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 ErlangenNuremberg, Institute of Sport Science. 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 walking or biking daily. 

Each session lasted one 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, weightbearing 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. 

Delivered by: The program was supervised by two 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. 
17

Single Interventions : Exercise

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 two-day training session, or to attend a 

comprehensive four-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: 

Ellen Freiberger PhD

Associate Professor

FAU Erlangen-Nürnberg Institute for Biomedicine of Aging

Kobergerstr. 6090408 Nürnberg

Tel: +49(0)911- 5302-96162

Fax: +49(0)911-5302-96151

E-mail: ellen.freiberger@fau.de
18

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Senior Fitness and Prevention (SEFIP) 

Kemmler, et al. (2010)

This study evaluated the effectiveness of an exercise intervention that consisted of two 

structured high-intensity group classes and two home exercise sessions per week. After 18 

months, participants were 46 percent less likely to fall and 67 percent less likely to suffer a 

fall-related injury compared with those who did not receive the intervention.

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

and were not taking medications that could affect bone health (e.g., bisphosphonates, 

hormone therapy).

Geographic Locale: Erlangen-Nuremberg, Germany

Focus: Determine the effect of high intensity exercise on falls, fractures, coronary heart 

disease (CHD) risk factors, and health care costs. 

Program Setting: This program took place in community gymnasiums.

Content: This program consisted of high-intensity group exercise classes and a home-based 

exercise routine.

Each group session lasted 60 minutes and included four components:

1. A 20 minute warm-up/aerobic dance sequence with progressively higher-impact elements 

2. A 5 minute period that included static and dynamic balance training 

3. A 15 minute period that included functional gymnastics, isometric strength training, and 

stretching sequences 

– Floor exercises for trunk, hip and leg muscles

– Exercises were replaced every 6 to 18 weeks by more strenuous ones.

4. A 15 minute circuit training period 

a. Upper body exercises

– Low and high belt rowing 

– Shoulder raises

– Continuous stretching using elastic belts (Thera-Band) 

b. Dynamic weight-bearing leg exercises 

The home exercise sessions emphasized strength and flexibility (including using Thera-bands). 

Every 12 weeks, the home exercises were made more difficult. The exercise trainer encouraged 

participants to practice their home exercises consistently.
19

Single Interventions : Exercise

Duration: Two 60-minute group classes and two 20-minute home exercise sessions were 

conducted weekly. The intervention lasted 18 months.

Delivered by: This program was delivered by certified exercise instructors under the 

guidance of the principal investigator. 

Minimum Level of Training Needed: Certified exercise instructors with experience 

teaching older adults.

Key Elements:

• Resistance exercises.

• Exercises that include high impact elements.

• Exercises to improve general coordination and balance.

• Exercises that become more challenging over time.

Available Materials: None at this time.

Study Citation: Kemmler W, von Stengel S, Engelke K, Häberle L, Kalender WA. Exercise 

effects on bone mineral density, falls, coronary risk factors, and health care costs in older 

women: the randomized controlled senior fitness and prevention (SEFIP)study. Arch Intern Med. 

2010 Jan 25;170(2):179–85.

Supplemental Article

von Stengel S, Kemmler W, Engelke K, Kalender WA. Effects of whole body vibration on 

bone mineral density and falls: results of the randomized controlled ELVIS study with 

postmenopausal women. Osteoporosis International. 2011 Jan;22(1):317–25.

Contact 

Practitioners interested in using this intervention may contact the principal investigator for 

more information: 

Wolfgang Kemmler, PhD

Institute of Medical Physics 

University of Erlangen 

Henkestrasse 91, 91052 Erlangen, Germany 

E-mail: wolfgang.kemmler@imp.uni-erlangen.de.
20

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Adapted Physical Activity Program 

Kovacs, et al. (2013)

This study evaluated an exercise program adapted for older women. One-hour classes were 

held twice a week for 25 weeks. Exercises were tailored to each participant’s physical abilities 

and became more difficult as the study progressed. 

Participants were 60 percent less likely to fall compared to those who did not receive the 

intervention.

Population: Participants were community-dwelling women aged 60 and older who had not 

exercised regularly in the past six months.

Geographic Location: Budapest, Hungary

Focus: Improve balance, decrease risk of falls, and improve quality of life.

Program Setting: The exercise program was conducted in the gymnasium of a local 

sports center.

Content: A physical therapist (PT) and a PT student assistant led a class of 30–38 participants. 

The PT encouraged participants to choose the music that was played during the structured 

exercises. 

The exercises were tailored to the abilities of each participant and became more difficult over 

the 25-week intervention by increasing the number of repetitions or the duration. The PT 

increased the difficulty of the ball games by reducing the ball’s size and increasing the ball’s 

weight over the course of the intervention.

While participants exercised, the PT explained how the exercises related to movements used in 

everyday situations 

Each class included:

• A 5–10 minute warm up that included stretching.

• A 20–25 minute period of structured exercises and functional activities.

– Exercises included raising arms over head while seated, partial squats, tandem stepping, 

and high stepping in place.

– Functional activities included sit to stand, stand to sit, and walking and turning. 

• A 20–25 minute group activity such as a relay race or ball game. Participants choose which 

group activity they preferred for each session. 

– Relay races included walking on toes, walking backward and stepping in and out of 

hoops as part of the course. 

– Ball games included adapted basketball and an adapted form of catch. 

• A 5–10 minute cool-down.
21

Single Interventions : Exercise

Duration: Classes were held one-hour twice a week and lasted for 25 weeks.

Delivered By: A PT with extensive geriatric experience and assisted by a physical therapy 

student. PTs in Hungary must have a minimum of three years of supervised work before he/she 

is permitted to practice alone.

Minimum Level of Training Needed: This program should be delivered by a PT with three 

or more years of experience to ensure the effectiveness and safety of the program.

Key Elements:

• Exercise sessions should be held at least twice a week and continue for at least six months.

• Each session must include all components. Exercises should be tailored for participants with 

limited abilities (e.g. performed slower, doing fewer repetitions, using lighter objects and 

balls, or with support).

• Each session must include functional activities (e.g., sit to stand and stand to sit, walking, 

and stepping in different directions).

• Exercises should be accompanied by brief explanations about how the exercises relate to 

movements used in everyday situations. 

Available Materials: A more detailed description of the structured and group exercises is 

available in the Appendix C-2. 

Study Citation: Kovács E, Prókai L, Mészáros L, Gondos T. Adapted physical activity is 

beneficial on balance, functional mobility, quality of life and fall risk in community-dwelling 

older women: a randomized single-blinded controlled trial. European Journal of Physical and 

Rehabilitation Medicine. 2013 Jun;49(3):301–10.

Contact 

Practitioners interested in using this intervention may contact the principal investigator for 

more information:

Éva Kovács, PhD

Faculty of Health Science, Semmelweis University

17 Vas street

1088—Budapest, Hungary

Tel: (+36 1) 486-4946

Email: kovacse@se-etk.hu
22

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Tai Chi: Moving for Better Balance 

Li, et al. (2005) 

This study compared the effectiveness of a six-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 multiple falls was decreased 55 percent. 

Note: This study has been translated for use in the United States. See page 23 for more information.

Population: Participants were inactive adults aged 70 or older. Three-quarters were female. 

All participants lived in the community. 

Geographic Locale: Portland, Oregon, United States. 

Focus: Improve balance and physical performance with Tai Chi classes designed for older adults. 

Program Setting: The Tai Chi program was 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 a 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 three times a week for 26 weeks, followed by a sixmonth 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. 

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. 
23

Single Interventions : Exercise

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 two 

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

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

U.S. Program Contact 

As implemented in the U.S., the key features of the Y’s efforts in Moving For Better Balance are:

1. A reduced number of Tai Chi forms. This program uses 8 modified forms of Tai Chi instead of 

the 24 used in the study intervention.

2. The Y is able to scale the program through a YMCA instructor delivery network. 

Practitioners interested in learning more may contact: 

Heather Hodge

Director, Chronic Disease Prevention Programs

Healthy Living

YMCA OF THE USA

101 N Wacker Drive, Chicago IL 60606

Tel: 800 872 9622 x8287

Direct: 312 419 8287

Email: heather.hodge@ymca.net
24

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Australian Group Exercise Program 

Lord, et al. (2003)

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 

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

compared with those who did not take part 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, gait and balance, and increase their 

ability to carry out activities of daily living such as standing up 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 four successive three-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 one-hour class had three components: 

• 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 four repetitions at week 2 and reaching 30 by week 10. Thirty repetitions were maintained 

for rest of the program.

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

guided imagery. 

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

four successive three-month terms. 
25

Single Interventions : Exercise

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 one-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
26

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Yaktrax® Walker 

McKiernan (2005)

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 each participant, 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: A research study coordinator. 

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. 

Reprinted with permission of the Yaktrax® 

Walker. Yaktrax® is a Registered Trademark 

of Implus Footcare LLC. 
27

Single Interventions : Exercise

• 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
28

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Veterans Affairs Group Exercise Program 

Rubenstein, et al. (2000) 

This study evaluated a structured group exercise program for fall-prone older men. At the end 

of the three-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 one of these fall risk factors: leg weakness; impaired gait, mobility, and/or 

balance; and/or had fallen two or more times in the previous six 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 four weeks, participants increased each exercise from one to three sets of 12 

repetitions. 

Resistance levels also were increased progressively. The rate of progression was modified for 

subjects with physical limitations. 

• Endurance training used bicycles, treadmills, and indoor walking sessions. Endurance 

training alternated between cycling (once a week), using a treadmill (twice a week), and 

indoor walking that included a walking loop as well as two flights of stairs (twice a week). 

Heart rates were monitored to ensure that participants did not exceed 70 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. 

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 (PTs). 
29

Single Interventions : Exercise

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

on-the-job training by an experienced exercise physiologist or PT. 

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 fallprone 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, FACP

Professor and Chairman, Donald W. Reynolds Department of Geriatric Medicine

The Donald W. Reynolds Chair in Geriatric Medicine

The University of Oklahoma, HSC

1122 NE 13th Street, ORB 1200

Oklahoma City, Oklahoma 73117

Tel: 405.271.8124

Fax: 405.271.3887

Email: laurence-rubenstein@ouhsc.edu
30

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Falls Management Exercise (FaME) Intervention 

Skelton, et al. (2005) 

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 

three or more times in the previous year. 

Geographic Locale: London, United Kingdom 

Focus: Improve balance and strength. 

Program Setting: Group classes were conducted at four 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 were 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 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. 
31

Single Interventions : Exercise

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 five 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 eight 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 (PTs), and occupational therapists (OTs) who have taken the fiveday training course, “Exercise for the Prevention of Falls and Injuries in Frailer Older People.”

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. 

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. PTs and OTs do not have to become 

an exercise instructor in order to take this training. 
32

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

The five-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. 

More information about the course content can be found at www.laterlifetraining.co.uk. 

The United Kingdom Chartered Society of Physiotherapists endorses the Postural Stability 

Instructor training course. Additional information can be found at www.csp.org.uk. 

Key Elements: 

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

• It should include a minimum of two 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 

http://www.ageuk.org.uk/documents/en-gb/id8950%20strength%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. 

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. Multicentre 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. 
33

Single Interventions : Exercise

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: 

Professor Dawn Skelton, PhD

Professor of Ageing and Health, Centre for Living, Institute of Applied Health Research

School of Health and Life Sciences 

Govan Mbeki Health Building, Glasgow Caledonian University

Cowcaddens Road, Glasgow G4 0BA, United Kingdom 

Tel: +44 (0) 141 331 8792 

E-mail: dawn.skelton@gcu.ac.uk
34

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Music-Based Multitask Exercise Program 

Trombetti, et al. (2011) 

This study evaluated the effectiveness of Jaques-Dalcroze eurhythmics, a music-based 

multitask exercise program, to improve gait and balance and reduce falls among high risk older 

adults. Experienced instructors led a one-hour class once a week for six months. At the end of 

the six-month program, participants were 54 percent less likely to fall compared to those who 

did not participate in the program.

Population: Participants were community-dwelling adults aged 65 and older with an 

increased risk of falling, defined as having had one or more self-reported falls, balance 

impairment, or being physically pre-frail. Most participants were female. 

Geographic Location: Geneva, Switzerland

Focus: Improve gait and balance using Jaques-Dalcroze eurhythmics classes modified for 

older adults.

Program Setting: Classes were conducted in common areas of residential retirement 

communities.

Content: A certified and experienced Jaques-Dalcroze instructor led each session and played 

the piano. The program included a combination of gait and balance movements, flexibility 

training, and coordinated movements of multiple joints (e.g., rotating a ball in your hand while 

moving your arms and walking). 

Participants wore thin soled shoes. The instructor constantly changed the music so participants 

could not predict the rhythm and had to adapt their movements in response. The participants 

helped select the style of music played. 

Each one-hour class had three segments:

A 5–10 minute warm-up that included stretching exercises. 

A 40 minute core-content period composed of multitask and balance challenging exercises. 

Basic exercises consisted of walking in time to the music and responding to changes in 

the music’s rhythmic patterns. Upper body exercises included sequences using percussion 

instruments or balls. 

Other typical exercises included quick reaction exercises, walking out of rhythm, and 

multidirectional weight shifting. Exercises gradually became more difficult over the 

six month period. 

The instructor requested participants to maintain a high level of attention and respond quickly 

to verbal instructions and changes in the rhythm of the music. 

A 5–10 minute cool-down period. 
35

Single Interventions : Exercise

Duration: A one-hour class once a week for six months.

Delivered by: Certified exercise instructors experienced in teaching Jaques-Dalcroze 

eurhythmics to older adults.

Minimum Level of Training Needed: Instructors should be trained in Jaques-Dalcroze 

eurhythmics instruction and have experience teaching older adults.

Key Elements: 

• This program should be led by an experienced Jaques-Dalcroze instructor.

• An average class size of 15-18 is ideal for effective learning and teaching.

• To maintain program fidelity, the program should not be altered.

Available Materials: Information about the Jaques-Dalcroze eurhythmics certification 

program in the United States is available at http://www.dalcrozeusa.org/.

Study Citation: Trombetti A, Hars M, Herrmann FR, Kressig RW, Ferrari S, Rizzoli R. Effect of 

music-based multitask training on gait, balance, and fall risk in elderly people: a randomized 

controlled trial. Archives of Internal Medicine. 2011 Mar 28;171(6):525–33.

Supplemental Articles 

Wahli-Delbos M. La Rythmique Jaques-Dalcroze, un atout pour les seniors. Geneva: Editions 

Papillon; 2010.

Hars M, Herrmann FR, Fielding RA, Reid KF, Rizzoli R, Trombetti A. Long-term exercise in older 

adults: 4-year outcomes of music-based multitask training. Calcified Tissue International. 2014 

Nov;95(5):393–404.

Contact

Practitioners interested in using this intervention may contact the principal investigator for 

more information:

Dr. Andrea Trombetti 

Division of Bone Diseases, Department of Internal Medicine Specialties,

Geneva University Hospitals and Faculty of Medicine,

Rue Gabrielle-Perret-Gentil 4, 1211

Geneva, Switzerland

E-mail: Andrea.Trombetti@hcuge.ch
36

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Central Sydney Tai Chi Trial 

Voukelatos, et al. (2007)

This study evaluated the effectiveness of community-based Tai Chi programs 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-week follow-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: Community Tai Chi classes were conducted at locations such as town 

halls and senior centers. Locations were 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 five 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. 

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. 
37

Single Interventions : Exer cise

• 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 C-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

School of Public Health and Community Medicine, University of New South Wales

Health Promotion, Sydney Local Health District

Level 9 (North), KGV building, Missenden Road

Camperdown, New South Wales 2050, Australia 

Tel: +61(0)2 9515 9079

Fax: +61(0)2 9515 9056

E-mail: avouk@email.cs.nsw.gov.au
38

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Simplified Tai Chi

Wolf, et al. (1996) 

This study compared a 15-week program of Tai Chi classes that used 10 simplified movements 

with a balance training program. After four 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 C-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. 

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. 

Image 1: This image depicts a Tai Chi form
39

Single Interventions : Exer cise

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 older adults who 

are similar to study participants. 

Available Materials: Illustrations of the 10 Tai Chi exercises are in Appendix C-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
40

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Multi-target Stepping Program 

Yamada, et al. (2013)

This study evaluated the effectiveness of a multi-target stepping (MTS) program with exercise 

compared to a walking program with exercise. Participants in the MTS program had fewer falls 

and fewer fall-related fractures. The fall rate was 65 percent lower among people who took 

part in the program compared to those who did not. 

Population: Participants were community-dwelling adults aged 65 and older who could 

walk independently and did not have severe cognitive impairment. Slightly more than half 

were female.

Geographic Location: Kyoto, Japan

Focus: Improve stepping performance, gait, balance, and control of foot movements. 

Program Setting: An academic health center that included a fitness center for older adults.

Content: The MTS program consisted of stepping on colored squares in a prescribed order at 

the participant’s own pace. This was repeated four times each session. Participants attended 

sessions twice a week for 24 weeks. 

An exercise trainer taped 15 rows of four inch paper squares onto a very thin (about 0.1 in), 

rubber mat 33 feet long by 3.3 feet wide. Each square was spaced two feet apart. A square 

with a new color was added every six weeks. The number of squares in each row increased 

from two to five over the course of 24 weeks.

• Weeks 1–6: two squares 

(red and blue)

• Weeks 7–12: three squares 

(red, blue, and yellow)

• Weeks 13–18: four squares 

(red, blue, yellow, and white)

• Weeks 19–24 five squares 

(red, blue, yellow, white, and green)

Each row contained at least two 

squares of different colors and their 

arrangement was randomized.

Participants stepped on the same color square during the entire course. The other colored 

square(s) served as distractors. Participants could step on the squares with either foot and were 

allowed to take as many steps as needed to reach their next target square. The course changed 

each week and became progressively more difficult. 

In weeks 1–6 In weeks 7–12 In weeks 13–18 In weeks 19–24

1 m

Reprinted with permission of the author.

10 m

This picture illustrates the progression of the 24-week MTS course
41

Single Interventions : Exer cise

A physical therapist (PT) or exercise trainer instructed each participant, who wore flat-soled 

shoes, to walk through the course at their own pace. It typically took one to two minutes to 

complete the course. After each trial, the PT or exercise trainer provided feedback, such as “You 

missed the second square, please pay more attention the next time you try.”

Both intervention and control participants took part in a 30 minute exercise class twice a week 

that included mild strength training, balance and flexibility exercises.

Duration: The MTS sessions took seven minutes and were held twice a week for 24 weeks.

Delivered by: A PT and exercise trainer who were experienced in working with older adults. 

The main role of the PT was risk management in the event of a fall or other injury, although 

he also provided instruction and feedback. The exercise trainer did not receive any additional 

training for this intervention. 

Minimum Level of Training Needed: Exercise instructors experienced in working with 

older adults.

Key Elements: The course should become gradually more difficult, based on the physical 

ability of each participant. 

Available Materials: No intervention materials were available at publication.

Study Citation: Yamada M, Higuchi T, Nishiguchi S, Yoshimura K, Kajiwara Y, Aoyama T. 

Multitarget stepping program in combination with a standardized multicomponent exercise 

program can prevent falls in community-dwelling older adults: a randomized, controlled trial. 

Journal of the American Geriatrics Society. 2013;61(10):1669–75.

Supplemental Articles

Yamada M, Aoyama T, Arai H, Nagai K, Tanaka B, Uemura K, Mori S, Ichihashi N. Complex 

obstacle negotiation exercise can prevent falls in community-dwelling elderly Japanese aged 

75 years and older. Geriatriatric Gerontology International. 2012 Jul;12(3):461–7. 

Yamada M, Tanaka B, Nagai K, Aoyama T, Ichihashi N. Rhythmic stepping exercise under 

cognitive conditions improves fall risk factors in community-dwelling older adults: Preliminary 

results of a cluster-randomized controlled trial. Aging Mental Health. 2011 Jul 1;15(5):647–53.

Yamada M, Tanaka B, Nagai K, Aoyama T, Ichihashi N. Trail-walking exercise and fall risk factors 

in community-dwelling older adults: preliminary results of a randomized controlled trial. 

Journal of the American Geriatrics Society. 2010 Oct;58(10):1946–51.
42

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Contact 

Practitioners interested in using this intervention may contact the principal investigator for 

more information: 

Minoru Yamada, PhD

Associate Professor

Graduate School of Comprehensive Human Sciences,

University of Tsukuba

3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan

Tel: +81-3-3942-6863

Fax: +81-3-3942-6895

E-mail: m-yamada@human.tsukuba.ac.jp
43

Single Interventions : Exer cise

The following three tables summarize the study population 

characteristics, study methodology, and intervention 

characteristics of the 15 Single Interventions focused on exercise.
44

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Table 1. Summary Table of Studies and Study Population 

Study No. Study Participants Mean Age % Female Race/Ethnicity Socioeconomic Status (SES) 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

Clemson 2012 317 83 55% Most were white 46% education >high 

school (HS)

90% had fall w/ injury in past year

Freiberger 2007 152 75 39% 100% White 33% education >HS 

Mean income $5,458/month

34% fell in past 6 months

Kemmler 2010 246 69 100% NA* NA Fall rate=0.39 falls/

person in 6 months before study

Kovacs 2013 76 68 100% 100% White 58 % > 12 years education 38% fell in past year

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

Rubenstein 2000 59 75 0% 95% White 63% education >HS 56% fell in past 6 

months

73% 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

Mean number of medications=415% used canes

Trombetti 2011 134 76 96% 100% White 79% education < HS 55% fell in past year

Voukelatos 2007 702 69 84% Most were White 44% education ≥HS 34% fell in past year

Wolf 1996 200 76 81% Most were White 77% education >HS 36% fell in past year

Yamada 2013 264 77 67% 100% Asian NA 34% fell in past year

*No information available
45

Single Interventions : Exercise

Table 2. Study Methodology

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 Measured 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 IRRa=0.60 (0.36–0.99) None

Fall w/ injury rate IRRa=0.66 (0.38–1.15)

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 Measured 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 RRb=0.67 (p<0.05) None

First fall HRc=0.81 (0.56–1.16) 

First fall with injury HRc=0.61 (0.39–0.97)

a Incidence Rate Ratio b Relative Rate c Hazard Ratio d Relative Risk eRate Ratio per 1,000 hrs of activity * Results shown with 95% confidence intervals
46

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Clemson 2012 Sydney, Australia Veterans, spouses & war 

widows recruited by mailings to Department of Veteran’s Affairs database in Sydney & 3 general databases. 

Age ≥70, ≥2 falls or one fall w/ injury in past 12 months

Moderate or severe cognitive impairment, lack of conversational English, inability to ambulate independently, neurological condition that severely impacted gait/mobility, nursing home residence, or terminal illness

Yes

Method of Recording Falls Length of Follow-up Measured Outcomes Results* Adverse Effects

Daily calendar mailed monthly with blinded follow-up telephone calls to non-responders

12 months Fall rate (structured vs 

control) 

IRRc=0.81 (0.56–1.17) One patient 

in structured exercise had groin strain; One LiFE participant had a pelvic stress fracture

Fall rate (LiFE vs control) IRRc=0.69 (0.48–0.99)

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, communitydwelling, & able to walk independently

Unable to walk independently or cognitively impaired

Yes

Method of Recording Falls Length of Follow-up Measured Outcomes Results* Adverse Effects

Monthly fall calendars. If not returned, participant received a follow-up telephone call. If a fall occurred, the participant was interviewed by telephone.

12 months Number of fallers RRd=0.77 (0.60–0.97) NA

Number of multiple fallers RRd=0.87 (0.75–1.01) 

Fall rate RRb=0.64 (0.38–1.06) 

Time to first fall (fitness vs control)

337 ±9 days vs. 216 ±15 days

a Incidence Rate Ratio b Relative Rate c Hazard Ratio d Relative Risk eRate Ratio per 1,000 hrs of activity * Results shown with 95% confidence intervals

Table 2. Study Methodology, Continued
47

Single Interventions : Exercise

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Kemmler 2010 Erlangen-Nuremberg, 

Germany

Members of Siemens Health Insurance recruited by mail between May 2005 and January 2006

Age ≥65, living independently

History of alcoholism or Cushing’s syndrome, use of medications (bisphosphonate, hormone therapy, glucocorticoids & laxatives) that affect bone metabolism or fall risk, inflammatory disease, secondary osteoporosis, past participation in an exercise study, very low physical capacity, or participation in sports in past 10 years

Yes

Method of Recording Falls Length of Follow-up Measured Outcomes Results* Adverse Effects

Fall calendars w/ monthly telephone calls for nonresponders

18 months Fall Rate RRd= 0.60 (0.47–0.76) None

Number of fallers RRa=0.54 (0.35–0.84) 

Number of fallers w/injury RRa=0.33 (0.15–0.74)

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Kovacs 2013 Budapest, Hungary Recruited by an 

advertisement in a local newspaper

Age ≥60, community dwelling. 

Personal doctor did not recommend, neurological disease, cardiovascular disease, severe lower limb pain, or participated in an exercise program in past 6 months

Yes

Method of Recording Falls Length of Follow-up Measured Outcomes Results* Adverse Effects

Monthly fall diary 6 months Number of fallers RRa= 0.40(0.17–0.92) None

a Incidence Rate Ratio b Relative Rate c Hazard Ratio d Relative Risk eRate Ratio per 1,000 hrs of activity * Results shown with 95% confidence intervals

Table 2. Study Methodology, Continued
48

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

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 w/ language or transportation

Yes

Method of Recording Falls Length of Follow-up Measured Outcomes Results* Adverse Effects

Falls recorded daily in a fall calendar that was collected by a research assistant.

12 months Fall rate RRd = 0.35 (p<0.001) None

Multiple fall rate(≥2 falls) RRd = 0.45 (0.30–0.70)

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Lord 2003 Sydney & Wollongong, 

Australia

Residents of self-care & intermediate-care retirement villages that 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 Measured Outcomes Results* Adverse Effects

Completed monthly questionnaires. If not received within a week after end of the month, received a home visit or telephone call. Nursing staff at each intermediate-care site also kept a falls record book.

12 months Fall rate RRd=0.78 (0.62–0.99) None

Fall rate for participants w/ no falls at baseline 

RRd=0.88 (0.65–1.20)

Fall rate for participants w/ falls at baseline

RRd=0.69 (0.48–0.99)

a Incidence Rate Ratio b Relative Rate c Hazard Ratio d Relative Risk eRate Ratio per 1,000 hrs of activity * Results shown with 95% confidence intervals

Table 2. Study Methodology, Continued
49

Single Interventions : Exercise

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 & been treated in a clinic or ED, one direct mailing, or an announcement in local print media

Age ≥65, communitydwelling, fell 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 Measured Outcomes Results* Adverse Effects

Participants kept a fall diary that they submitted at the end of the study.

10,724 observation-days Outdoor slip RR=0.50 (0.26–0.96) None

Outdoor fall RR=0.45 (0.23–0.85)Outdoor fall on day walked on snow or ice

RR=0.42 (0.26–0.92)

Outdoor injurious fall RR=0.10 (0.02–0.53)Outdoor injurious fall on day walked on snow or ice

RR=0.13 (0.03–0.66)

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, cardiac or pulmonary disease, dementia, terminal illness, severe joint pain, unresponsive, depression, or progressive neurologic disease

No

Method of Recording Falls Length of Follow-up Measured Outcomes Results* Adverse Effects

Questioned about falls & injuries every 2 weeks by phone or in-person 

12 weeks (at end of intervention)

Activity-adjusted fall rate RRe=0.37 (p=0.027) None

a Incidence Rate Ratio b Relative Rate c Hazard Ratio d Relative Risk eRate Ratio per 1,000 hrs of activity * Results shown with 95% confidence intervals

Table 2. Study Methodology, Continued
50

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

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 Measured Outcomes Results* Adverse Effects

Falls diaries were returned every 2 weeks by mail. Every fall was followed up by telephone to determine the circumstances & outcome.

20 months Fall rate IRRc=0.66 (0.49–0.90) None

Fall w/injury rate IRRc=0.60 (0.33–1.07)

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Trombetti 2011 Geneva, Switzerland Recruited from the local 

community through multiple strategies including advertisements in local newspapers

Age ≥65, community dwelling, no experience w/ Jaques-Dalcroze eurhythmics except during childhood, increased risk of falling (≥1 falls, balance impairment defined as a score >2 on Tinetti test, or physical frailty)

Neurological disease associated w/ motor deficit or orthopedic disease that significantly affects gait/balance, a medical condition such as terminal illness, or fully dependent on assistive device

Yes

Method of Recording Falls Length of Follow-up Measured Outcomes Results* Adverse Effects

Fall diary mailed monthly to study coordinator. Followup phone calls were made to non-responders

12 months Risk for >1 fall RRd=0.61 (0.39–0.96) None

Risk for ≥ 2 falls RRd=0.19 (0.06–0.63) 

Fall rate IRRa=0.46 (0.27–0.79) 

Time to first fall HRc=0.53 (0.30–0.94)

a Incidence Rate Ratio b Relative Rate c Hazard Ratio d Relative Risk eRate Ratio per 1,000 hrs of activity * Results shown with 95% confidence intervals

Table 2. Study Methodology, Continued
51

Single Interventions : Exercise

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 Measured Outcomes Results* Adverse Effects

Participants recorded falls daily & mailed calendars to study coordinator monthly. If not received within 2 weeks after the end of the month, the participant was contacted by telephone.

24 weeks Number of falls An instructor 

tried to help a participant into a movement & the participant twisted a ligament.

After 16 weeks follow-up IRRa=0.73 (0.50–1.07) 

After 24 weeks follow-up IRRa=0.67 (0.47–0.94) Participants w/ ≥2 falls after 24 weeks follow-up

RRd=0.54 (0.28–0.96) 

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Yamada 2013 Kyoto, Japan Recruited by an 

advertisement in a local newspaper

Aged≥65, community dwelling , no severe cognitive impairment (Rapid Dementia Screening Test score <5), certified for longterm care insurance service, able to walk independently, willing to participate, no significant hearing or vision loss, access to transportation, & had not exercised in the past 12 months

Serious visual impairment, severe cardiac, pulmonary, or musculoskeletal disorder, Parkinson’s disease, history of stroke, or current use of psychotropic drugs.

Yes

Method of Recording Falls Length of Follow-up Measured Outcomes Results* Adverse Effects

Monthly fall diary w/ telephone follow-up if needed

12 months after the end of the intervention

Fall rate IRRa= 0.35(0.19–0.66) None

a Incidence Rate Ratio b Relative Rate c Hazard Ratio d Relative Risk eRate Ratio per 1,000 hrs of activity * Results shown with 95% confidence intervals

Table 2. Study Methodology, Continued
52

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

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 Measured Outcomes Results* Adverse Effects

Monthly calendar or monthly phone calls from staff.

7–20 months Fall risk RRd=0.53 (0.32–0.86) None

≥1 falls w/ injury RRd=0.81 (0.33–2.02)

a Incidence Rate Ratio b Relative Rate c Hazard Ratio d Relative Risk eRate Ratio per 1,000 hrs of activity * Results shown with 95% confidence intervals
53

Single Interventions : Exercise

Table 3. Intervention Characteristics 

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

Clemson 2012 Integrate balance & strength 

training into personal lifestyle

Physical therapist or occupational therapist

One-on-one 5 regular sessions, 

2 booster sessions & 2 follow-up phone calls

Initial visit: 90 minutes5–7 follow-up visits: 40–60 minutes each

Freiberger 2007 Improve functional skills, 

strength, endurance, & flexibility

Specially trained instructors w/ 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

Kemmler 2010 High intensity exercise Certified trainers Group exercise 

w/ individual practice at home

1-hour class 2 times a week for 78 weeks20-minute home training sessions 2 times a week for 78 weeks

Classes: 156 hours

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

Kovacs 2013 Improve balance, decrease risk 

of falls, & improve quality of life.

A physical therapist Group exercise 1-hour class 2 times a 

week for 25 weeks

Classes: 50 hours

Lord 2003 Increase strength, coordination, 

balance & gait, & improve activities of daily life

Trained exercise instructors certified in 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

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
54

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Study Focus Providers Structure Number of Sessions Provider Contact Time

Rubenstein 2000 Increase strength & endurance, 

improve mobility & balance

Exercise physiology graduate student w/ 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

Skelton 2005 Improve balance & strength Postural Stability 

Instructors

Group exercise classes & home-based exercises

1 pre-exercise assessment 36 weekly 1-hour group exercise classesA 30-minute exercise session 2 times a week for 36 weeks

Pre-exercise assessment: 40 minutesClasses: 36 hours

Trombetti 2011 Multitask training for gait & 

balance improvements as well 

as fall reduction

Experienced exercise instructors

Group exercise 24 weekly 1-hour 

classes

Classes: 24 hours

Voukelatos 2007 Improve balance & reduce falls Community-based Tai Chi 

instructors

Group exercise classes 16 weekly 1-hour 

classes

Classes: 16 hours

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 weeks15-minute practice at home 2 times a week

Classes: 12 hours

Yamada 2013 Improve stepping performance, 

gait, balance, & control of foot movements

A physical therapist & exercise instructor

One-on-one 5–7 minute sessions 

twice a week for 24 weeks

Classes: 4 hours

Table 3. Intervention Characteristics, Continued
55

Home Modification

ToC3

SINGLE INTERVENTIONS

Home Modification

The VIP Trial Campbell, et al. (2005) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Home Visits by an Occupational Therapist Cumming, et al. (1999) . . . . . . . . . . . . . 58

Falls-HIT (Home Intervention Team) Program Nikolaus, et al. (2003) . . . . . . . . . . . .60

Home Assessment and Modification Pighills, et al. (2011) . . . . . . . . . . . . . . . . . . .62

Table 1. Summary Table of Studies and Study Population . . . . . . . . . . . . . . . . . . 65

Table 2. Study Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Table 3. Intervention Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
56

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

The VIP Trial 

Campbell, et al. (2005) 

This study looked at the effectiveness of two 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 (OT) 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 Program 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 OT 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. It included a discussion about items, behavior, or 

lack of equipment that could lead to falls. The OT and participant then agreed on which 

recommendations to implement.

The OT 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 were funded by the participant or 

from research funds. The OT made a follow-up visit if equipment needed to be installed. 

Duration: The intervention consisted of one or two home visits. The first visit lasted about 

two hours. If the OT needed to approve new equipment, she made a second visit two to three 

weeks later. The second visit lasted about 45 minutes. 

Delivered by: OTs who attended a two-day training course. 

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

familiar with the specific focus on falls prevention among people with poor vision. 

Key Elements: 

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

• A trained and experienced OT is critical to the success of this intervention. 
57

Single Interventions : Home Mo dification

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: 

M. Clare Robertson, PhD 

Research Honorary 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
58

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Home Visits by an Occupational Therapist 

Cumming, et al. (1999)

This study 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 

one 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 OT also assessed each participant’s 

abilities and behaviors, and how each functioned in his or her home environment. Specific 

unsafe behaviors were identified such as wearing loose shoes, leaving clutter in high-traffic 

areas, and using furniture to reach high places. The OT discussed with each participant 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. 

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

contact time was approximately two hours. 

Delivered by: An OT with two years of 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. 
59

Single Interventions : Home Modification

Key Elements: 

• Using an experienced OT 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
60

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Falls-HIT (Home Intervention Team) Program 

Nikolaus, et al. (2003) 

This study 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 two or more falls in the past 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 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 (OT) with either a nurse or a physical therapist (PT), 

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 two to three subsequent home visits, an OT 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 

Duration: The program consisted of two or more home visits, each lasting about 11⁄2 hours. 

After the participant was discharged from the hospital, three 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 

eight hours. 
61

Single Interventions : Home Modification

Delivered by: The home intervention team was composed of a PT, OT, three nurses, a social 

worker, and a secretary. OTs generally worked with all participants. Depending on individual 

need, either a PT 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
62

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Home Assessment and Modification 

Pighills, et al. (2011)

This study examined the effectiveness of home assessment and modification to reduce falls. 

The intervention was delivered in the participants’ homes by either an occupational therapist 

(OT) or by a home care worker (HCW). After identifying potential home hazards and risky 

behaviors, the OT or HCW discussed their findings with the participant. Together they agreed 

on specific home modifications and behavior changes.

The intervention was only effective when it was implemented by OTs. Fall rates were reduced 

46 percent among those who received home assessments by OTs. 

Population: Participants were community-dwelling adults aged 70 or older who had fallen 

in the past year. About two-thirds of participants were female.

Geographic Location: Yorkshire, England. 

Focus: Assess and reduce home hazards and unsafe behaviors that increased fall risk.

Program Setting: The intervention occurred in participants’ homes.

Content: An OT visited each participant’s home and conducted an assessment using the 

Westmead Home Safety Assessment (WeHSA) as a guide. The WeHSA identifies 72 categories 

of hazards and provides a comprehensive list of items and behaviors that the OT should 

identify. During the visit, the OT observed the participant performing daily activities in the 

home and identified behaviors that could increase fall risk. 

The OT and participant discussed the identified hazards and behaviors and worked together 

to generate mutually acceptable solutions. The OT provided a written summary of the agreed 

upon recommendations to the participant and made referrals for equipment if needed. 

The OT called the participant after four weeks to determine if he or she was following the 

recommendations.

Duration: Each home assessment lasted 11⁄2–2 hours.

Delivered by: OTs who attended a half day training course. The course trainer, an OT with 

19 years of experience, used the WeHSA to assess a video of a sample patient carrying out 

activities in their own home. The OTs were instructed to use the principles outlined in the 

WeHSA to evaluate the safety of the person in their home, shown in the video, and to 

suggest modifications. 

The professional experience of the OTs ranged from less than a year to more than 20 years.

Minimum Level of Training Needed: A degree in occupational therapy. 
63

Single Interventions : Home Mo dification

Key Elements: 

• Conduct a functional assessment. The OT should observe the older adult perform tasks in 

their home.

• Acknowledge the older adult’s capacity to act independently and to make his or her own 

choices. 

• Determine modifications and changes jointly with the older adult.

Available Materials: 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: Pighills AC, Torgerson DJ, Sheldon TA, Drummond AE, Bland JM. 

Environmental assessment and modification to prevent falls in older people. Journal of the 

American Geriatrics Society. 2011;59(1):26–33.

Contact 

Practitioners interested in using this intervention may contact the principal investigator for 

more information:

Alison Pighills, PhD

Education and Research Centre (K Block)

Mackay Base Hospital

P.O Box 5580

Mackay Mail Centre 

Mackay, Queensland 4741, Australia

Tel: (07) 4885 7081

E-mail: Alison.Pighills@health.qld.gov.au
64

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

The following three tables summarize the study population 

characteristics, study methodology, and intervention 

characteristics for the four single focused interventions 

highlighting home modification
65

Single Interventions : HomeModification

Table 1. Summary Table of Studies and Study Population 

Study No. Study Participants Mean Age % Female Race/Ethnicity Socioeconomic Status (SES) Previous Falls Other Characteristics

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) services84% age-related macular degeneration43% cataract3% diabetic retinopathy15% glaucoma

Cumming 1999 530 77 57% 100% White NA 31% fell in past year 37% used a walking 

aid

Nikolaus 2003 360 82 73% 98% White NA 30% ≥2 falls in past 

year

All showed functional decline, especially in mobility

Pighills 2011 238 79 67% 100% White NA 100% ≥2 falls in past 

year

*No information available
66

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Table 2. Study Methodology

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Campbell 2005 Dunedin and Auckland, New 

Zealand

Participants identified from Royal New Zealand Foundation of the Blind, university and& hospital low vision clinics, & ophthalmology practices

Age >75, poor vision (visual acuity 6/24 or worse)

Unable to walk around own home, currently receiving physical therapy, or unable to understand study requirements

Yes

Method of Recording Falls Length of Follow-up Measured 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 Fall rate IRRa = 0.39 (0.24–0.62) None

Fall w/ injury rate IRRa = 0.56 (0.36–0.87)

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Cumming 1999 Sydney, Australia Recruited while a hospital 

patient or among people attending outpatient clinics or a local senior center

Age ≥ 65 & ambulatory Cognitively impaired 

& not living w/ 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 Measured Outcomes Results* Adverse Effects

Monthly falls calendar were completed daily & returned by mail each month. If not received w/in 10 days, participant was contacted by telephone.

12 months Fall rate for participants 

w/ no falls at baseline 

RRb = 1.03 (0.75–1.41) None

Fall rate for participants w/ falls at baseline

RRb = 0.64 (0.50–0.83)

a Incidence Rate Ratio b Relative Rate c Hazard Ratio d Relative Risk
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Single Interventions : Home Modification

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, & was discharged to home

Severe cognitive impairment, terminal illness, or lived >15 km away

Yes

Method of Recording Falls Length of Follow-up Measured Outcomes Results* Adverse Effects

Participants kept a falls diary & also were contacted monthly by phone.

12 months Fall rate IRR = 0.69 (0.51–0.97) None

Fall rate for participants w/ ≤1 fall at baseline

IRR = 0.91 (0.72–1.22)

Fall rate for participants w/ ≥2 falls at baseline

IRR = 0.63 (0.43–0.94)

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Pighills 2011 Yorkshire, England Residents of the catchment 

area of Airdale National Health Service Trust, recruited by mail

Age ≥70, community dwelling, had experienced ≥1 falls in the past year

Living in a nursing home or residential clinic, currently receiving occupational therapy, or hx of falls-specific OT in the past year

Yes

Method of Recording Falls Length of Follow-up Measured Outcomes Results* Adverse Effects

Monthly fall calendars, blinded telephone calls for non-responders

12 months Fall rate (OT group v 

control)

IRR=0.54 (0.36–0.83) None

Fall rate (Trained assessor v control)

IRR=0.78 (0.51–1.21)

a Incidence Rate Ratio b Relative Rate c Hazard Ratio d Relative Risk

Table 2. Study Methodology, Continued
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Table 3. Intervention Characteristics 

Study Focus Providers Structure Number of Sessions Provider Contact Time

Campbell 2005 Assess & reduce home hazards & 

encourage changes in behavior

Occupational therapist One-on-one 1–2 home visits Initial home visit: 

2 hoursFollow-up visit: 45 minutes

Cumming 1999 Assess & reduce home hazards Occupational therapist One-on-one 1-hour home 

assessment & followup telephone call

Total about 2 hours

Nikolaus 2003 Assess & reduce home hazards Home intervention team 

incl. 3 nurses, a PT, an OT, & a social worker

Home visits >2 (usually 3-4) home 

visits of about 11⁄2 hours each 

Home visits: 8 hours on average

Pighills 2011 Assess & reduce home hazards. Occupational therapists One-on-one 1 home visit & 1 

follow-up telephone call

Total: 2–2 1⁄2 hours
69

Clinical

SINGLE INTERVENTIONS

Clinical 

Three-Year Study of Vitamin D (Cholecalciferol) Plus Calcium 

Bischoff-Ferrari, et al. (2006) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70

Psychotropic Medication Withdrawal Campbell, et al. (1999) . . . . . . . . . . . . . . . .72

Active Vitamin D (Calcitriol) as a Falls Intervention Gallagher, et al. (2007) . . . . . . . .74

VISIBLE (Visual Intervention Strategy Incorporating Bifocal and 

Long-distance Eyewear) Study Haran, et al. (2010) . . . . . . . . . . . . . . . . . . . . . . .76

Vitamin D to Prevent Falls After Hip Fracture Harwood, et al. (2004) . . . . . . . . . . . .79

Cataract Surgery Harwood, et al. (2006) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81

Pacemaker Surgery Kenny, et al. (2001) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83

Study of 1000 IU Vitamin D Daily for One Year Pfeifer, et al. (2009) . . . . . . . . . . . . 85

Quality Use of Medicines Program Pit, et al. (2007) . . . . . . . . . . . . . . . . . . . . . . 87

Podiatry & Exercise Intervention Spink, et al. (2011) . . . . . . . . . . . . . . . . . . . . . .90

Table 1. Summary Table of Studies and Study Population Characteristics . . . . . . . . . 94

Table 2. Study Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

Table 3 Intervention Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Three-Year Study of Vitamin D 

(Cholecalciferol) Plus Calcium

Bischoff-Ferrari, et al. (2006) 

This study evaluated the effectiveness of a three-year vitamin D (cholecalciferol) and 

calcium supplementation program in reducing falls among older adults. Although the 

study included both men and women, the intervention was only effective among women. 

After three years, women in the intervention group were 46 percent less likely to fall once 

compared to women who did not participate in the program. 

Population: Participants were community-dwelling adults aged 65 or older.

Geographic Location: Boston, Massachusetts 

Focus: Investigate the effectiveness of long term vitamin D and calcium supplementation 

on falls.

Program Setting: A study center at a research institution. 

Content: Research staff met with participants at the beginning of the study to perform an 

initial assessment. They collected medical history, height and weight, blood samples, and 

information on nutrition, physical activity, tobacco use, and alcohol use. Participants were 

given a six-month supply of 700 IU vitamin D and 500 mg calcium supplements and told to 

take these once a day at bedtime. Participants visited the study center every six months to 

repeat the assessment and to receive additional supplements. 

Duration: Participants visited the study center once every six months; a visit lasted 2–31⁄2 

hours. They took vitamin D and calcium supplements daily for three years. 

Delivered by: A research manager and research assistants delivered the intervention. 

A physician developed the intervention, trained the research coordinators, and provided 

technical assistance. 

Minimum Level of Training Needed: This intervention could be delivered by a nurse’s 

aide or other allied health professional within a clinical setting. 

Key Elements: A dose of 700 IU taken orally every day. Adhering to the supplementation 

schedule is critical.

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

Study Citation: Bischoff-Ferrari HA, Orav EJ, Dawson-Hughes B. Effect of cholecalciferol 

plus calcium on falling in ambulatory older men and women: a 3-year randomized 

controlled trial. Archives of Internal Medicine. 2006 Feb 27;166(4):424–30.
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Contact 

Practitioners interested in using this intervention may contact the principal investigator for 

more information:

Bess Dawson-Hughes, MD

Senior Scientist and Director

Bone Metabolism Laboratory

Tufts University

E-mail: bess.dawson-hughes@tufts.edu
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Psychotropic Medication Withdrawal

Campbell, et al. (1999) 

This study tested the effectiveness of psychotropic medication withdrawal and/or a homebased exercise program in reducing falls among older adults. Only the medication withdrawal 

was effective in reducing falls. Participants who had their psychotropic medications 

withdrawn were 64 percent less likely to fall compared with the comparison group.

Population: Participants were community-dwelling adults aged 65 or older who were 

currently taking a psychotropic medication (defined as a benzodiazepine or other hypnotic 

drug, antidepressant, or major tranquilizer) and whose general practitioner thought they 

might benefit from psychotropic medication withdrawal. 

Geographic Location: Dunedin, New Zealand

Focus: Reduce psychotropic medication use among older adults.

Program Setting: Initial assessments were performed at home and in a research clinic. 

The trial medications were provided to participants in their homes.

Content: General practitioners (GP) identified patients they thought could benefit from 

discontinuing psychotropic medications. These were defined as benzodiazepines, other 

hypnotic drugs, antidepressants, and major tranquilizers. The research trial GP completed a 

physical examination and provided a basic overview of the study. A research nurse collected 

baseline data on patients’ current medication and falls history. 

A pharmacist reformulated each psychotropic medication into capsules to prevent both 

participants and researchers from knowing who was receiving the withdrawal intervention. 

The control participants received their own medication at the original dose throughout the 

trial. For participants randomized to the withdrawal group, all psychotropic medications were 

reduced gradually over 14 weeks by diluting active ingredients with an inert substance on the 

following schedule:

• Start of study: 100 percent active medication

• At 2 weeks: 80 percent active medication 

• At 4 weeks: 60 percent active medication

• At 8 weeks: 40 percent active medication

• At 11 weeks: 20 percent active medication

• From 14 weeks until the end of the trial, capsules contained no active medication

To implement this intervention in a community setting, physicians would prescribe a gradual 

reduction in dose and/or frequency over time to help their patients withdraw successfully. 
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Although this study did not include a counselling component, the authors noted that a 

psychologist should be involved to help participants adjust to issues such as changing 

sleep patterns. 

Duration: The GP conducted the initial assessment at a clinic visit. A research nurse took half 

an hour to conduct an initial assessment at the participant’s home. Medication was tapered off 

gradually over 14 weeks.

Delivered by: A GP explained the interventions. A nurse assessed fall history and current 

medication use. A pharmacist reformulated the medications. 

Minimum Level of Training Needed: A physician with knowledge about medications that 

increase falls risk.

Key Elements: Gradually withdrawing rather than suddenly stopping psychotropic 

medications.

Available Materials: The 2012 AGS Beers Criteria for Potentially Inappropriate Medication 

Use in Older Adults is available at

http://www.americangeriatrics.org/files/documents/beers/2012AGSBeersCriteriaCitations.pdf.

Study Citation: 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. 

Contact 

Practitioners interested in using this intervention may contact the co-investigator for more 

information:

M. Clare Robertson, PhD

Honorary Research Associate Professor Department of Medicine 

Dunedin School of Medicine University of Otago 

P.O. Box 913 Dunedin 9054, New Zealand

E-mail: clare.robertson@otago.ac.nz
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Active Vitamin D (Calcitriol) 

as a Falls Intervention

Gallagher, et al. (2007) 

This study evaluated the effectiveness of three different supplementation interventions at 

reducing falls. Participants were assigned to hormone therapy, hormone therapy and active 

vitamin D supplementation (0.25 μg [micrograms] calcitriol twice daily), or active vitamin 

D supplementation alone. Only the active vitamin D supplementation group experienced 

a reduced rate of falls. After three years, women who took active vitamin D supplements 

experienced 38 percent fewer falls than women who did not. 

Population: Participants were community-dwelling women. The average age of 

participants was 72 at the start of the intervention.

Geographic Location: Omaha, Nebraska

Focus: Investigate the effectiveness of long term active vitamin D supplementation on falls.

Program Setting: A study center at a research institution. 

Content: Research coordinators met with participants at the beginning of the study to 

perform an initial assessment. They conducted a physical examination and collected medical 

history and information on nutrition. Participants were given a six-month supply of 0.25 μg 

calcitriol and were instructed to take them twice daily. Participants visited the study center 

at six and twelve weeks and then every six months for follow-up assessments and to receive 

additional supplements. 

Duration: Participants visited the study center once every six months; a visit lasted 45–60 

minutes. Participants took active vitamin D supplements twice daily for three years. 

Delivered by: All research coordinators were trained by a physician and had a college 

degree (bachelors). An endocrinologist oversaw the intervention. A physician wrote a 

prescription of calcitriol for each participant. 

Minimum Level of Training Needed: Allied health professionals, with the supervision 

of a physician could conduct the assessments and provide information about vitamin D 

supplementation. A physician would be needed to prescribe calcitriol and to monitor any 

side effects. 

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

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

Study Citation: Gallagher JC, Fowler S, Sherman SS. Combination treatment with estrogen 

and calcitriol in the prevention of Age-Related Bone Loss. Journal of Clinical Endocrinology 

and Metabolism 86:3618–3628, 2001.
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Supplemental Articles

Gallagher JC, Rapuri PB, Smith LM. An age related decrease in creatinine clearance is associated 

with an increase in number of falls in untreated women but not in women receiving calcitriol 

treatment. Journal of Clinical Endocrinology and Metabolism. 2007 Jan 92:51–58, 2007.

Gallagher JC, Rapuri P, Smith L. Falls are associated with decreased renal function and 

insufficient calcitriol production by the kidney. Journal of Steroid Biochemistry and Molecular 

Biology. 2007 Mar;103(3–5):610–3.

Contact 

Practitioners interested in using this intervention may contact the principal investigator for 

more information:

J Christopher Gallagher, MD

Department of Endocrinology

Creighton University School of Medicine 

601 N 30th St, Suite 6718 Omaha, NE-68131

Tel: 402-280-4518 

Fax: 402-280-4517

Email: jcg@creighton.edu
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

VISIBLE (Visual Intervention Strategy 

Incorporating Bifocal and Long-distance 

Eyewear) Study

Haran, et al. (2010)

This study tested the effectiveness of an optometry intervention that provided older adults 

who normally used multifocal lenses with single lens distance glasses to wear outdoors. 

Although falls were not reduced among participants overall, falls were decreased 40 percent 

among participants who regularly took part in outdoor activities. Outdoor falls increased 

among participants who did not regularly engage in outdoor activities.

Population: Participants were high risk community-dwelling adults aged 65 or older. 

Participants were considered high risk if they had fallen in the previous 12 months, scored ≥15 

seconds on the Timed Up and Go test, or were aged 80 or older. About 65 percent were female.

Geographic Location: Sydney and Illawarra, Australia

Focus: Increase use of single lens distance glasses for outdoor activities among older adults 

who normally wear multifocal glasses

Program Setting: An optometrist’s office

Content:

During an initial visit an optometrist:

• Performed a standard visual assessment

• Recorded participant’s current type of glasses 

• Updated the current multifocal prescription as needed

• Prescribed single lens distance glasses 

• Encouraged use of transition or tinted distance lenses

At the second visit, approximately one-month later, the optometrist:

• Dispensed and fitted new glasses 

• Demonstrated how multifocal glasses can cause falls by distorting depth perception and 

limiting the ability to see obstacles. The optometrist:

– Had participants look at images through the upper and lower portion of their multifocal 

lenses and through single distance lenses (depth perception and visual contrast tests)

– Showed photographs of street scenes and steps with and without simulated blurred 

lower field to reinforce how multifocal glasses may increase fall risk
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Single Interventions : Clinic al

• Advised using single lens glasses for most walking and standing activities, in particular:

– Walking up or down outdoor stairs 

– Walking outside, in shopping centers, and in unfamiliar buildings 

(e.g., other people’s homes) 

– Exiting public transport or personal vehicles

• Discouraged single lens distance glasses for:

– activities inside their own home, 

– seated tasks,

– driving, and

– low risk tasks that require changes in depth of focus while standing or walking 

(e.g., cooking and shopping at the supermarket)

• Provided a reminder card and instruction booklet 

Duration: The initial visit lasted 15–20 minutes and the second visit was about 30 minutes. 

Participants were encouraged to wear their single lens glasses while outdoors for the duration 

of the intervention.

Delivered by: An optometrist conducted all initial study visits and the majority of second 

visits. If this optometrist was unavailable, an alternative optometrist, research assistant, or 

study investigator conducted the education and counselling component of the second visit.

Minimum Level of Training Needed:

An optometrist is needed to prescribe distance glasses to eligible candidates. Either an 

optometrist or optical technician could fit the glasses. An optical technician with 1-hour of 

additional training could perform the activities carried out during the second visit. Counselling 

and education could be delivered by an optometrist or optical technician, or, with additional 

training, by a person with allied health, nursing, or a medical background.

Key Elements:

• Applying this intervention only to people who leave their homes daily. 

• Educating and counselling participants about the importance of using single lens 

glasses to prevent falls outdoors.

• Using the streetscape photographs to reinforce how multifocal lenses affect depth 

perception and perceived contrast.

• Providing wallet cards and pamphlets as memory aids for some participants.

Available Materials: Pictures of the depth perception and visual contrast tests, the 

photographs of street and step scenes, and the contents of the wallet card are located in 

Appendix C-5
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Study Citation: Haran MJ, Cameron ID, Ivers RQ, Simpson JM, Lee BB, Tanzer M, et al. Effect 

on falls of providing single lens distance vision glasses to multifocal glasses wearers: VISIBLE 

randomised controlled trial. British Medical Journal (Clinical research ed). 2010;340:c2265.

Contact 

Practitioners interested in using this intervention may contact the principal investigator 

for more information:

Dr. Mark Haran

Rehabilitation Physician

Royal North Shore Hospital, Sydney Australia

Ph. 612-94629333

Fax 612-99064301

Email: mharan@med.usyd.edu.au
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Vitamin D to Prevent Falls After Hip Fracture

Harwood, et al. (2004)

This study evaluated the effectiveness of vitamin D supplementation with or without calcium 

in reducing falls among older women who had sustained a hip fracture. Participants received 

either a single injection of D2 (300,000 IU), a single injection of D2 (300,000 IU) with daily oral 

calcium supplementation (1000 mg), or a daily oral dose of D3 (800 IU) with calcium (1000 mg). 

After 1 year, participants who received the intervention were 52 percent less likely to fall 

compared to those who received no supplementation. Not enough women participated to 

detect differences in effectiveness by the type of vitamin D received.

Population: Participants were community-dwelling women aged 65 or older who underwent 

surgery for a hip fracture.

Geographic Location: Nottingham, United Kingdom 

Focus: Investigate the effects of different vitamin and calcium supplementation regimens on 

bone mineral density, serum vitamin D, serum parathyroid hormone, and on rate of falls among 

older women who have fractured their hip.

Program Setting: A geriatric rehabilitation ward. 

Content: A research nurse met with participants within seven days of surgery for a hip fracture 

to assess bone mineral density and to collect medical history, height and weight, blood, and 

information on nutrition, physical activity, tobacco use, and alcohol use. The nurse provided 

participants with either a single injection of D2 (300,000 IU) and no calcium, a single injection 

of D2 (300,000 IU) plus a month’s prescription of oral calcium (500 mg tablets to take twice 

daily) or with a month’s prescription of combined oral 800 IU vitamin D and 1000 mg calcium. 

The research team contacted the participant’s general practitioner to inform them of the 

plan of care, and request that they prescribe the study dose of oral supplements and avoid 

prescribing additional vitamin D or other osteoporosis drugs during the intervention. The 

participant’s general practitioner prescribed one to three month supplies of oral supplements 

at a time. Patients took their own tablets, or were supervised by family members or home care 

workers to do so. Participants visited the study center at 3, 6, and 12 months post hip surgery 

to report falls. 

Duration: The initial visit lasted an hour. Follow-up visits occurred at 3, 6, and 12 months and 

lasted 15 minutes. Participants who received oral supplements took them daily for a year.

Delivered by: A research nurse and general practitioner.

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

investigator.
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Key Elements:

• Vitamin D supplementation after hip fracture improves bone mineral density one year later 

and reduces falls incidence. 

• Oral calcium supplementation is required as well as vitamin D. 

• Three hundred thousdand IU vitamin D2 does not give adequate supplementation 

for a whole year. 

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

Study Citation: Harwood RH, Sahota O, Gaynor K, Masud T, Hosking DJ; Nottingham Neck 

of Femur (NONOF) Study. A randomised, controlled comparison of different calcium and 

vitamin D supplementation regimens in elderly women after hip fracture: The Nottingham 

Neck of Femur (NONOF) Study. Age and Ageing. 2004;33(1):45–51.

Contact 

Practitioners interested in using this intervention may contact the principal investigator for 

more information:

Professor Rowan H. Harwood

Nottingham University Hospitals NHS Trust & University of Nottingham 

Email: rowan.harwood@nuh.nhs.uk
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Cataract Surgery

Harwood, et al. (2006)

This study evaluated the effectiveness of first eye cataract surgery in reducing falls 

compared with a control group who were awaiting surgery. After 12 months, participants 

in the intervention group had experienced 34 percent fewer falls than those who did not 

have cataract surgery. 

Population: Participants were women aged 70 or older with cataract who had no prior 

eye surgery.

Geographic Location: Nottingham, United Kingdom

Focus: Determine if first cataract surgery reduces falls.

Program Setting: This intervention was conducted in either an ophthalmologist’s office or 

an optometrist-led cataract clinic. 

Content: An optometrist assessed patients for cataracts during routine visits and if eligible, 

referred them to the study. An initial assessment was conducted one to two weeks later. 

During the assessment, an ophthalmic research nurse collected the participant’s medical 

(e.g., history of falls, depression) and ophthalmic (i.e., use of glasses, eye problems) history 

and conducted a full eye exam. 

An ophthalmologist performed the cataract surgery by phacoemulsification and implanted 

a silicon intraocular lens within three weeks after the initial assessment. Ninety-nine percent 

of women had local anesthetic and the surgery lasted 15–30 minutes. The ophthalmologist 

reassessed the participant’s vision four weeks after surgery. 

Duration: The initial assessment took 60 minutes. The cataract surgery lasted 15–30 minutes.

Delivered by: An ophthalmic research nurse conducted the initial assessment and vision 

tests. An ophthalmologist performed the surgery.

Minimum Level of Training Needed: An ophthalmologist would be needed to 

perform cataract surgery. The vision tests could be performed by an optometrist or 

optometry technician. 

Key Elements:

• Assess for cataracts during routine visits.

• Early surgery is beneficial for operable cataract. 

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

Study Citation: Harwood RH, Foss AJ, Osborn F, Gregson RM, Zaman A, Masud T. Falls and 

health status in elderly women following first eye cataract surgery: a randomised controlled 

trial. British Journal of Ophthalmology. 2005 Jan;89(1):53–9.
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Supplemental Article

Foss AJ, Harwood RH, Osborn F, Gregson RM, Zaman A, Masud T. Falls and health status 

in elderly women following second eye cataract surgery: a randomized controlled trial. 

Age and Ageing. 2006 Jan;35(1):66–71.

Contact 

Practitioners interested in using this intervention may contact the principal investigator 

for more information:

Professor Rowan H. Harwood 

Nottingham University Hospitals NHS Trust & University of Nottingham 

Email: rowan.harwood@nuh.nhs.uk
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Pacemaker Surgery

Kenny, et al. (2001)

This study evaluated the effectiveness of surgical insertion of a dual chamber pacemaker at 

reducing falls among older adults with cardioinhibitory carotid sinus hypersensitivity (CSH). 

After 12 months, participants in the intervention group experienced 58 percent fewer falls 

than those who did not have the surgery.

Population: Participants were community-dwelling adults aged 50 or older with 

cardioinhibitory CSH and who had gone to the emergency department because of an 

unexplained fall. Mean age of participants was 73. More than half were women.

Geographic Location: Newcastle Upon Tyne, United Kingdom

Focus: Determine if cardiac pacing reduces falls among older adults with CSH.

Program Setting: This intervention took place in the surgical ward of a hospital.

Content: Research staff screened older adults who visited the emergency department for 

falls. If patients reported an unexplained fall (not caused by a slip or a trip or attributable to a 

medical cause) they were eligible for clinical assessment from the Cardiovascular Investigation 

Unit (CIU). The CIU screened the patients for other causes of falls such as medications and gait 

and balance issues. The CIU screened for cardioinhibitory CSH by massaging the carotid sinus 

while continually monitoring blood pressure and heart rate. Patients that screened positive 

for cardioinhibitory CSH received a rate response dual-chamber pacemaker.

Duration: The initial assessment took 60 minutes. The pacemaker surgery lasted two to 

three hours and patients stayed in the hospital overnight.

Delivered by: A surgeon delivered this intervention. A nurse or physician performed 

the initial screening.

Minimum Level of Training Needed: A physician experienced at performing a pacemaker 

surgery. Screening for cardioinhibitory CSH should be done by a health professional 

experienced at performing carotid sinus massage. 

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

Available Materials: None at this time.

Study Citation: Kenny RA, Richardson DA, Steen N, Bexton RS, Shaw FE, Bond J. Carotid 

sinus syndrome: a modifiable risk factor for nonaccidental falls in older adults (SAFE PACE). 

The Journal of American College of Cardiology. 2001 Nov 1;38(5):1491–6.
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Contact 

Practitioners interested in using this intervention may contact the principal investigator 

for more information:

Rose Kenny

Cardiovascular Investigation Unit

Royal Victoria Infirmary/MRC Development Centre for Clinical Brain Ageing

Newcastle General Hospital

Newcastle Upon Tyne, United Kingdom. 

Email: RKENNY@tcd.ie
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Study of 1000 IU Vitamin D Daily for One Year

Pfeifer, et al. (2009) 

This study evaluated the effectiveness of a one-year vitamin D and calcium supplementation 

program in reducing falls among older adults compared to a calcium only supplementation 

program. After one year, the intervention participants were 27 percent less likely to fall. After 

an additional eight months, participants were 39 percent less likely to fall compared to those 

who did not receive vitamin D.

Population: Participants were community-dwelling adults aged 70 or older with vitamin D 

(25[OH] D) serum levels below 78 nmol/l (nanomoles per liter)

Geographic Location: Bad Pyrmont, Germany 

Focus: Investigate the effectiveness of long term vitamin D supplementation on falls.

Program Setting: A study center at a research institution. 

Content: At the beginning of the study, a physician met with participants and collected 

medical history, height and weight, blood, and information on nutrition, physical activity, 

tobacco use, and alcohol use. 

Participants were given a four month supply of 500 IU of vitamin D and 500 mg of calcium 

supplements and told to take the supplements twice daily at breakfast and dinner. 

Participants were told to avoid taking additional vitamin D and calcium supplements. 

The participants visited the clinic every four months to have their progress monitored and 

to receive additional supplements.

Duration: Participants took vitamin D and calcium supplements twice a day for one year 

and were monitored for an additional eight months. Participants attended five 1-hour clinical 

visits over the 20-month study period

Delivered by: This intervention was delivered by a physician. 

Minimum Level of Training Needed: A nurse, with the supervision of a physician, could deliver 

this intervention. A physician needs to make the recommendation.

Key Elements: 

• Physicians should discuss possible benefits and side effects with each patient. 

• It may be beneficial to assess medical history and dietary habits. 

• Measuring 25(OH) D serum levels in every patient is not necessary. 

• A good personal relationship between the physician and patient increases compliance.

Available Materials: No intervention materials were available at the time of publication.
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Study Citation: Pfeifer M, Begerow B, Minne HW, Suppan K, Fahrleitner-Pammer A, Dobnig 

H. Effects of a long-term vitamin D and calcium supplementation on falls and parameters of 

muscle function in community-dwelling older individuals. Osteoporosis International. 2009 

Feb;20(2):315–22.

Supplemental Article

Pfeifer M, Begerow B, Minne HW, Nachtigall D, Hansen C. Effects of a short-term vitamin D(3) 

and calcium supplementation on blood pressure and parathyroid hormone levels in elderly 

women. Journal of Clinical Endocrinology and Metabolism. 2001 Apr;86(4):1633–7.

Contact 

Practitioners interested in using this intervention may contact the principal investigator 

for more information:

M. Pfeifer

Institute of Clinical Osteology “Gustav Pommer”

Clinic “Der Fürstenhof”,

Am Hylligen Born 7,

31812 Bad Pyrmont, Germany

E-mail: iko_pyrmont@t-online.de
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Quality Use of Medicines Program

Pit, et al. (2007)

This intervention focused on:

• Designing a convenient system for reviewing medicine within routine general practice visits.

• Teaching physicians to conduct medication reviews with their older patients. 

Certain medications increase the risk of falling. Participating physicians received instruction 

on geriatric prescribing and a financial incentive to review medications. The physicians 

recruited their patients to participate in the study. Participants completed the Medication 

Risk Assessment (MRA) form in the waiting room and showed this feedback to their physician. 

After 12 months, participants in the intervention group were 39 percent less likely to fall and 

46 percent less likely to experience a fall-related injury than those whose physician’s did not 

receive the educational program.

Population: Participants were adults 65 or older who lived in the community and were 

recruited by their general practitioners (GPs) to participate in this study.

Geographic Location: Hunter Region, New South Wales, Australia

Focus: Educate GPs about the importance of reviewing medications with their older patients.

Program Setting: This intervention was conducted in the GP’s office. 

Content: The intervention consisted of three parts: 1) education, 2) MRA, and 3) completion of 

a Medication Review Checklist (MRC).

A behavioral scientist conducted an initial 15-minute session and introduced the intervention 

to the physician and clinical staff. A clinical pharmacist who was experienced in conducting 

medication reviews visited each GP twice. The pharmacist also provided materials about 

prescribing for older adults, the MRC and the MRA for patients. The MRA contained a list of 31 

risk factors for experiencing medication issues (e.g., taking more than four medications/day, 

medication side effects). 

Patients completed the MRA in the waiting room. The GP later reviewed the Assessment to 

determine if the patient would benefit from a medication review. 

The MRC contained a list of potential problems and possible solutions. Problems included:

• Number of medications prescribed to patient. 

• Patient compliance in taking prescribed medications.

• If the patient was prescribed specific drug categories (e.g., benzodiazepines, NSAIDS, 

over-the-counter medicines).

• If the patient had experienced any adverse drug reactions.

• After reviewing the patient’s medications, the GP initiated appropriate prescribing changes. 
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

An MRC was completed for each at-risk patient. Physicians received a monetary incentive after 

completing 10 MRCs. 

Duration: The introductory session lasted 15 minutes. Each GP received two 1-hour 

educational sessions from the pharmacist. Office staff reported that it took on average 3.5 

minutes per patient to hand out the risk assessments and to answer any questions. Medication 

reviews took place during regular office visits and lasted 15–20 minutes.

Delivered by: A behavioral scientist explained the intervention to the GP and office staff. 

A clinical pharmacist explained the medication-related issues. GPs conducted medication 

reviews.

Minimum Level of Training Needed: A pharmacist or physician with experience 

conducting medications reviews should lead the education sessions. A physician should 

conduct the medication reviews.

Key Elements:

• To maintain program fidelity the program should not be altered.

• An understanding of behaviour change theory. 

Available Materials: The medication risk self-assessment for patients, and a MRC are 

available in Appendix C-6.

Study Citation: Pit SW, Byles JE, Henry DA, Holt L, Hansen V, Bowman DA. A Quality Use 

of Medicines program for general practitioners and older people: a cluster randomised 

controlled trial. Medical Journal of Australia. 2007 Jul 2;187(1):23–30.

Supplemental Articles

Pit, SW. Improving quality use of medicines for older people in general practice. University of 

Newcastle (Australia); 2004. PhD thesis.

Pit, SW, Byles, JE. Older Australians’ medication use: self-report by phone showed good 

agreement and accuracy compared with home visit. Journal of Clinical Epidemiology. 2010 

63:428–34.

Pit, SW, Byles, JE, Cockburn, J. Prevalence of self-reported risk factors for medication 

misadventure among older people in general practice. Journal of Evaluation in Clinical Practice. 

2008 14(2), 203–208.

Pit, SW, Byles, JE. Accuracy of telephone self-report of drug use in older people and agreement 

with pharmaceutical claims data. Drugs and Aging. 2008 25(1), 7–80.

Pit, SW, Byles, JE, Henry, DA, Holt, L, Hansen, V, Bowman, D. (2007) Quality Use of Medicines 

Program for general practitioners and older people: a cluster randomised controlled trial. 

Medical Journal of Australia. 2007 187(1), 23–30. 
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Single Interventions : Clinic al

Pit, SW, Byles, JE, Cockburn, J. Medication review: patient selection and general practitioner’s 

report of medication-related problems and actions taken. Journal of the American Geriatrics 

Society. 2007 55(6), 927–934.

Contact 

Practitioners interested in using this intervention may contact the principal investigator 

for more information:

Dr. Sabrina Pit

University Centre for Rural Health

61 Uralba Street

Lismore | NSW 2480

Tel: +61 2 6620 7570| F + 61 2 6620 7270 | M 04 29 45 57 20

Email: sabrina.pit@sydney.edu.au
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Podiatry & Exercise Intervention

Spink, et al. (2011)

This study tested the effectiveness of a podiatry intervention coupled with exercise and 

education to prevent falls among older adults with disabling foot pain and an increased 

risk of falls. 

• Disabling foot pain was defined as foot pain lasting for at least a day within the last month 

and a positive response of “some days” or “most/every days” to at least one item on the 

Manchester foot pain and disability index. 

• Participants were considered at increased risk of falling if they had fallen in the previous 12 

months, scored greater than one on the physiological profile assessment tool, or took >10 

seconds on the alternate stepping test.

Intervention components included orthoses (custom molded shoe inserts), advice about and 

subsidies to pay for safe footwear, a foot and ankle exercise program, and fall prevention 

education. Overall, the fall rate for the intervention group was 36 percent lower than for the 

control group.

Population: Participants were adults aged 65 and older who lived in the community and 

were not cognitively impaired. All participants reported disabling foot pain and were at 

increased risk for falling. Over two-thirds of participants were female.

Geographic Location: Melbourne, Australia

Focus: A podiatry intervention to reduce fall risk among older adults with disabling foot pain.

Program Setting: A podiatrist fitted participants with customized shoe inserts and 

provided advice about safe footwear and fall prevention education at a health science clinic. 

The recommended exercises were performed at home. 

Content:

Foot orthoses: The podiatrist issued participants shoe inserts (FormthoticsTM) that were heat 

molded to the participants’ foot shape and customized with 3mm of cushioning material to 

redistribute pressure away from any painful plantar lesions.

Footwear: The podiatrist also assessed participants’ outdoor footwear using a validated form. 

Inappropriate footwear included heels over 13⁄4”, narrow heels, no ankle support, and a fully 

worn or smooth sole. 

For participants with inappropriate footwear, the podiatrist provided a handout with pictures 

that illustrated safe and unsafe shoes, information about retailers of orthopedic footwear, and 

a subsidy to use toward purchasing safer shoes.
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Single Interventions : Clinic al

Exercise: The exercise component consisted of a 30-minute foot and ankle exercise routine 

that participants performed at home three times a week for six months. Participants received 

an instruction booklet and DVD that detailed the exercises. These included:

• Calf and toe stretches (using a rubber band).

• Strength training for the ankles (heel raises and using a TherabandTM) and toes 

(using an archxerciser).

• Range of motion exercises such as ankle circling.

• Participants were instructed to increase the number of repetitions and/or level of resistance 

as the study progressed, based on their ability. 

Education: The podiatrist used the Australian government produced booklet entitled Don’t Fall 

for It, Falls can be Prevented, which outlines fall risk factors and prevention strategies. 

Duration:

Foot orthoses: Participants were instructed to wear their shoe inserts every day during the six 

months of the intervention period.

Exercise: 30 minutes three times a week 

for six months. 

Education: Fall prevention education and 

information about appropriate footwear were 

provided during a single visit lasting 45–60 

minutes. The podiatrist contacted participants 

at 1, 4, 12, and 20 weeks after their visit to 

provide encouragement, promote adherence, 

and to answer questions

Delivered by: A podiatrist with experience in older adult fall prevention delivered the general 

falls prevention education and instructions about safe footwear. He also fitted the participants 

with their shoe inserts and gave each participant a booklet and a DVD detailing the foot and 

ankle exercises. 

Minimum Level of Training Needed: Podiatrist or other health professional with 

experience in delivering exercise programs and prescribing foot orthoses. 

Key Elements: Foot and ankle exercises performed three times a week. 

Available Materials: “Podiatry and Fall Research Project: Project Booklet” that includes the 

safe shoe handout and foot and ankle exercise program* 

*See Appendix C-7
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Study Citation: Spink MJ, Menz HB, Fotoohabadi MR, Wee E, Landorf KB, Hill KD, et al. 

Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling 

older people with disabling foot pain: randomised controlled trial. British Medical Journal 

(Clinical Research Ed). 2011;342:d3411.

Supplemental Article 

Barton CJ, Bonanno D, Menz HB. Development and evaluation of a tool for the assessment 

of footwear characteristics. Journal of Foot Ankle Research. 2009 Apr 23;2:10.

Contact 

Practitioners interested in using this intervention may contact the principal investigator 

for more information:

Dr. Martin Spink

Faculty of Health and Medicine

University of Newcastle

Building BE

10 Chittaway Road

Ourimbah NSW 2258

Australia

Email: Martin.Spink@newcastle.edu.au
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Single Interventions : Clinic al

The following three tables summarize the study population 

characteristics, study methodology, and intervention 

characteristics for the 10 Single Focused clinical interventions.
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Table 1. Summary Table of Studies and Study Population Characteristics 

Study No. Study Participants Mean Age % Female Race/Ethnicity Socioeconomic Status (SES) Previous Falls Other Characteristics

Bischoff-Ferrari 2006 445 71 55% 97% White 

2.7 % Black 0.2% Asian

NA* NA

Campbell 1999 72 75 78% Most were White NA 44% Mean number of 

medications=6

Gallagher 2004 245 72 100% NA NA 100%

Haran 2010 606 80 65% Most were White NA 37% had ≥2 in 

past year

Harwood 2004 150 81.2 100% Most were White NA 100% 100% had a hip 

fracture

Harwood 2005 306 78.5 100% Most were White NA About 50% fell in 

past year

Mean number of medications=4

Kenny 2001 175 73 60% NA NA 100%

Pfeifer 2009 242 76.5 75% 100% white 100%≥12 year of 

education

NA

Pit 2007 849 older 

adults; 20 General practitioners

NA 59% NA for doctors; 

Patients mostly white

NA 25%

Spink 2011 305 74 69% 67% born in 

Australia

75% received a state funded pension 24% had primary level education only

56% fell in past year; 31% >2 falls in past year

34% lived alone

*No information available
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Single Interventions : Clinical

Table 2. Study Methodology

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Bischoff-Ferrari 2006 Boston, Massachusetts Participants recruited 

through mailing lists and presentations

≥65 Use of 

bisphosphonate, calcitonin, estrogen, tamoxifen citrate, or testosterone (w/in 6 mo) or fluoride (w/in 2 yrs); hx of renal disease or renal stone(w/in 5 yr); current cancer, hyperparathyroidism, dietary calcium intake > 1500 mg/d, laboratory evidence of kidney or liver disease; or bilateral hip surgery

Yes

Method of Recording 

Falls Length of Follow-up Measured Outcomes Results* Adverse Effects

Participants sent a postcard after every fall. Falls also were recorded every 6 months during clinical visits.

3 years Fall risk, overall ORf=0.77(0.51–1.15) Hypercalciuria, 

constipation, epigastric distress, sweating

Fall risk, female ORf=0.54(0.30–0.97) Fall risk, male ORf=0.93 (0.50–1.72) Fall risk, less active female ORf=0.35(0.15–0.81)

a Incidence Rate Ratio b Relative Rate c Hazard Ratio d Relative Risk e Rate Ratio per 1,000 hrs of activity f Odds Ratio
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Campbell 1999 Dunedin, New Zealand Identified from general 

practice registers

≥65 years old; currently taking a benzodiazepine, other hypnotic, antidepressant, or major tranquillizer; ambulatory in own home; not receiving physical therapy; physician though patient would benefit from psychotropic medication withdrawal

Cognitive impairment Yes

Method of Recording 

Falls Length of Follow-up Measured Outcomes Results* Adverse Effects

Monthly fall calendars 44 weeks Fall Rate RRb = 0.34 (0.16–0.73) None

Number of fallers RRb = 0.61 (0.32–1.17)

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Gallagher 2004 Omaha, Nebraska Mailing lists used to contact 

women in the Omaha, Nebraska area

Age 65 to 77 years, not osteoporotic (femoral neck density in normal range

Severe chronic illness, primary hyperparathyroidism, active renal stone disease, or use of thiazide estrogen, fluoride, diuretics, bisphosphonates or anticonvulsants in past 6 months

No

Method of Recording 

Falls Length of Follow-up Measured Outcomes Results* Adverse Effects

In person at week 6, 3 months & then every 6 months

3 years Number of fallers RRd=0.62 (0.54–0.93) Hypercalcaemia, 

hypercalciuria;

a Incidence Rate Ratio b Relative Rate c Hazard Ratio d Relative Risk e Rate Ratio per 1,000 hrs of activity f Odds Ratio

Table 2. Study Methodology, Continued
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Single Interventions : Clinical

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Haran 2010 Sydney and llawarra 

regions of New South Wales, Australia

Recruited between May 2005 and June 2007

Community dwelling; age ≥80 or age ≥65 & fell in past 12 months or failed the TUGT; used multifocal lenses >3x week; had seen an optometrist or ophthalmologist in past 12 months 

Current use of single lens glasses

Yes

Method of Recording 

Falls Length of Follow-up Measured Outcomes Results* Adverse Effects

Monthly fall diary w/ telephone follow up if needed

13 months after randomization (Average 12 months after receiving glasses)

Fall rate (Overall) IRRa= 0.92(0.73–1.16) Fall related 

fractures in both groups. Intervention group experienced more non-fall related injuries. Increased number of outdoor falls in intervention members who were less active 

Fall rate (High outside activity)

IRRa=0.60 (0.42–0.87) 

Fall rate (Low outside activity) 

IRRa=1.29 (0.95–1.75) 

Fall rate (Outside falls, overall)

IRRa=1.00 (0.78–1.28) 

Fall rate (Outside falls-High outside activity)

IRRa=0.61 (0.42–0.87) 

Fall rate (Outside falls-Low outside activity)

IRRa=1.56 (1.11–2.19)

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Harwood 2004 Nottingham, United 

Kingdom

Women admitted to orthogeriatric rehab ward w/in 7 days of surgery for hip fracture

Recent surgery for hip fracture, previous community residence, previously independent in activities of daily life

Previously institutionalized, disease or medication known to affect bone metabolism, < 7 on 10-point mental status test

No

Method of Recording 

Falls Length of Follow-up Measured Outcomes Results* Adverse Effects

In person interviews at 3, 6, and 12 months

12 months Number of fallers RRd=0.48(0.26–0.90) None reported

a Incidence Rate Ratio b Relative Rate c Hazard Ratio d Relative Risk e Rate Ratio per 1,000 hrs of activity f Odds Ratio

Table 2. Study Methodology, Continued
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Harwood 2005 Nottingham, United 

Kingdom

Participants referred to program by optometrist

Aged > 70 years w/ cataract & no previous ocular surgery

Cataract not suitable for surgery by phacoemulsification, severe refraction error in 2nd eye, visual field deficits, severe co-morbid eye disease affecting visual acuity, registered partially sighted as a result of cataract, or memory problems

Yes

Method of Recording 

Falls Length of Follow-up Measured Outcomes Results* Adverse Effects

Monthly fall diary w/ telephone or in person interviews

12 months Fall rate RRb=0.66 (0.45–0.95) None reported

Number of fallers RRd=0.95 (0.68–1.33)

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Kenny 2001 Newcastle Upon Tyne, 

United Kingdom

Older adults who were seen in an emergency room because of an unexplained fall

Age ≥50 w/ cardioinhibitory carotid sinus syndrome who were seen in an ER because of an unexplained fall

Cognitive impairment, medical explanation for fall, blind, documented accident caused fall, lived outside the study, contraindication to cardioinhibitory CSM, or taking medications known to cause a hypersensitive response to cardioinhibitory CSM

Yes

Method of Recording 

Falls Length of Follow-up Measured Outcomes Results* Adverse Effects

Weekly fall diary 12 months Fall rate ORf=0.42 (0.23–0.75) None reported

a Incidence Rate Ratio b Relative Rate c Hazard Ratio d Relative Risk e Rate Ratio per 1,000 hrs of activity f Odds Ratio

Table 2. Study Methodology, Continued
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Single Interventions : Clinical

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Pfeifer 2009 Bad Pyrmont, Germany Recruited by newspaper 

advertisements and mailing lists

Age ≥60, community dwelling w/ vitamin D serum level below 78 nmol/l

Hypercalcemia or primary hyperparathyroidism; fractures of extremities due to osteoporosis; therapy w/a thiazide, vitamin D, vitamin D metabolite, calcitonin, bisphosphonate, estrogen, antiestrogen (w/in 6 mo) or fluoride treatment (w/in 2 yrs); intolerance to study medication; chronic renal failure; serum creatinine >20% upper limit of reference range, hx of drug or alcohol abuse; >7 cups coffee/day; >20 cigarettes/day; scheduled holidays out of the current latitude during the study period; diabetes mellitus; or severe cardiovascular disease 

Yes

Method of Recording 

Falls Length of Follow-up Measured Outcomes Results* Adverse Effects

Monthly fall diary and follow-up phone calls

20 months Number of fallers at 12 

months 

RRd=0.73(0.54–0.96) None

Number of fallers at 20 months

RRd=0.61(0.34–0.76)

a Incidence Rate Ratio b Relative Rate c Hazard Ratio d Relative Risk e Rate Ratio per 1,000 hrs of activity f Odds Ratio

Table 2. Study Methodology, Continued
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Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Pit 2007 Hunter Region, New South 

Wales, Australia

General practitioners randomly selected from a network of practices and their patients

GPs: at their current practice at least 12 months & who worked 10 hour/wkPatients aged >65, community-dwelling

Confused patients not accompanied by a caregiver

No

Method of Recording 

Falls Length of Follow-up Measured Outcomes Results* Adverse Effects

Interviewed by telephone or at home at baseline, 4 months, and 12 months

12 months Number of fallers RRd=0.61 (0.41–0.91) None 

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Spink 2011 Melbourne, Australia Recruited between July 

2008 and September 2009 from a database of people who were using podiatry services at the La Trobe University Health Sciences clinic in Bundoora Victoria, AU

Aged ≥65,communitydwelling cognitively intact, reported: disabling foot pain, a fall in the past 12 months, or took >10 seconds on alternate stepping test, or scored >1 on physiological profile

Neurodegenerative disorder, leg amputation, inability to walk 10 m w/out walking aid, did not speak English, leg surgery planned in next 2 months or that occurred in the 3 months before start of study

Yes

Method of Recording 

Falls Length of Follow-up Measured Outcomes Results* Adverse Effects

Monthly fall calendars with follow-up telephone calls 

12 months Number of fallers RRd= 0.85 (0.66–1.08) None

Number of multiple fallers RRd=0.63 (0.38–1.04)Fall rate IRRa=0.64 (0.45–0.91)

a Incidence Rate Ratio b Relative Rate c Hazard Ratio d Relative Risk e Rate Ratio per 1,000 hrs of activity f Odds Ratio

Table 2. Study Methodology, Continued
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Single Interventions : Clinical

Table 3 Intervention Characteristics 

Study Focus Providers Structure Number of Sessions Provider Contact Time

Bischoff-Ferrari 2006

Investigate the effectiveness of long term vitamin D & calcium supplementation on falls

A physician & allied health staff

One-on-one 7 clinic visits Clinic visits: 7 hours

Campbell 1999 Reduce psychotropic medication 

use among older adults

A physician & nurse One-on-one 2 assessments. 

5 home visits by research nurse to provide new medication

Clinical Assessment: 30–60 minutesHome visits: 30 minutes

Gallagher 2004 Active vitamin D 

supplementation

A physician & allied health staff

One-on-one 10 one-hour clinic visits Clinic visits: 10 hours

Haran 2010 Provide single lens distance 

glasses for older adults who are at risk & normally wear multifocal glasses

Optometrist One-on-one 2 optometry sessions of 

45–50 minutes each

Optometry sessions: approx. 11⁄2 hours

Harwood 2004 Investigate the effects of 

different vitamin D & calcium supplementation regimens 

A physician & allied health staff

One-on-one Four 30-minute clinic visits Clinic visits: 2 hours

Harwood 2005 Determine if cataract surgery 

reduces falls

An ophthalmologist One-on-one 1 assessment

1 surgery

Assessment: 60 minutesSurgery: 30 minutes

Kenny 2001 Pacemaker surgery for older 

adults w/ cardioinhibitory carotid sinus hypersensitivity 

A surgeon One-on-one Two 90 minute assessments 

1 surgery

Assessments: 3 hoursSurgery: 2–3 hours

Pfeifer 2009 One-year vitamin D & calcium 

supplementation

A physician One-on one Five 1-hour clinical 

assessments

Clinical assessment: 5 hours

Pit 2007 Educate GPs about the 

importance of reviewing medications w/ their older patients

A behavioral scientist and clinical pharmacist provided education to GPs. GPs assessed patients’ medications

One-on-one 1 physician and office 

staff session2 physician education sessions 1 medication review

Physician/staff education: 15 minutesPhysician education: 1 hour Medication review: 15–20 minutes

Spink 2011 Prevent falls w/ podiatry 

intervention plus foot & ankle exercises

Podiatrist One-on-one 

assessment w/home-based exercises

1 podiatry session30-minute exercise routine 3 times a week for 24 weeks

Podiatry visit: 1 hour

103

Multifaceted Interventions

MULTIFACETED INTERVENTIONS

Stepping On Clemson, et al. (2004) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

PROFET (Prevention of Falls in the Elderly Trial) Close, et al. (1999) . . . . . . . . . . . . 107

Accident & Emergency Fallers Davison, et al. (2005) . . . . . . . . . . . . . . . . . . . . . 109

The NoFalls Intervention Day, et al. (2002) . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

The SAFE Health Behavior and Exercise Intervention Hornbrook, et al. (1994) . . . . . 115

Falls Team Prevention Program Logan, et al. (2010) . . . . . . . . . . . . . . . . . . . . . 118

KAAOS (Falls and Osteoporosis Clinic) Palvanen, et al. (2014) . . . . . . . . . . . . . . . 120

Multifactorial Fall Prevention Program Salminen, et al. (2009) . . . . . . . . . . . . . . 124

Nijmegen Falls Prevention Program (NFPP) for adults with Osteoporosis 

Smulders, et al. (2010) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

The Winchester Falls Project Spice, et al. (2009) . . . . . . . . . . . . . . . . . . . . . . . 130

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

Tinetti, et al. (1994) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133

A Multifactorial Program Wagner, et al. (1994) . . . . . . . . . . . . . . . . . . . . . . . . 136

Table 1. Summary Table of Studies and Study Population Characteristics . . . . . . . . .139

Table 2. Study Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140

Table 3. Intervention Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .146
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Stepping On

Clemson, et al. (2004) 

This study used a series of seven 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. 

Note: This study has been translated for use in the United States. See page 106 for more information.

Population: Participants were individuals who had fallen in the past 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 vision and medical screenings to check for poor vision and possible 

medication problems. 

Each session covered different aspects to reducing fall risk: 

• Session one: Risk appraisal; introducing balance and strength exercises 

• Session two: Review and practice exercises; how to move safely in the home 

• Session three: Hazards in and around the home and how to remove or reduce them 

• Session four: How to move safely in the community; safe footwear and clothing 

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

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

in the community 

• Session seven: Review of topics covered in program 

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

modifications, if needed 

• Three-month booster session: Review achievements and how to maintain motivation 
105

Multifaceted Interventions

Duration:

• Seven weekly two-hour program sessions 

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

• A 1-hour booster session three 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 (PT) 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 PT, 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. 

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 as it provides a step-by-step 

guide to running the seven-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 
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

• A guide to useful resources 

• Handouts for group participants 

• Ideas on recruitment and evaluation 

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. 

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

U.S. Program Contact 

In 2011, CDC funded the translation of Stepping On for dissemination and 

implementation in the U.S. 

Practitioners interested in learning more may contact: 

Betsy Abramson 

Deputy Director

Wisconsin Institute for Healthy Aging

Office: 608-243-5691

E-mail: info@wihealthyaging.org
107

Multifaceted Interventions

PROFET (Prevention of Falls in the Elderly Trial) 

Close, et al. (1999) 

This study 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 three 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. 
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

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 C-8. 

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 1120 

E-mail: j.close@neura.edu.au
109

Multifaceted Interventions

Accident & Emergency Fallers 

Davison, et al. (2005)

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 therapists (PTs) and occupational therapists (OTs). 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 

one 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 Kingdom 

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 PT 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, participants were given assistive devices, 

had their footwear modified or replaced, and were referred to a podiatrist. 

An OT 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). 
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

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 one hour and the medical intervention visit was 20 

minutes. Participants received two 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 one month later lasted 20 minutes. 

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

referrals to specialists; a PT conducted the gait and balance assessment and re-education; and 

an OT 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 three 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.

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. 
111

Multifaceted Interventions

Contact 

Practitioners interested in using this intervention may contact the principal investigator 

for more information: 

Dr. John Davison

Falls and Syncope Service 

Newcastle upon Tyne Hospitals 

NHS Trust Royal Victoria Infirmary

Newcastle upon Tyne NEI 4LP, United Kingdom 

Fax: (+44) 191 222 5638

E-mail: john.davison@ncl.ac.uk
112

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

The NoFalls Intervention 

Day, et al. (2002)

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 three components were one-third less likely to fall. 

Population: All participants were aged 70 or 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. 

Content:

Exercise: The exercise intervention consisted of weekly one-hour classes plus daily home 

exercises. Classes were designed by a physical therapist (PT) 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 four lines difference between the line of smallest letters read 

correctly on the high and low contrast sections of the vision chart or any loss of field of view. 
113

Multifaceted Interventions

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. 

Duration: 

Exercise: Weekly one-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 PT 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 one-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. 
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

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

training such as that received by a PT 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. 

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: 

Professor Lesley Day PhD, MPH

Monash Injury Research Institute

Building 70

Monash University

Wellington Road

Clayton Victoria 3800

Australia

Tel: +61 (3) 9905 4020

Fax: +61 (3) 9905 4363

E-mail: lesley.day@monash.edu
115

Multifaceted Interventions

The SAFE Health Behavior and 

Exercise Intervention 

Hornbrook, et al. (1994) 

The Study of Accidental Falls in the Elderly (SAFE) health behavior intervention was a 

program of four group classes on how to prevent falls. The classes addressed environmental, 

behavioral, and physical risk factors and included exercise with instructions and supervised 

practice. The home safety portion included a home inspection 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 four 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 

Each class session also had an exercise component that included a brief demonstration 

of fall prevention exercises and about 20 minutes of supervised practice. Participants 

received a manual describing the exercises and were encouraged to begin walking at least 

three times a week. 

The exercises were chosen to: 

• Actively involve all parts of the body 

• Maintain full range of motion of all joints 
116

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

• 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 four classes were completed, the assessor returned to the participant’s home to 

check on the progress of repairs and to offer financial and technical assistance if needed, 

as well as discounts on safety equipment. 

Duration: 

• Two home visits, each lasting about 15 minutes 

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

a one-month period 

Delivered by:

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

a two-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. 

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

Available Materials: No intervention materials were available 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. 
117

Multifaceted Interventions

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
118

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Falls Team Prevention Program

Logan, et al. (2010)

This study examined the effectiveness of a team-based, individually tailored intervention 

designed to reduce falls among older adults. The multifaceted intervention included group 

education, group and home-based strength and balance exercises, medication review, blood 

pressure screening, and home hazard assessments and modifications. After 12 months, the 

fall rate was 55 percent lower among people who took part in the program compared to 

those who did not. 

Population: Participants were adults aged 60 or older who lived in the community (95 percent) 

or nursing homes (5 percent), and had called emergency services for an ambulance because 

of a fall, but were not taken to a hospital.

Geographic Location: Nottinghamshire, United Kingdom

Focus: Increase strength and balance, identify inappropriate medications, and reduce 

home hazards.

Program Setting: Programs were conducted primarily in patients’ homes. Optional group 

sessions were offered at community centers. 

Content: The falls team was composed of an occupational therapist (OT), physical therapist 

(PT), and a nurse. The team provided participants with as many home sessions as they deemed 

clinically necessary. 

• The OT and PT led optional group sessions twice a week for six weeks. These included 

group exercises and fall prevention education (e.g., reducing home hazards, information 

about safe footwear).

• A nurse reviewed participants’ medications and assessed their blood pressure.

• The PT taught the strength and balance exercises to participants in their homes. The PT 

used exercises from the Postural Stability program that was based on the FaMe and Otago 

Exercise programs (See pages 8 and 30).

• The OT conducted the home hazard assessments and suggested modifications. The OT 

provided equipment (e.g., grab bars), advice (e.g., improved lighting), and taught participants 

how to get up from a fall.

• Referrals (e.g., family physician for follow-up, social services for home care) were made 

if needed.

Duration: 

• Group sessions lasted two hours. These were held twice a week for six weeks on an ongoing 

basis. The first hour was devoted to strength and balance exercises and the second hour to 

fall prevention education. 
119

Multifaceted Interventions

• Strength and balance sessions in the home lasted one-hour and were conducted once a 

week for a minimum of six weeks. However, sessions were continued for as long as the PT 

deemed necessary. 

• Conducting the home hazard assessments and modifications took an hour, with subsequent 

follow-up if needed. 

• Reviewing medications and screening blood pressure lasted about 30 minutes. 

Delivered by: The intervention was delivered by a team composed of an OT, a PT, and a nurse.

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

health care professionals. A PT who has experience with the Postural Stability program should 

deliver strength and balance exercises. An OT should conduct the home hazard assessments 

and modification recommendations. A nurse should complete the medication review.

Key Elements: Qualified health care professionals should continually assess the participants 

over the length of the program. The duration and the intensity should be modified as needed 

based on these ongoing assessments.

Available Materials: The educational materials were modified from the Guide to Action to 

Prevent Falls, available at: http://eprints.nottingham.ac.uk/1414.

Information about the accredited Postural Stability Instructor course in the United Kingdom is 

available at: http://www.laterlifetraining.co.uk.

Study Citation: Logan PA, Coupland CA, Gladman JR, Sahota O, Stoner-Hobbs V, Robertson K, 

et al. Community falls prevention for people who call an emergency ambulance after a fall: 

randomised controlled trial. British Medical Journal (Clinical Research Ed). 2010;340:c2102.

Contact 

Practitioners interested in using this intervention may contact the principal investigator for 

more information:

Pip Logan, PhD, MPhil 

HPHC Occupational Therapist 

Professor of Rehabilitation Research 

Deputy Head of Division 

B108a, B Floor 

Division of Rehabilitation and Ageing 

School of Medicine 

University of Nottingham

NG7 2UH

Tel: 0115 8230235

Fax: 0788 4318920

Email: Pip.Logan@nottingham.ac.uk
120

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

KAAOS (Falls and Osteoporosis Clinic)

Palvanen, et al. (2014)

This study evaluated the effectiveness of a multidisciplinary falls risk assessment [assessment 

(by a doctor, nurse, and physical therapist [PT]) followed by appropriate interventions and 

follow-up if necessary. After one year, participants were 28 percent less likely to fall and 

26 percent less likely to have an injurious fall compared to those who did not participant 

in the intervention.

Population: Participants were community-dwelling adults aged 70 and older with an 

increased risk of falling or fall induced injury.

• Participants were considered at increased risk of falling or fall induced injury if they 

had self-reported mobility issues, or more than two falls in previous 12 months, or a 

previous fracture, or history of hip fracture in a close relative, or confirmed or suspected 

osteoporosis, or a BMI <19, or illness that increases the risk of osteoporosis, falls, 

and fractures.

Geographic Location: Tampere and Lappeenranta, Finland

Focus: Identify and modify risk factors for falls at a center-based falls clinic.

Program Setting: The intervention occurred at two falls clinics situated within 

health care centers.

Content: During the initial visit, the intervention team conducted a three hour assessment 

of fall risk factors for each participant. 

• A nurse 

– collected basic information and body measurements,

– assessed cognitive function, and 

– measured blood pressure including postural blood pressure. 

• A PT 

– tested physical function using the Short Physical Performance Battery and the Timed 

Up and Go-test.

• A physician 

– conducted a thorough medical examination including a review of medications. 

• A PT or nurse 

– conducted a one hour home hazard assessment on a separate day. 
121

Multifaceted Interventions

Risk Factor Intervention

Assessed by physician:

General medical history and examination Referred to primary care physician.

Medications

Recommended reduction of drugs known to increase 

risk of falling. Withdrawal of redundant psychotropic 

medications.

Visual impairment Referral to optician or ophthalmologist for glasses if 

necessary. Referral to ophthalmologist for cataracts.

Assessed by a PT:

Low mobility

Referral to home or group strength and balance 

program if needed. The home training session lasted 

45 minutes two to three times a week. Group classes 

were led by an exercise instructors experienced at 

teaching older adults and were 45 minutes once per 

week. Exercises were strength and balance focused 

and included half-squats, heel walking, and tandemwalking. Hip protectors, mobility assistive devices, 

and anti-slip shoe devices were recommended if 

deemed necessary.

Low physical activity Prescription for increased physical activity according 

to functional ability.

Assessed by a nurse:

Nutrition

Vitamin D and calcium supplementation 

recommended if dietary intake assessed as inadequate 

(>1000–1500 mg Calcium/day, >600–800 IU vitamin D/

day). The physician wrote a prescription if necessary.

Alcohol and smoking Reduction of alcohol advised. Cessation of smoking 

recommended.

Assessed by a PT or nurse:

Home hazards

In-home visit; recommend grab bars, mats for slippery 

floors; assessed lighting, security lights, smoke alarms 

and fire extinguishers, placement of wires and cords.
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

A nurse made a telephone call twice (after three months and again after nine months) to 

check adherence to the prescribed interventions and to provide further recommendations 

as needed. The participant visited the falls clinic at 6 months and 12 months after the 

initial intervention to receive a booster assessment from the doctor, nurse, and PT. The PT 

revaluated mobility, emphasized increasing physical activity, and measured adherence to 

at-home or group balance and training exercises. The nurse and doctor measured adherence 

to their previous recommendations and provided additional guidance if needed. The visit 

lasted 21⁄4 hours. 

Duration:

• Three-hour fall risk assessment (one-hour each with the physician, nurse, and PT)

• One-hour home hazard assessment

• 45 minutes of home balance and strength training two to three times per week if necessary

• 45 minutes of group balance and strength exercise once per week if necessary

• Two short telephone calls three and nine months after the initial assessment

• Two, 21⁄4 hour follow-up visits (45 minutes each with physician, nurse, and PT) at six and 

twelve months after the initial assessment

Delivered by: Assessment and individualized interventions were conducted by physicians, 

nurses, and physical therapists.

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

health care professionals including a physician, nurse, and PT. Preparation for conducting 

the baseline assessments requires a half-day training session.

Key Elements:

• Measuring functional ability and recommending strength and balance training

• Performing a medication review and eliminating/reducing medications that increase falls

• Assessing nutrition and prescribing supplementation if necessary

• Assessing home hazards and providing modifications and referrals

• Medical referrals, hip protectors and assistive devices, if indicated

Available Materials: The structured home exercise handout and home hazard assessment 

checklist are available in Finnish. 

Study Citation: Palvanen M, et al. Effectiveness of the Chaos Falls Clinic in preventing 

falls and injuries of home-dwelling older adults: a randomised controlled trial. Injury

2014;45(1):265–71.
123

Multifaceted Interventions

Contact 

Practitioners interested in using this intervention may contact the co-investigator 

for more information:

Professor Pekka Kannus, MD, PhD

UKK Institute for Health Promotion Research

P.O. Box 30

Fin-33501 Tampere

Finland

Tel: +358-3-2829-336

E-mail: Pekka.Kannus@uta.fi
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Multifactorial Fall Prevention Program

Salminen, et al. (2009) 

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 homebased 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 three 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 one 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. 

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 one year later. 

A physical therapist (PT) led a group exercise class every two 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. 
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Multifaceted Interventions

• 20 minutes of circuit training for muscle strength. Two to four 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 PT’s 

judgment of each person’s fitness level. 

Participants also performed similar exercises at home three times a week. Participants 

received written information on performing home exercises based on the PT’s judgment of 

their physical condition. 

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

causes of falls, 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 two weeks plus 25 minutes of exercise at 

home three 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 PT facilitated 

the group exercise sessions; and various health professionals (e.g., geriatricians, public health 

nurses, PTs, 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 PT or PT student, combined with at-home exercises 

tailored to each participant 

• Exercise intensity must increase progressively over time 
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

• 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 home-dwelling elderly people: A randomizedcontrolled 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. 

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 riskbased multifactorial fall prevention on maximal isometric muscle strength in communitydwelling 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 communitydwelling 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
127

Multifaceted Interventions

Nijmegen Falls Prevention Program (NFPP) 

for adults with Osteoporosis

Smulders, et al. (2010)

This study evaluated a 51⁄2-week multicomponent falls exercise program designed to reduce 

falls among older adults with osteoporosis. The program consisted of six elements: 

1) education, 2) an obstacle course, 3) walking exercises, 4) weight-bearing exercises, 

5) correction of gait abnormalities, and 6) training for how to fall safely. Participants were 

39 percent less likely to fall compared to those who did not receive the intervention.

Population: Participants were community-dwelling adults aged 65 or older with 

osteoporosis and a history of falls (one or more falls in the previous 12 months).

Geographic Location: Arnhem-Nijmegen, the Netherlands

Focus: Improve balance, decrease fall risk, and enhance quality of life among older adults 

with osteoporosis.

Program Setting: The program was conducted at a rehabilitation center in a local hospital. 

Participants were encouraged to incorporate walking and weight bearing exercises into their 

daily lives.

Content: A physical therapist (PT) and an occupational therapist (OT) led sessions twice 

a week for 51⁄2 weeks. Sessions included 10 participants and consisted of one or more key 

elements: 

• Education—60 minutes 

– Explanation of osteoporosis

– Overview of medications

– Simulations of situations in which people were likely to fall

• An obstacle course—90 minutes

– Navigating a complex course (e.g. uneven pavement, slopes, stepping stones)

– Motor dual task (e.g., walking in pairs while holding a stick)

– Limited visual input (e.g., walking in dim light)

– Cognitive dual task (e.g., listening to a story while walking through an obstacle course) 

• Walking exercises—30 minutes

– Changes in speed and direction 

– Walking while handling a ball

– Following commands (e.g., stop, turn)
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

• Weight-bearing exercises—15 minutes

– Walking up stairs

– Lifting and reaching exercises

• Correction of gait abnormalities—45 minutes 

– Trunk extension and rotation

– Hip, knee, and ankle extension exercises

• Falling safely techniques—30 minutes

– Weight shifting

– Learning to fall sideways, forward, and backward as safely as possible

– Learning to get up safely from the ground

Session elements:

• Session 1: Education 

• Session 2: Correction of gait abnormalities and obstacle course 

• Session 3: Falling safely techniques , weight-bearing exercises, and walking exercises 

• Session 4: Correction of gait abnormalities and obstacle course 

• Session 5: Education, falling safely techniques, weight-bearing exercises, and 

walking exercises 

• Session 6: Correction of gait abnormalities and obstacle course

• Session 7: Falling safely techniques , weight-bearing exercises, and walking exercises 

• Session 8: Correction of gait abnormalities and obstacle course

• Session 9: Education, falling safely techniques, weight-bearing exercises, and 

walking exercises

• Session 10: Correction of gait abnormalities and obstacle course

• Session 11: Falling safely techniques and weight bearing exercises

Duration: Sessions were held twice a week for 51⁄2 weeks. Each session lasted between 

1 and 23⁄4 hours. 

Delivered by: A PT led the walking and weight bearing exercises and the sessions devoted 

to correcting gait abnormalities. An OT led the educational sessions that covered home 

safety. The PT and OT jointly delivered the initial education session, the obstacle course, 

and the training in how to fall safely. 

The PTs and OTs attended a two-day training course that covered the theoretical and 

practical background of the program. The PTs attended an additional one-day course on 

functional walking.
129

Multifaceted Interventions

Minimum Level of Training Needed: This program should be delivered by a PT and OT 

with additional training in teaching older adults with osteoporosis how to fall safely. 

Key Elements:

• The obstacle course, especially the emphasis on dual task activities

• Training in teaching older adults with osteoporosis how to fall safely

• Walking exercises in a distracting environment

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

Study Citation: Smulders E, Weerdesteyn V, Groen BE, Duysens J, Eijsbouts A, Laan R, van 

Lankveld W. Efficacy of a short multidisciplinary falls prevention program for elderly persons 

with osteoporosis and a fall history: a randomized controlled trial. Archives of Physical Medical 

Rehabilitation. 2010;91(11):1705–11.

Supplemental Articles

Weerdesteyn V, Rijken H, Geurts AC, Smits-Engelsman BC, Mulder T, Duysens J. A five-week 

exercise program can reduce falls and improve obstacle avoidance in the elderly. Gerontology. 

2006;52(3):131–41.

Smulders E, Weerdesteyn V, Groen BE, Duysens J, Eijsbouts A, Laan R, van Lankveld W. 

The development of a multi-modal fall prevention program for persons with osteoporosis 

M.L. Vincent, T.M. Moreau (Eds.), Accidental falls: causes, preventions and interventions, Nova 

Publisher Inc, New York (2008), pp. 185–201.

Contact 

Practitioners interested in using this intervention may contact the principal investigator 

for more information:

Ellen Smulders, PhD

Senior Researcher Tolbrug

Tolbrug Specialistische Revalidatie 

Henri Dunantstraat 7

5223 GZ’s-Hertogenbosch

P.O. Box 90153

5200 ME ’s-Hertogenbosch

The Netherlands

Tel: 0031 73 553 57 13 

Email: ellen.smulders@tolbrug.nl

5200 ME ’s-Hertogenbosch

Website: www.tolbrug.nl
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

The Winchester Falls Project

Spice, et al. (2009) 

This study evaluated the effectiveness of two 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 physician, nurse, physical therapist (PT), and occupational therapist (OT)], 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 fallrelated 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 two or more falls in the previous year. About three-quarters 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.
131

Multifaceted Interventions

Risk Factor Intervention

Assessed by physician:

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 PT:

Poor mobility

Provide physical therapy interventions such as 

strength, balance, and gait training. 

Exercise instruction. 

Provide mobility aids.

Assessed by an OT:

Improper footwear

Share information on footwear. 

Refer for orthotics or corrective shoes.

Environmental hazards

Recommend 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

Provide daily living advice.

Refer to social services for assistance.
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Duration: Fall risk assessments took about two 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 

physicians, nurses, PTs, and OTs.

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: Physicians, nurses, PTs, and OTs used a structured in-depth assessment 

instrument. 

Available Materials: Structured assessment instrument*

*See Appendix C-9. 

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. 

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 Hill139

Cosham PO6 3LY, United Kingdom 

E-mail: claire.spice@porthosp.nhs.uk
133

Multifaceted Interventions

Yale FICSIT (Frailty and Injuries: Cooperative 

Studies of Intervention Techniques) 

Tinetti, et al. (1994)

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 three balance and strength training programs. 
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

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 care physician. The final decision 

on medication changes was made by the primary care 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.

Duration: The intervention was conducted over a three-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 PT or OT, or a PT or OT 

assistant with supervision by a PT or OT. 

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. 
135

Multifaceted Interventions

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. 

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
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

A Multifactorial Program

Wagner, et al. (1994) 

This study tested a moderate-intensity intervention that used tailored strategies based on 

assessments of each participant’s risk factors. After one 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 six risk factors. The 

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

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 a psychoactive drug 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.
137

Multifaceted Interventions

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 one 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
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

The following three tables summarize the study population 

characteristics, study methodology, and intervention 

characteristics for the 12 Multifaceted Interventions. 
139

Multifaceted Interventions

Table 1. Summary Table of Studies and Study Population Characteristics 

Study No. Study Participants Mean Age % Female Race/Ethnicity Socioeconomic Status (SES) Previous Falls Other Characteristics

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

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

Hornbrook 1994 3,182 73 62% 90% White 33% education >HS 15% fell in past year 37% lived alone

56% married

Logan 2010 204 82.5 65 99% White 53% Unskilled workers or 

never worked

100% fell in past 3 months; 72% had ≥2 falls in past 3 months 2

56% of intervention and 66% of control lived alone

Palvanen 2014 1,314 77.6 86% 100% White All participants were 

retired and received state benefits

36% fell in past 6 months

Mean number of medications= 5.6

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 year 41% fell once in past year

53% lived alone 45% married

Smulders 2010 96 71 94% 100% White NA 100%

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

Wagner 1994 1,559 73 59% 93% White 25% education >16 years 

35% income <$15,000

33% fell in past year

*No information available
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Table 2. Study Methodology

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 fell in past year or had a fear of falling, spoke English

Cognitively impaired or homebound

No

Method of Recording 

Falls Length of Follow-up Measured Outcomes Results* Adverse Effects

Participants mailed in a pre-addressed, stamped calendar each month.

14 months Fall rate, overall RRb = 0.69 (0.50–0.96) None

Fall rate, males RRb = 0.32 (0.17–0.59) Fall rate, females RRb = 0.96 (0.50–1.85)

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 survey to determine their fall hx. Repeat fallers were recruited by telephone.

Age >65 treated in ED for a fall or fall injury, & who 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 Measured 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 RRd = 0.64 (0.46–0.90) None

Number of fallers RRd = 0.95 (0.81–1.12)Neck or femur fractures RRd = 0.48 (0.04–5.29) Other fracture RRd = 0.53 (0.20–1.39) Fall-related ED visit RRd = 0.90 (0.55–1.47) Fall-related hospital admission

RRd = 0.80 (0.41–1.56) 

a Incidence Rate Ratio b Relative Rate c Hazard Ratio d Relative Risk e Rate Ratio per 1,000 hrs of activity f Odds Ratio
141

Multifaceted Interventions

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, owned or leased home & able to make home modifications

Planning to move w/in 2 years; recent physical activity w/ a balance component; unable to walk 10–20 m w/o rest, help, or angina; severe respiratory or cardiac disease; cognitively impaired; made recent major home modifications; or did not have physician approval

No

Method of Recording 

Falls Length of Follow-up Measured 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:

RRb = 0.82 (0.70–0.97) 

None

Exercise + vision:RRb = 0.73 (0.58–0.91) Exercise + home mod:RRb = 0.76 (0.60–0.95) Exercise + vision + home mod:RRb =0.67 (0.51–0.88)

a Incidence Rate Ratio b Relative Rate c Hazard Ratio d Relative Risk e Rate Ratio per 1,000 hrs of activity f Odds Ratio

Table 2. Study Methodology, Continued
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A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

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, terminally ill, nonEnglish speaking, severely mentally ill, not willing to travel or lived >20 mi. from research center

YesAlso “near falls”

Method of Recording 

Falls Length of Follow-up Measured Outcomes Results* Adverse Effects

Fall reported by postcard immediately. Participant interviewed by telephone about circumstances & consequences. Monthly diaries monitored quarterly by mail or telephone for selfreported falls, fall injuries & medical care.

24 months Fall risk, overall OR = 0.85 (p<0.05) None

Fall risk, males OR = 0.82 (p<0.05)Fall risk, males age 75+ OR = 0.53 (p<0.05)

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Logan 2010 Nottinghamshire, UK Nottinghamshire, UK; w/in 

primary trust of Nottingham City, Rushcliffe, Broxtowe and Hucknall, and Gedling. Includes city, suburban, and rural populations. Recruited over 16 months beginning in Sep 2005

Age ≥60, in the geographic area of interest, had called the East Midland Ambulance Service because of a fall but was not taken to the hospital

Unable to give consent, too ill to participate, or already in a falls prevention rehabilitation program

Yes

Method of Recording 

Falls

Length of Follow-up Measured Outcomes Results* Adverse Effects

Monthly fall diary w/ telephone follow-up if needed

12 months Fall rate IRRa=0.45 (0.35–0.58) None

Time to first fall HRc 0.20 (0.23–0.44)

Number of fallers RRd=0.56 (0.78–0.94)

a Incidence Rate Ratio b Relative Rate c Hazard Ratio d Relative Risk e Rate Ratio per 1,000 hrs of activity f Odds Ratio

Table 2. Study Methodology, Continued
143

Multifaceted Interventions

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Palvanen 2014 Tampere and 

Lappeenranta, Finland

Referred to clinic by self, relative or primary care doctor

Community-dwelling aged ≥70, 1 fall risk factor: mobility issues, ≥3 falls in past 12 months, previous fracture, hip fracture in 1st degree relative, osteoporosis, low body weight, or illness that increased the risk of falls, fracture or osteoporosis

Inability to give consent, disabilities that prevented physical activity, or terminal illness

Yes

Method of Recording 

Falls

Length of Follow-up Measured Outcomes Results* Adverse Effects

Collected every 3 months using telephone interviews & during clinic visits.

12 months Fall rate IRRa=0.72 (0.61–0.91) None

Fall rate HRc=0.78 (0.67–0.91)

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 Measured 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 year 

IRRa = 0.59 (0.38–0.91) 2 participants 

stopped while exercising because they felt unwell 3 falls w/o injury occurred during exercise

Fall rate for participants w/ more symptoms of depression

IRRa = 0.50 (0.28–0.88)

a Incidence Rate Ratio b Relative Rate c Hazard Ratio d Relative Risk e Rate Ratio per 1,000 hrs of activity f Odds Ratio

Table 2. Study Methodology, Continued
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Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Smulders 2010 Nijmegan, Netherlands Identified from databases of 

DXA scans, mail to members of Dutch Osteoporosis Patient Council, by advertising

Age ≥65, communitydwelling, w/ osteoporosis (DXA femoral neck or lower back T-score -2.5), 1 fall in past year, & able to walk 15min w/o a walking aid 

Severe cardiac, pulmonary, or musculoskeletal disorders or disorders associated w/ higher fall risk (e.g. neurologic disorders)

Yes

Method of Recording 

Falls

Length of Follow-up Measured Outcomes Results* Adverse Effects

Monthly fall calendar w/ follow-up phone call if necessary

12 months Fall rate RRb= 0.61 (0.40–0.94) None

Number of fallers RRd= 0.87 (0.56–1.34)

Study Location Study Population & Recruitment Inclusion Criteria Exclusion Criteria Defined Falls

Spice 2009 Nijmegan, Netherlands Identified from databases of 

DXA scans, mail to members of Dutch Osteoporosis Patient Council, by advertising

Age ≥65, communitydwelling, w/ osteoporosis (DXA femoral neck or lower back T-score -2.5), 1 fall in past year, & able to walk 15min w/o a walking aid 

Severe cardiac, pulmonary, or musculoskeletal disorders or disorders associated w/ higher fall risk (e.g. neurologic disorders)

Yes

Method of Recording 

Falls Length of Follow-up Measured Outcomes Results* Adverse Effects

Monthly fall calendar w/ follow-up phone call if necessary

12 months Fall rate RR = 0.76 (0.58–0.98) None

Fall per person-week RR = 0.69 (0.52–0.90)

a Incidence Rate Ratio b Relative Rate c Hazard Ratio d Relative Risk e Rate Ratio per 1,000 hrs of activity f Odds Ratio

Table 2. Study Methodology, Continued
145

Multifaceted Interventions

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 past month

No

Method of Recording 

Falls

Length of Follow-up Measured Outcomes Results* Adverse Effects

A monthly falls calendar was returned by mail. If not received or if it indicated a fall, participant was interviewed by telephone.

12 months Fall rate RR = 0.76 (0.58–0.98) None

Fall per person-week RR = 0.69 (0.52–0.90)

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 Measured Outcomes Results* Adverse Effects

Mailed survey at baseline, at 1 & 2 years. If not returned, participants were interviewed by telephone. Fall injuries were identified through self-report & hospital discharge files. 

24 months Difference in % falling None 

Falls, Year 1 9.3% (4.1–14.5)Falls, Year 2 +2.2% n.sFalls w/ injury, Year 1 -4.6% (p<0.01)Falls w/ injury, Year 2 +3.3% n.s.

a Incidence Rate Ratio b Relative Rate c Hazard Ratio d Relative Risk e Rate Ratio per 1,000 hrs of activity f Odds Ratio

Table 2. Study Methodology, Continued
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Table 3. Intervention Characteristics 

Study Focus Providers Structure Number of Sessions Provider Contact Time

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 1 medical assessment

Classes: 14 hours Home visit: 1 to 11⁄2 hours Booster: 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 home assessment

1 medical assessment

Home assessment: 1 hour Medical assessment: 45 minutes

Davison 2005 Identify & modify each 

participant’s fall risk factors

Physician, physical therapist, & occupational therapist

Hospital-based medical exam & treatment followed by PT & OT in-home assessments & risk factor reduction

2 hospital sessions 2 physical therapy visits 1 occupational therapy visit w/ 1 follow-up visit 15 weekly 1-hour classes

Medical assessment: 1 hour Medical intervention: 20 minutes PT assessment: 45 minutes PT intervention: 15 minutes OT assessment: 45 minutes Follow-up visit: 20 minutes Classes: 15 hours

Day 2002 Improve strength & balance, 

improve poor vision, & reduce home hazards

State accredited trained for the intervention

Group exercise classes

Vision assessment & treatment, home assessment & modification

Vision management: NA Home modification: 

NA
147

Multifaceted Interventions

Study Focus Providers Structure Number of Sessions Provider Contact Time

Hornbrook 1994 Reduce risky behaviors, improve 

physical fitness, & reduce home hazards

BA-level assessor trained for intervention, a health behaviorist, & a 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 hoursHome visits: 1⁄2 hour

Logan 2010 Reduce risky behaviors, improve 

physical fitness, & reduce home hazards

Occupational therapist, physical therapist, & nurse

One-on-one w/ optional group classes

12 twice weekly 2-hour classes 6 or more 1-hour PT home visits 11 home assessment 1 medical assessment

Classes: 24 hoursPhysical therapy: 6 hoursHome assessment: 1 hourMedical Assessment: 1 hour

Palvanen 2014 Identify & modify each 

participants fall risk factors 

A physician, PT, & nurse

Assessment: One-on one Intervention: varied by type of intervention 

Assessment: 3 hours Intervention: varied by type & number of interventions received 

Varied

Salminen 2009 Assess & address each 

participant’s 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 assessment 1 counseling & information session 1 home assessment 12 1-hour health lectures 12 1-hour psychosocial group sessions 45- to 50-minute group exercise classes every 2 weeks for 26 weeks Home exercises 3 times a week for 52 weeks

Risk assessment: 45 minutes Counseling: 45 minutes Home assessment: 

45 minutes Health lectures: 12 hours Psychosocial group sessions: 12 hours Exercise classes: 10–11 hours

Table 3. Intervention Characteristics, Continued
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Study Focus Providers Structure Number of Sessions Provider Contact Time

Smulders 2010 Improve balance, decrease fall 

risk, & improve quality of life for women w/ osteoporosis.

A physical therapist & occupational therapist

Group education & exercises

11 sessions comprised of education, exercise & obstacle course navigation

Sessions: 18 1⁄2 hours

Spice 2009 Assess fall risk factors & provide 

individualized interventions

Doctor, nurse, physical therapist, & occupational therapist

One-on-one assessment w/ follow-up interventions

1 fall risk assessment Length & number of subsequent sessions varied by type of intervention(s)

Risk assessment: 2 hours Intervention: varied

Tinetti 1994 Identify & modify each 

participant’s fall risk factors

Medication adjustments coordinated w/ participant’s primary physician, exercise conducted by PT

Varied by type of intervention

Varied by type & number of interventions received

Varied

Wagner 1994 Reduce disability &/or falls by 

addressing 6 specific risk factors

Specially trained nurse-educator

Home visit w/ follow-up behavioral intervention

1 initial interview Length & number of subsequent sessions varied by type of intervention(s)

Initial interview: 1 to 11⁄2 hours Intervention: varied

Table 3. Intervention Characteristics, Continued
149

Appendices

Appendix A: Intervention Study selection process

ToC3

APPENDICES

Appendix A: 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 three 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 community-dwelling 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 one fall outcome (e.g., showed statistically 

fewer falls for intervention participants). As illustrated in Figure 1, CDC excluded one study 

that focused on nursing home residents, four that did not include falls as a primary outcome, 

and 25 that did not demonstrate statistically significant, positive results. Of the remaining 

eight, two described the same study and were combined. Lastly, CDC identified seven 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, two 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 communitydwelling 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, eight studies published 

between January 2005 and December 2009 were added to the Compendium.
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Updates in the Third Edition

n 2014, CDC updated the Compendium again by conducting a comprehensive literature search 

of randomized controlled trials of fall interventions. The search included literature published 

between January 1, 2009 and August 31, 2014. 

MEDLINE was searched using the following terms “fall and prevention OR accidental falls 

[MESH]” AND “randomized control trial OR controlled clinical trial” AND “Aged”. MEDLINE 

search identified 386 studies. PubMed was searched using the same criteria and identified 

two additional, unique interventions for a total of 388. 

As Figure 2 illustrates, 39 interventions were excluded as duplicate listings in MEDLINE and 171 

were excluded because they were not fall intervention studies (excluded studies included: costbenefit analyses, fall RCT protocol papers, drug trials where falls were a side effect, and crosssectional papers that used RCT data). Of the remaining 178 studies, CDC excluded two that 

were already in the Compendium, 91 that did not include falls as an outcome (e.g., outcome 

measured changes in gait and balance, fear of falling, or scores on functional tests were used 

as proxy for fall risk), nine that were not randomized controlled trials or did not have adequate 

control groups (intervention did not have a placebo or usual care group e.g. compared inperson Tai Chi to a Tai Chi video intervention), 25 that did not focus on community-dwelling 

adults aged ≥60 years, and 36 that did not demonstrate statistically significant, positive 

results. In situations where the same research group had published a pilot intervention and a 

subsequent follow-up and both were effective at reducing falls, the follow-up paper is included 

and the pilots are listed as supplemental materials; three pilot interventions were excluded for 

this. Lastly CDC used the 2012 Cochrane review to identify clinically focused interventions that 

had previously been excluded. There were seven studies that met the criteria and have been 

added to this edition of the Compendium. In total, 19 studies, were added to the Compendium. 
151

Appendices

Figure 1. Flow chart showing the selection process for studies used in the first edition of the Compendium

826 

Fall intervention 

studies

95

Relavent & 

rigorous studies

1

Nursing home 

population

25

Not statistically 

significant 

positive results

1

Reported on 

same study

4

Falls not the 

primary outcome

57

Falls as an 

outcome

38

Rand Report:

Data on subjects who 

fell at least once or the 

monthly fall rate

37 

Community- dwelling 

population

8

Met CDC criteria

14 

Compendium 

studies

7

Relavent, rigorous, 

& effective studies 

published 2003–2005 
152

A CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: WHAT WORKS FOR COMMUNITY-DWELLING OLDER ADULTS 

Figure 2. Flow chart showing the selection process for studies used in the third edition of the Compendium

349 

Unique studies

178

Fall intervention 

studies

25

Not communitydwelling adults ≥60

9

Not randomized 

controlled trial studies

171

Not fall intervention 

studies

2

Intervention already 

in Compendium

36

Not statistically 

significant 

positive results

3

Reported on 

same study

85

Falls as an 

outcome

76

Randomized 

controlled 

trial studies

51 

Community-dwelling 

population ≥60

15

Met CDC criteria

19 

Compendium 

studies

7

Relavent, rigorous, 

& effective clinically 

focused studies 

published 2003–2005 

388

Studies published

2009–2014 

91

Falls not and 

outcome
153

Appendices

Appendix B: Bibliography of Compendium Studies and Supplemental Articles

Appendix B: Bibliography of Compendium Studies and 

Supplemental Articles 

Barnett A, Smith B, Lord SR, 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. 

*Barton CJ, Bonanno D, Menz HB. Development 

and evaluation of a tool for the assessment 

of footwear characteristics. Journal of Foot 

and Ankle Research. 2009 Apr 23;2:10. doi: 

10.1186/1757-1146-2-10.

Bischoff-Ferrari HA, Orav EJ, Dawson-Hughes B. 

Effect of cholecalciferol plus calcium on falling 

in ambulatory older men and women: 

a 3-year randomized controlled trial. Archives 

of Internal Medicine. 2006 Feb 27;166(4):424–30.

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, Fiatarone Singh MA, Bundy A, 

Cumming RG, Manollaras K, O’Loughlin P, 

et al. Integration of balance and strength 

training into daily life activity to reduce 

rate of falls in older people (the LiFE study): 

randomised parallel trial. British Medical 

Journal (Clinical research ed). 2012;345:e4547.

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. 
154

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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. “Minimental 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 community-dwelling 

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. 

Gallagher JC. The effects of calcitriol on falls 

and fractures and physical performance tests. 

Journal of Steroid Biochemistry and Molecular 

Biology. 2004 May;89–90(1–5):497–501.

*Gallagher JC, Rapuri PB, Smith LM. An age 

related decrease in creatinine clearance is 

associated with an increase in number of 

falls in untreated women but not in women 

receiving calcitriol treatment. Journal of 

Clinical. Endocrinology and Metabolism. 2007 

Jan 92:51–58, 2007.

*Gallagher JC, Rapuri P, Smith L. Falls are 

associated with decreased renal function 

and insufficient calcitriol production by the 

kidney. Journal of Steroid Biochemistry and 

Molecular Biology. 2007 Mar;103(3–5):610–3.

*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. 

Haran MJ, Cameron ID, Ivers RQ, Simpson JM, 

Lee BB, Tanzer M, et al. Effect on falls of 

providing single lens distance vision glasses 

to multifocal glasses wearers: VISIBLE 

randomised controlled trial. British Medical 

Journal. 2010;340:c2265

Harwood RH, Foss AJ, Osborn F, Gregson RM, 

Zaman A, Masud T. Falls and health status in 

elderly women following first eye cataract 

surgery: a randomised controlled trial. British 

Journal of Ophthalmology. 2005 Jan;89(1):53–9.

Harwood RH, Sahota O, Gaynor K, Masud T, 

Hosking DJ; Nottingham Neck of Femur 

(NONOF) Study. A randomised, controlled 

comparison of different calcium and vitamin 

D supplementation regimens in elderly 

women after hip fracture: The Nottingham 

Neck of Femur (NONOF) Study. Age and 

Ageing. 2004;33(1):45–51.
155

Appendices

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. 

Kemmler W, von Stengel S, Engelke K, Häberle L, 

Kalender WA. Exercise effects on bone 

mineral density, falls, coronary risk factors, 

and health care costs in older women: the 

randomized controlled senior fitness and 

prevention (SEFIP)study. Archives of Internal 

Medicine. 2010 Jan 25;170(2):179–85.

Kenny RA, Richardson DA, Steen N, Bexton RS, 

Shaw FE, Bond J. Carotid sinus syndrome: a 

modifiable risk factor for nonaccidental falls in 

older adults (SAFE PACE). Journal of American 

College of Cardiology. 2001 Nov 1;38(5):1491–6.

*Iliffe A, Kendrick D, Morris R, Skelton D, Gage H, 

Dinan S, Stevens Z, Pearl M, Masud T. Multicentre 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. 

Kovacs E, et al., Adapted physical activity is 

beneficial on balance, functional mobility, 

quality of life and fall risk in communitydwelling older women: a randomized 

single-blinded controlled trial. European 

Journal of Physical Rehabilitation Medicine. 

2013;49(3):301–10

*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. 

Logan PA, Coupland CA, Gladman JR, Sahota O, 

Stoner-Hobbs V, Robertson K, et al. 

Community falls prevention for people who 

call an emergency ambulance after a fall: 

randomised controlled trial. British Medical 

Journal (Clinical Research Ed). 2010;340:c2102.

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. 
156

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Palvanen M, et al. Effectiveness of the Chaos 

Falls Clinic in preventing falls and injuries of 

home-dwelling older adults: a randomised 

controlled trial. Injury 2014;45(1):265–71

*Pfeifer M, Begerow B, Minne HW, Nachtigall D, 

Hansen C. Effects of a short-term vitamin 

D(3) and calcium supplementation on 

blood pressure and parathyroid hormone 

levels in elderly women. Journal of Clinical 

Endocrinology and Metabolism. 2001

Pfeifer M, Begerow B, Minne HW, Suppan K, 

Fahrleitner-Pammer A, Dobnig H. Effects 

of a long-term vitamin D and calcium 

supplementation on falls and parameters of 

muscle function in community-dwelling older 

individuals. Osteoporosis International. 2009 

Feb;20(2):315–22.

*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. 

Pighills AC, Torgerson DJ, Sheldon TA, 

Drummond AE, Bland JM. Environmental 

assessment and modification to prevent 

falls in older people. Journal of the American 

Geriatrics Society. 2011;59(1):26–33.

Pit SW, Byles JE, Henry DA, Holt L, Hansen V, 

Bowman DA. A Quality Use of Medicines 

program for general practitioners and older 

people: a cluster randomised controlled trial. 

Medical Journal of Australia. 2007 Jul 2;

187(1):23–30.

*Pit SW. Improving quality use of medicines for 

older people in general practice. University 

of Newcastle (Australia); 2004. PhD thesis.

*Pit, SW, Byles, JE. Older Australians’ 

medication use: self-report by phone 

showed good agreement and accuracy 

compared with home visit. Journal of Clinical 

Epidemiology. 2010 63:428–34.

*Pit, SW, Byles, JE, Cockburn, J. Prevalence 

of self-reported risk factors for medication 

misadventure among older people in 

general practice. Journal of Evaluation in 

Clinical Practice. 2008 14(2), 203–208.

*Pit, SW, Byles, JE. Accuracy of telephone 

self-report of drug use in older people and 

agreement with pharmaceutical claims data. 

Drugs & Aging. 2008 25(1), 71–80.

Pit, SW, Byles, JE, Henry, DA, Holt, L, Hansen, V, 

Bowman, D. (2007) Quality Use of Medicines 

Program for general practitioners and older 

people: a cluster randomised controlled 

trial. Medical Journal of Australia. 2007 187(1), 

23–30. 

*Pit, SW, Byles, JE, Cockburn, J. Medication 

review: patient selection and general 

practitioner’s report of medication-related 

problems and actions taken. Journal of 

the American Geriatrics Society. 2007 55(6), 

927–934.
157

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*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 riskbased 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. 

*Sheik J, Yesavage J. Geriatric depression scale 

(GDS): Recent evidence and development of 

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*Sjösten NM, Salonoja M, Piirtola M, Vahlberg T, 

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Smulders E, Weerdesteyn V, Groen BE, 

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Tanaka B, Uemura K, Mori S, Ichihashi N. 

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can prevent falls in community-dwelling 

elderly Japanese aged 75 years and older. 

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Yamada M, Higuchi T, Nishiguchi S, Yoshimura K, 

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Ichihashi N. Trail-walking exercise and fall risk 

factors in community-dwelling older adults: 

preliminary results of a randomized controlled 

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*Supplemental Article 
Appendix C: Original Intervention Materials

Appendix C: Original Intervention Materials 

Appendix C-1 Barnett Materials Exercises 161

Appendix C-2 Kovacs Materials 166

Appendix C-3 Voukelatos Materials 167

Appendix C-4 Wolf Materials 169

Appendix C-5 Haran Materials 173

Appendix C-6 Pit Materials 176

Appendix C-7 Spink Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179

Appendix C-8 Close Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194

Appendix C-9 Spice Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201

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Appendix C-1 Barnett Materials Exercises

1.Warm Up

Breathe in deeply 

through nose, lift 

arms above head 

and stretch. Lower 

arms and breathe 

out 6 times.

2. Shoulder rolls (flexibility)

Gently rotate 

shoulders up to 

ceiling, backwards, 

and down. Then 

reverse: up, forward 

and down. 6 times 

each way.

3. March on spot (mobility)

Hold onto chair with 

2 hands. Walking on 

the spot. Try to lift 

knees a bit higher 

than usual. Step 10 

times with each leg.

4. Ankle (strength)

Hold onto chair. 

Rise up onto toes 

of both feet, hold 

for 5 seconds, then 

lower. Keep heels 

on the floor and 

lift toes off the 

floor; hold for 5 

seconds. Repeat 

both movements 

6 times.

5. Knee bend (strength)

Hold onto chair. 

Stand with knees 

soft and back 

straight. Keeps 

knees pointing 

over toes. Bend 

your knees gently, 

and then raise 

your body by 

straightening your 

knees. Do this 6 

times.

6. Sit to Stand (strength)

Sit in chair against 

wall. Stand up 

without using your 

hands 6 times. If 

this is too hard, 

use a pillow on the 

chair to start until 

you get stronger.

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7. Calf (stretch)

Hold onto chair; 

stretch one leg 

behind, toes facing 

forward, gently 

bend front knee 

until you feel a 

stretch in your calf. 

Hold stretch for 10 

seconds. Do 6 

stretches.

8. Calf (stretch)

Hold onto chair, 

stretch as in 

previous exercise. 

When you feel the 

stretch in your back 

calf, keep the heel 

of that foot on the 

ground, and 

slightly bend the 

back knee.

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General Information on Exercise

As we age our muscles tend to become 

less flexible and strong, and our joints 

become stiffer. This can affect our balance. 

Exercise is the best way to improve 

strength and mobility. Greater strength 

and mobility means you may be able 

to recover your balance if you lose it, 

therefore avoiding a fall.

Tips for Exercising

• Wear comfortable clothes and shoes

• Drink some water before and after 

the exercise.

• Do exercises slowly and gently

• If you feel pain STOP that exercise 

and discuss with your exercise leader 

or project manager

• If you feel breathless or dizzy, 

STOP and rest.

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 project manager.
Stage 1 Home Program—Stay Safe Stay Active: 

Falls Prevention in Primary Care 2001, SWSAHS

Stay Safe Stay Active Daily Exercise Program (Stage 1)

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Stay Safe Stay Active Daily Exercise Program (Stage 2)

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Stay Safe Stay Active Daily Exercise Program (Stage 2)

1. Medications

Discuss with GP or Pharmacist if you feel they may be causing drowsiness or dizziness. 

2. The environment

Loose rugs, slippery surfaces, unsecured cords, poor lighting especially at night, and spills 

of water or grease, all increase the risk of falling. Try and clear away clutter, especially where 

you need to walk, and secure rugs with grippers to the floor. Mop up any spills immediately.

3. Shoes

Wear non-slip shoes that fit well, and have laces or Velcro fastening. Shoes with medium or 

low heels, which are rounded, are better than high thin heels. Slippers and thongs are not 

a good idea, as they do not offer enough support. Be careful of wet or slippery surfaces.

4. Hearing

A loss of hearing can cause dizziness and balance problems, see your GP if this occurs. 

It could be something as simple as a lump of wax.

5. Vision

Adequate lighting is very important, do not forget to turn the light on if you get up at night, 

or keep a nightlight on - keep your glasses by your bed! Bifocals can make going up and 

down stairs difficult as they alter the perception of where the stair edges are. When walking 

outside in the sun it is useful to wear a broad rimmed hat, it helps you pick up contrasts on 

the ground such as steps and edges. Remember to have annual eye tests, as this can detect 

any changes in your vision.

6. Good diet

Eat a well balance diet, and don’t allow yourself to become too thin.

7. Colds/Sinus

If you have a cold or sinus problems then take extra care as this can affect your balance.

8. Walking aid

If you use a walking aid, make sure the rubber on the bottom is not worn, and keep it 

by your bed at night in case you need to get up.

If you do fall in the house do not panic. Stay still for a few minutes to get over the shock. 

If you are OK try to slide yourself over to a sturdy piece of furniture, sofa, bed or chair and 

position yourself along side of it. Get into a kneeling position and gradually push yourself 

up and sit down until you recover. If you are unable to move try to cover yourself with 

something to keep warm until help arrives.

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Appendix C-2 Kovacs Materials

Exercises Purpose Means of progression 

and adaptation

First part: Structured exercises with music chosen by participants

Lift arms over head

Lower arms to side and reach toward 

the floor 

Strengthening of trunk muscles

Posture correction

Increase repetitions from 4–8

Standing

Steps in multiple directions BOS1 change Amount of support

Increase repetitions and speed of 

stepping

Reaching overhead and to side behind 

a chair

COG2

 change in direction of reach Amount of support

Increasing distance of reaching

Partial squats Strengthen lower limb muscles Increase repetitions from 4–8

Turning while standing Functional activity Increase repetition and turning speed

Tandem standing Decrease of BOS1

 while standing Increase duration 

Sit to stand and stand to sit Functional activity Increase repetitions

Stepping in place with high knees BOS1 change in dynamic context Increase height of stepping

Second part: physical activity chosen by participants: relay race OR ballgames

Heel walking

Toe walking

Walking on line

BOS1

 change in functional context Increase distance

Walking on exercise mat Walking on uneven terrain Increase distance

Decrease mat stiffness

Slalom walking between cones BOS1

 change in functional context Increase number of cones Decrease 

distance between cones

Walking backward Increase distance

Picking up and transferring objects 

placed on the floor

Ankle and hip balance strategy 

training involving practicing dual task

Change size and weight of objects

Stepping in and out of hoops placed 

on the floor

BOS1

 change in functional context Increase number of hoops and 

decrease distance between hoops

Ballgames

Catching and throwing balls in 

different directions

Vestibular stimulation

Multiple task activity

Decreasing size and increasing weight 

of the ball. Begin with a balloon then 

progress to heavier and smaller balls. 

The speed of the game will increase

Adapted basketball Vestibular stimulation

Multiple task activity

Increase length of play and size of 

course

1

BOS: Base of Support 2COG: Center of Gravity

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Appendix C-3 Voukelatos Materials

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  relaxes muscles  lowers center of gravity

Lowered center of gravity  increases load on lower limbs  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.

Gait: decreased stepping height and decreased stride length.

Women tend to have a narrow walking and standing base, closer foot placement, 

erect posture  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.

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Appendice s
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.

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.

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Appendix C-4 Wolf Materials

Directions and Therapeutic Elements for Learning 10 Forms of Tai Chi

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FORM 1. Directions

1. Stand upright with feet shoulder-width 

apart, toes pointing forward, arms 

hanging naturally at sides. Look straight 

ahead (1A).

2. Raise arms slowly forward to shoulder 

level, palms down.

The hands do not go above the shoulders 

and the elbows are held in (1B & 1C).

3. Bend knees as you press palms down 

gently, with elbows dropping towards 

knees. Look straight ahead (1D).

FORM 1. Therapeutic elements 3, 4

This “warm-up” form begins with nonstressful bilateral stance where all thoughts 

other than those about movement clear the 

head. Attention is directed to relaxing all 

muscles except those of the legs—the feet 

are to “stick to the ground.” As movement 

begins, concentration is directed to move all 

four extremities at the same constant speed 

that begins and ends concomitantly in the 

arms and legs.

FORM 2. Directions

The body is turned slightly to the left, with 

left foot at 9 o’clock for a left bow stance. 

The left forearm and back of hand are at 

shoulder level, while right hand is at the side 

of fight hip, palm down. Look at left forearm 

(2A). Turn torso slight to left (9 o’clock) while 

extending left hand forward, palm down. 

Turn torso slightly right while pulling both 

hands down in a curve past abdomen, until 

right hand is extended sideways at shoulder 

level, palm up, and left forearm is across 

chest, palm turned inward. Shift weight 

onto right leg. Look at right hand (2B). past 

face, palm turned slowly outward, while 

left hand moves in a curve past abdomen 

up to shoulder level with palm turned slowly 

obliquely inward (4B & 4C).

FORM 2. Therapeutic elements 1–7

The trunk and head rotate while both 

feet remain on floor. The arms move in 

asymmetrical positions so that the center of 

mass is extended further from left to right 

due to arm positions. The trunk and head are 

kept erect so that rotation is around a central 

axis. The body weight is predominantly on a 

flexed leg for greater balance and strength 

mechanism.

FORM 3. Directions

Look straight ahead; face 9 o’clock with weight 

on left leg in a bow stance and hands forward 

at shoulder height in a pushing position (3A). 

Turn both palms downward as right hand 

passes over left wrist, moves forward, then to 

the right until it is on the same level with left 

hand. Separate hand shoulder-width apart 

and draw them back to the front of abdomen, 

palms facing obliquely downward. At the same 

time, sit back and shift weight onto right leg, 

slightly bent, raising toes of left foot. Look 

straight ahead (3B & 3C).

FORM 3. Therapeutic elements 1–4 & 7

The body center of mass moves diagonally 

posteriorly than other forms with a decreased 

base of support from only heel contact of 

the left leg, demanding greater balance and 

strength than the previous form. The trunk 

rotation is decreased and the arm movement 

is symmetrical

FORM 4. Directions

Turn torso to the left (10–11 o’clock), shifting 

weight to left leg. Move left hand in a curve 

past face with palm turned slowly leftward, 

while right hand moves up to the front of left 

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shoulder with palm turned obliquely inward. 

As right hand moves upward, fight foot and 

left foot are parallel and 10 to 20cm apart. 

Look at right hand (4A). Turn torso gradually 

to the right (1 to 2 o’clock), shifting weight 

onto right leg. 

At the same time, move right hand 

continuously to right

While the legs are symmetrical, weight is 

shifted laterally. The arms are asymmetrical, 

the trunk and had rotate with arm 

movement. Both knees are flexed and weight 

shifts to the leg on the side to which the 

arms are moving.

FORM 5. Directions

Turn torso slightly to the fight, moving right 

hand down in a curve past abdomen and 

then upward to shoulder level, palm up and 

arm slightly bent. Turn left palm up and place 

toes of left foot on floor. Eyes first look to 

the right as body turns in that direction, and 

then to look at left hand (5A & 5B).

FORM 5. Therapeutic elements 1–7

Again a smaller base of support with the 

majority of weight on one extremity. The 

arm on the weight bearing side is curved 

back into shoulder extension. Done on the 

right leg and then reversed and done on the 

left leg. Again trunk rotates at the end of the 

movement.

FORM 6.Directions

Hold torso erect and keep chest relaxed. 

Move arms in a curve without stretching 

them when you separate hands. Use waist 

as the axis in body turns. The movements 

in taking a bow stance and separating 

hands must be smooth and synchronized in 

tempo. Place front foot slowly in position, 

heel coming down first. The knee of front 

leg should not go beyond toes while rear 

leg should be straightened, forming a 45 

with ground. There should be a transverse 

distance of 10 to 30cm between heals. Face 9 

o’clock in final position.

FORM 6. Therapeutic elements 1–7

Hand assumes a position of holding a 

ball initially. Movements in the form are 

diagonals and rotations of the trunk and 

head. Movements slide back and forth in 

and out of 6A and 6B, and then position is 

reversed for right and left.

FORM 7. Directions

Turn torso to the right (11 o’clock) as right 

hand circles up to ear level with arm slightly 

bent and palm facing obliquely upward, 

while left hand moves to the front of the 

right part of chest, palm facing obliquely 

downward. Look at right hand (7A). Turn 

torso to the left (9 o’clock) as left foot takes 

a step in that direction for a left bow stance. 

At the same time, right hand draws leftward 

past right ear and, following body turn, 

pushes forward at nose level with palm 

facing forward, while left hand circles around 

left knee to stop beside left hip, palm down. 

Look at fingers of right hand (7B & 7C).

FORM 7. Therapeutic elements 1–7

This form begins in the position of 7 A, but 

with both feet flat on the floor. They remain 

on the floor throughout the exercise. Move in 

and out of the position 7 A, B, C, A, B, C, then 

reverse right-left positions.

FORM 8. Directions

Continue to move hands in a downwardinward-upward curve until wrists come in 

front of chest, with right hand in front and 

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Appendice s
both palms turned inward. At the same time, 

draw right foot to the side of left foot, toes on 

floor. Look forward to the right (SA). Separate 

hands, turning torso slightly to S o’clock and 

extending both arms sideways at should level 

with elbows slightly bent and palms turned 

outward. At the same time, raise right knee 

and thrust foot gradually towards 10 o’clock. 

Look at right hand (8B & 8C).

FORM 8. Therapeutic elements 1–7

With the elderly, the kick is only a small part 

of their available range. The form is utilized 

for kicking with both dorsiflexion and plantar 

flexion of the foot. Forms 8 and 9 are the 

most stressful for maintaining balance due 

to the small base of support and the extreme 

movement of the kicking leg. However, forms 

are done continuously with slow movements 

and a strong degree of concentration. The 

range for the kick is not extreme in the elderly.

FORM 9. Directions

Shift weight onto right leg and draw left foot 

to the side of right foot, toes on floor. At the 

same time, move both hands in a downwardinward-upward curve until wrists cross in 

front of chest, with left hand in front and 

both palms facing inward. Look forward to 

the left (9A & 9B). Separate hands, extending 

both arms sideways at shoulder level, elbows 

slightly bent and palms facing outward. 

Meanwhile, raise left knee and thrust foot 

gradually towards 4 o’clock. Look at left hand 

(9C & 9D).

FORM 9. Therapeutic elements 1–7 

The same as Form S but right and left are 

reversed.

FORM 10. Directions

Turn palms forward and downward while 

lowering both hands gradually to the side of 

hips. Look straight ahead (10A, 10B & 10C).

FORM 10. Therapeutic elements

This is a warm-down form like Form 1 and 

constitutes both a physical and mental 

ending of the exercise. 

Materials reprinted with permission from 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;78:886–892.

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Appendix C-5 Haran Materials

The optometrist re-administering the tests of depth perception (figure A) and distance edge 

contrast sensitivity (Figure B) with participants viewing the visual stimuli through upper and 

lower portion of their multifocal lenses and distance lenses. A chin rest was used to prevent 

neck flexion, thereby forcing the person to look through the lower portion of the multifocal 

lens during testing.

FIGURE A—DEPTH PERCEPTION—HOWARD-DOHLMAN device at 3 meters

Figure B—VISUAL CONTRAST—135 cm Melbourne Edge Test

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FIGURE C—Streetscape

Image A Image B

Figure C. Simulated view of street scenes as viewed through single lens distance glasses and 

bifocal glasses. The footpath misalignment (the commonest reported environmental factor 

involved in outdoor falls) is clearly seen in Image A but blurred in Image B.

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FIGURE D—View of shaded stairs

a) Seen through distance glasses b) Seen through bifocal glasses

SIDE 1 of card

When to use your new DISTANCE GLASSES: 

• Walking on stairs indoors and outside

• Getting into or out of a vehicle

• Walking in a street or shopping centre

• Walking in buildings other than your home

• Walking in gardens or on uneven ground

(Please turn over)

SIDE 2 of card

Use your BI, TRI & MULTIFOCALS when:

• Walking in your own home on level ground

• Sitting at a desk, table or on a lounge

• Driving

• Working at a bench

• Selecting items from a shelf

175

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Appendix C-6 Pit Materials

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Appendix C-7 Spink Materials

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Appendix C-8 Close Materials

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PROFET – Environmental Assessment 

Name: Number: 

At time of 

fall

In the 

home

In the 

environment

Slip Hazards 1 Liquid/solid spills 

2 Wet floors 

3 Incorrect footwear 

4 Loose mats on polished 

floors

5 Rain, sleet, snow, ice 

6 Change from wet to dry 

surface

7 Unsuitable floor surface 

8 Dusty floors 

9 Sloping surfaces 

Trip Hazards 10 Loose floorboards / tiles 

11 Loose and worn mats / 

carpets

12 Uneven outdoor surfaces 

13 Holes / cracks 

14 Change in surface level – 

ramps, steps, stairs 

15 Cables across walking areas 

16 Obstructions

17 Bumps, ridges and 

protruding nails etc 

18 Low wall and floor fixtures, 

door catches, door stops etc. 

Risk Factors 19 Organisation of walkways 

20 Badly placed mirrors / 

reflections from glazing 

21 Poor or unsuitable lighting 

22 Wrong cleaning regime / 

materials 

23 Moving goods, carrying, 

pushing or pulling a load 

24 Rushing around 

25 Distractions 

26 Fatigue

27 Effects of alcohol 

28 Effects of other drugs 

29 Other factor (describe)

Close-PROFET.

D-3, Close Materials, 5 of 10

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Appendix C-9 Spice Materials

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

Question 8—Drug history

List all medications (including over the counter 

and prescribed)

_______________________________________

_______________________________________

_______________________________________

_______________________________________

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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 ___________________________________

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) __________________

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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

Bed ___________________________________

Chair __________________________________

Toilet __________________________________

Bath (reported) __________________________

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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) _____________________

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

_______________________________________

_______________________________________

_______________________________________

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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 ______________________________

_______________________________________

_______________________________________

Question 42—Planned investigations and/

or interventions _______________________

_______________________________________

Question 43—Follow-up arrangements/

referrals ______________________________

_______________________________________

Question 44—Timings

Physician: ______________________________

Physiotherapist: _________________________

Nurse: _________________________________

Occupational therapist: ___________________

Other (please specify): ____________________

_______________________________________

_______________________________________

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