Preventing Falls: 

What Works

A CDC Compendium of Effective Community-based 

Interventions from Around the World

2008 Injury Prevention 

·

Exercise-based Interventions

Home Modification Interventions

Multifaceted Interventions
A CDC Compendium of Effective Community-based

Interventions from Around the World

by

Judy A. Stevens, Ph.D.

Ellen D. Sogolow, Ph.D.

National Center for Injury Prevention and Control

Atlanta, Georgia

2008

Preventing Falls: What Works
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

Julie L. Gerberding, MD, MPH, Director

Coordinating Center for Environmental Health and Injury Prevention

Henry Falk, MD, MPH, Director

National Center for Injury Prevention and Control

Ileana Arias, PhD, Director

Division of Unintentional Injury Prevention

David Wallace, MSEH, Acting Director

Home and Recreation Injury Prevention Team

Michael Ballesteros, PhD, Team Leader

Authors

Judy A. Stevens, PhD

Ellen D. Sogolow, PhD

Cover and Text Design 

Lucinda Austin

Heather Coleman

Monika Gullett

Mary E. Miller

Acknowledgements

We acknowledge and appreciate the contributions of Dr. Christine Branche who provided encouragement 

and unwavering support of this project; Dr. Patricia D. Nolan and Mr. David Ramsey who developed the 

Compendium data base; Ms. Lisa Jeanette who produced the initial draft; and Dr. David Sleet, Dr. Daphne 

Moffett, and Dr. Michael Ballesteros who reviewed the content and provided valuable suggestions.

Suggested Citation: Stevens JA, Sogolow ED. Preventing Falls: What Works. A CDC Compendium of 

Effective Community-Based Interventions from Around the World. Atlanta, GA: Centers for Disease 

Control and Prevention, National Center for Injury Prevention and Control, 2008

Exercise-based Interventions

Stay Safe, Stay Active (Barnett, et al.) ............................................................. 5

The Otago Exercise Program (Campbell, et al. and Robertson, et al. ) ............ 7

Tai Chi: Moving for Better Balance (Li, et al.).............................................. 11

Australian Group Exercise Program (Lord, et al.)...........................................13

Veterans Affairs Group Exercise Program (Rubenstein, et al.) ........................15

Simplified Tai Chi (Wolf, et al.).................................................................... 17

Home Modification Interventions

Home Visits by an Occupational Therapist (Cumming, et al.).......................21

Falls-HIT (Home Intervention Team) Program (Nikolaus, et al.) ................. 23

Multifaceted Interventions

Stepping On (Clemson, et al.)...................................................................... 27

PROFET (Prevention of Falls in the Elderly Trial) (Close, et al.).................. 31

The NoFalls Intervention (Day, et al.) .......................................................... 33

The SAFE Health Behavior and Exercise Intervention (Hornbrook, et al.) ....37

Yale FICSIT (Frailty and Injuries: Cooperative Studies of Intervention 

 Techniques) (Tinetti, et al.) ...................................................................... 39

A Multifactorial Program (Wagner, et al.)......................................................43

Appendix A Intervention Study Selection Process.........................................46

Appendix B Bibliography of Compendium Studies......................................50

Appendix C Tables .......................................................................................54

Table 1 Overall Population Characteristics...............................................55

Table 2 Study Characteristics ...................................................................57

Table 3 Intervention Characteristics.........................................................67

Appendix D Original Intervention Materials................................................70

Appendix D-1 Barnett Materials..............................................................71

Appendix D-2 Wolf Materials..................................................................83

Appendix D-3 Close Materials.................................................................87

Contents
Older adults value their independence, and a fall 

can significantly limit their ability to remain 

self-sufficient. More than one-third of people aged 

65 and older fall each year, and those who fall once 

are two to three times more likely to fall again. Fall 

injuries are responsible for significant disability, reduced 

physical function, and loss of independence. In 2000, 

direct medical costs for fall injuries totaled $19 billion. 

However, we know that falls are not an inevitable result 

of aging. In recent years, systematic reviews of fall 

intervention studies have established that prevention 

interventions can reduce falls.

 

The Centers for Disease Control and Prevention (CDC) 

developed the Compendium of Effective Community-based

Interventions to help public health practitioners effectively

address the problem of falls. This Compendium includes 

specific interventions that have rigorous scientific evidence

of effectiveness and provides relevant information about 

these interventions to public health practitioners, senior 

service providers, and others who wish to implement fall 

prevention programs. 

More than one-third

of people aged 65 

and older fall each 

year, and those who 

fall once are two 

to three times more 

likely to fall again.

Purpose

Introduction
CDC gathered information about science-based fall prevention intervention 

studies that met the following criteria:*

•	 Included community-dwelling adults aged 65 and older

•	 Used a randomized controlled study design

•	 Measured falls as a primary outcome (did not include intervention 

studies using other outcomes, such as balance improvement or reduced 

fear of falling) 

•	 Demonstrated statistically significant positive results in reducing 

older adult falls 

Using this selection process, CDC identified 14 studies of effective fall 

interventions published before January 2006.

* For details about the selection process, see Appendix A.

The Compendium groups interventions into three categories: exercise-based, 

home modification, and multifaceted interventions. Information about each 

intervention was obtained from the published study and by directly contacting 

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

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

section describing relevant details about the intervention. The intervention 

description includes information about the focus, program setting, content, 

number of sessions, duration, provider, provider’s training, key elements, 

available intervention materials, and contact information for the study’s 

principal investigator. 

The Compendium also has appendices. These include a figure illustrating the 

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

tables comparing the participating populations, study characteristics, and 

intervention characteristics of the 14 studies; and supplemental materials, 

such as assessment instruments and evaluation materials, provided by the 

principal investigators.

Content

Process

Stay Safe, Stay Active (Barnett, et al.) ........................................................................ 5

The Otago Exercise Program (Campbell, et al. and Robertson, et al. )....................... 7

Tai Chi: Moving for Better Balance (Li, et al.)......................................................... 11

Australian Group Exercise Program (Lord, et al.)...................................................... 13

Veterans Affairs Group Exercise Program (Rubenstein, et al.) ................................... 15

Simplified Tai Chi (Wolf, et al.)............................................................................... 17

Exercise-based

 Interventions
Injury Prevention 

This study used weekly structured group sessions of moderate-intensity 

exercise, held in community settings, with additional exercises performed 

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

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

receive the intervention.

Population: Participants were individuals at risk for falling because 

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

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

participants were female. 

Geographic Locale: Southwest Sydney, Australia 

Focus: Improve balance and coordination, muscle strength, reaction 

time, and aerobic capacity. 

Program Setting: Classes were conducted in local indoor lawn bowling 

and sports clubs that hosted community programs for various sports and 

exercise activities, comparable to U.S. community exercise, sports, and 

recreation facilities. Many lawn bowling and sports clubs also included 

other indoor attractions such as restaurants, meeting facilities, and movies. 

Content: The classes were designed by a physical therapist to address 

physical fall risk factors: balance and coordination, strength, reaction time, 

and aerobic capacity. Each class began with 5 to 10 minutes of warm-up 

that included stretching of the major lower limb muscle groups and 

10 minutes of cool-down that included gentle stretching, relaxation, 

and controlled-breathing practice. Each class included music chosen 

by the participants.

The classes included the following types of exercises:

•	 Balance and coordination exercises, including modified Tai Chi 

exercises, practice in stepping and in changing direction, dance steps, 

and catching and throwing a ball

•	 Strengthening exercises, including exercises that used the participant’s 

weight (e.g., sit-to-stand, wall press-ups) and resistance-band exercises 

that worked both upper and lower limbs

•	 Aerobic exercises, including fast-walking practice with changes in 

pace and direction

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.

Barnett,

et al.

5

Stay Safe, Stay Active
Exercise-based

Interventions

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

1-year period.

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

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

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

already had a good understanding of the exercise principles. 

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

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

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

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

physical therapist for support once each term.

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

investigator.

Key Elements: 

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

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

to support their participation in an exercise program when appropriate.

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

sustainable and transferable to other settings.

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

sessions, participants received: 

•	 A home exercise program based on class content*

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

hands and feet if a loss of balance occurs*

* See Appendix D-1. 

Study Citation: Barnett A, Smith B, Lord S, Williams M, Baumand A. Communitybased group exercise improves balance and reduces falls in at-risk older people: A 

randomized controlled trial. Age and Ageing. 2003 Jul;32(4):407-14.

Contact

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

more information:

Anne Barnett, MPH

Physiotherapy Department

Bankstown Hospital, Locked Mailbag 1600

Bankstown NSW 2200

Australia

Tel: +61 (9) 722 7154

Fax: +61 (9) 722 7125

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

6
Injury Prevention 

This intervention, 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. 

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 

and was intended for people who did not want to attend, or could not 

reach, a group exercise program or recreation facility. 

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

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

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

participants were telephoned once a month during the months when no 

visits were scheduled. 

The first home visit lasted an hour; all subsequent visits took about half 

an hour. During the visits, the PT or nurse prescribed a set of in-home 

exercises (selected at appropriate and increasing levels of difficulty) and a 

walking plan. 

Campbell,

et al. and

Robertson,

et al.

7

The Otago Exercise Program
Exercise-based

Interventions

The exercises included:

•	 Strengthening exercises for lower leg muscle groups using ankle cuff weights

•	 Balance and stability exercises such as standing with one foot in front 

of the other and walking on the toes

•	 Active range of motion exercises such as neck rotation and hip and knee extensions

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

instructions and an illustration for each exercise. 

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

complete the exercises 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 1 year and in one trial was extended to 2 years.

Delivered by: The program was delivered by either a PT experienced in prescribing 

exercises for older adults, or a nurse who was given special training and received ongoing 

supervision from a PT.

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

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

program and with ongoing supervision by a PT. 

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

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

particular combination of exercises worked to reduce falls.

Available Materials: The Otago Exercise Program instruction guide, which 

describes the program exercises, is available to health professionals at: 

http://www.acc.co.nz/injury-prevention/home-safety/older-adults/otago-exerciseprogramme/index.htm 

8
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. 

BMJ. 1997 Oct 25;315(7115):1065-9. 

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

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

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

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

Psychotropic medication withdrawal and a home-based exercise program 

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

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

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

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

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

BMJ. 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. BMJ. 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.

BMJ. 2001 Mar 24;322(7288):701-4.

Supplemental articles 

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

implementation of an exercise-based falls prevention programme. 

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

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

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

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

9
Exercise-based

Interventions

Contact

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

more information:

M. Clare Robertson, PhD

Department of Medical and Surgical Sciences

University of Otago Medical School

PO Box 913

Dunedin 9054

New Zealand

Tel: +64 (3) 474 7007 extension 8508

Fax: +64 (3) 474 7641

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

10
Injury Prevention 

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

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

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

decreased 55 percent. 

Population: Participants were inactive seniors aged 70 years or older. 

Three-quarters were female. All participants lived in the community. 

Geographic Locale: Portland, Oregon, USA 

Focus: Improve balance and physical performance with Tai Chi classes 

designed for older adults.

Program Setting: The Tai Chi programs were conducted in community 

settings such as local senior centers and adult activity centers.

Content: The program included 24 Tai Chi forms that emphasized 

weight shifting, postural alignment, and coordinated movements. 

Synchronized breathing aligned with Tai Chi movements was integrated 

into the movement routine. 

Each session included instructions in new movements as well as review of 

movements from previous sessions. Each practice session incorporated 

musical accompaniment. 

Each hourlong 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 6-month period in which there were no organized classes. 

Delivered by: Experienced Tai Chi instructors who followed the classical 

Yang style, which emphasizes multidirectional weight shifting, body 

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

Li, et al.

11

Tai Chi: Moving for Better Balance
Exercise-based

Interventions

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

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

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

older adults.

Key Elements: 

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

and community centers. 

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

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

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

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

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

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

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

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

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

Contact

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

more information:

Fuzhong Li, PhD

Oregon Research Institute

1715 Franklin Boulevard

Eugene, OR 97403

Tel: 541-484-2123

E-mail: fuzhongl@ori.org

12
Injury Prevention 

This study evaluated a 12-month group exercise program for frail older 

adults. The program was tailored to each participant’s abilities. Overall, the 

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

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

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

Population: Ages ranged from 62 to 95, although nearly all were 

70 years or older. Most study participants were female. Participants 

lived in retirement villages and most were independent. 

Geographic Locale: Sydney and Wollongong, Australia

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

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

from a chair and climbing stairs. 

Program Setting: Programs were conducted in common rooms in 

residential care community centers and senior centers within the 

retirement villages.

Content: The group classes included weight-bearing exercises and 

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

participation or cause any adverse events. The program emphasized social 

interaction and enjoyment. 

The program consisted of four 3-month terms. The first term included 

understanding movement, how the body works, training principles, 

and basic exercise principles. This was followed by progressive strength 

training and increasingly challenging balance exercises, using equipment 

to maintain interest. In each term, the exercise sessions built on the skills 

acquired in the previous term.

Each hourlong class had three segments:

•	 A 5- to 15-minute warm-up period that included chair-based activities, 

stretching large muscle groups, and later in the program, slow to 

moderate walking.

•	 A 35- to 40- minute conditioning period that included aerobic 

exercises, strengthening exercises, and activities to improve balance, 

hand-eye and foot-eye coordination, and flexibility. As the program 

progressed, the number of repetitions of each exercise increased, 

beginning with 4 repetitions at week 2 and reaching 30 by week 10. 

Thirty repetitions were maintained for rest of the program.

Lord, et al.

13

Australian Group Exercise Program
Exercise-based

Interventions

•	 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 3-month terms. 

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

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

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

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

monitor program fidelity and consistency. 

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

regularly to discuss issues and training updates. 

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

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

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

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

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

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

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

Geriatric 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

Prince of Wales Medical Research Institute

Barker Street, Randwick,

Sydney NSW 2031, Australia

Tel: +61 (2) 9399 1061 

Fax: +61 (2) 9399 1005

E-mail: s.lord@unsw.edu.au

14
Injury Prevention 

 

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

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

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

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

physical activity.

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

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

leg weakness; impaired gait, mobility, and/or balance; and had fallen two 

or more times in the previous 6 months. 

Geographic Locale: Los Angeles, California, USA

Focus: Increase strength and endurance and improve mobility and 

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

Program Setting: The program was conducted at a Veterans Affairs 

ambulatory care center.

Content:

•	 Strength training included hip flexion, extension, abduction, and 

adduction; knee flexion and extension; squats, dorsiflexion, and 

plantar flexion. Over the first 4 weeks, participants increased each 

exercise from 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. 

Rubenstein, 

et al.

15

Veterans Affairs Group Exercise 

Program
Exercise-based

Interventions

Duration: Three 1 1⁄2-hour sessions a week for 12 weeks. 

Delivered by: Exercise physiology graduate students with training from experienced 

exercise physiologists or physical therapists. 

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

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

Key Elements: 

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

•	 Focusing on strength, balance, and endurance

•	 Providing personal encouragement and reinforcement

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

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

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

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

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

Contact

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

more information:

Laurence Z. Rubenstein, MD, MPH

VA Medical Center, GRECC (11e)

16111 Plummer St.

Sepulveda, CA 91343

Tel: 818-895-9311

Fax: 818-891-8181

E-mail: laurence.rubenstein@va.gov

16
Injury Prevention 

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

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

4 months, the risk of falling more than once among participants in the 

Tai Chi classes was almost half that of people in the comparison group. 

Participants reported that after the study they were better able to stop 

themselves from falling by using their environment and appropriate body 

maneuvers. After the study ended, almost half the participants chose to 

continue meeting informally to practice Tai Chi.

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

study participants were female. 

Geographic Locale: Atlanta, Georgia, USA

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

measures among seniors using Tai Chi.

Program Setting: The program used facilities in a residential 

retirement community.

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

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

forms (see Appendix D-2) that could be completed during the 15-week 

period. The composite forms emphasized all elements of movement that 

generally become limited with age. 

Exercises systematically progressed in difficulty. The progression of 

movements led to gradually reducing the base of standing support until, 

in the most advanced form, a person was standing on one leg. This 

progression also included increasing the ability to rotate the body and 

trunk as well as performing reciprocal arm movements. These exercises 

were led during the group sessions; however, individuals were encouraged 

to practice these forms on their own, outside of the group setting.

Example of a simplified Tai Chi form:

Wolf, et al.

17

Simplified Tai Chi
Exercise-based

Interventions

Duration: The 15-week program included: 

•	 Twice weekly 25-minute group sessions 

•	 Weekly 45-minute individual contact time with the instructor

•	 Twice daily 15-minute individual practice sessions at home without an instructor

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

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

with participants to ensure their participation. 

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

investigator.

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

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

who are similar to study participants.

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

Appendix D-2.

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 Geriatric 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

Tel: 404-712-4801

Fax: 404-712-5895

E-mail: swolf@emory.edu

18

Home Visits by an Occupational Therapist (Cumming, et al.).................................. 21

Falls-HIT (Home Intervention Team) Program (Nikolaus, et al.)............................ 23

Home Modification

 Interventions
Injury Prevention 

This intervention used an occupational therapist (OT) who visited 

participants in their homes, identified environmental hazards and unsafe 

behaviors, and recommended home modifications and behavior changes. 

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

had experienced 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 therapist also 

assessed each participant’s abilities and behaviors, and how each functioned 

in his or her home environment. Specific unsafe behaviors were identified 

such as wearing loose shoes, leaving clutter in high-traffic areas, and using 

furniture to reach high places. The OT discussed with the participants ways 

to avoid these unsafe behaviors.

Two weeks after the initial home visit the OT telephoned each participant 

to ask whether they had made the modifications and to encourage them to 

adopt the recommended behavioral changes. 

Cumming,

et al.

21

Home Visits by an Occupational 

Therapist
Home 

Modification

Interventions

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

contact time was approximately 2 hours.

Delivered by: An occupational therapist with 2 years experience. 

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

minimum qualification needed to conduct the home assessments, develop the 

recommendations, and supervise the home modifications. 

Key Elements: 

•	 Using an experienced occupational therapist is critical

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

untargeted home modification programs implemented by people who do not have 

skills in caring for older people

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

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

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

Co-ordinates Therapy Services

10 Collier Crescent

Brunswick 3055 Australia

Tel: +61 (3) 9380 1127

Fax: +61 (3) 9387 4829

Email: 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 Geriatric 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

Centre for Education and Research on Ageing (CERA)

Concord Hospital C25

Concord NSW 2139

Australia

Tel: +61 (2) 9767 6818 or +61 (2) 9767 7212

Fax: +61 (2) 9767 5419

E-mail: bobc@health.usyd.edu.au

22
Injury Prevention 

This intervention provided home visits to identify environmental hazards 

that can increase the risk of falling, provided advice about possible changes, 

offered assistance with home modifications, and provided training in using 

safety devices and mobility aids. The fall rate for participants was reduced 

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

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

participants was reduced 37 percent.

Population: Participants were frail community-dwelling older adults 

who had been hospitalized for conditions unrelated to a fall, and then 

discharged to home. Participants showed functional decline, especially 

in mobility. All were 65 years or older and lived in the community. 

Three-quarters were female. 

Geographic Locale: Mid-sized town, Southern Germany 

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

Program Setting: Intervention team members contacted patients once 

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

took place in participants’ homes.

Content: The first home visit was conducted while the participant was 

still hospitalized. Two team members, an occupational therapist with 

either a nurse or a physical therapist, depending on patient’s anticipated 

needs, conducted a home assessment. They identified home hazards 

using a standardized home safety checklist and determined what safety 

equipment a participant needed. 

During two to three subsequent home visits, an occupational therapist or 

nurse met with the participant to:

•	 Discuss home hazards

•	 Recommend home modifications

•	 Facilitate necessary modifications

•	 Teach participants how to use safety devices and mobility aids 

when necessary 

Nikolaus,

et al.

23

Falls-HIT (Home Intervention Team) 

Program
Home 

Modification

Interventions

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

1.5 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 8 hours.

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

occupational therapist, three nurses, a social worker, and a secretary. Occupational 

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

a physical therapist or nurse also helped the participant. The social worker was available 

to provide information about ambulatory services and to help participants complete 

applications for additional money from the mandatory care insurance. 

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

investigator. 

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

they were discharged, which facilitated follow-up.

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

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

people using a home intervention team (HIT): Results from the Randomized Falls HIT 

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

Contact

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

more information:

Thorsten Nikolaus, MD 

Department of Geriatric Medicine, 

University of Ulm and Bethesda Geriatric Clinic

Zollernring 26, D-89073 Ulm

Germany

Tel: +49 731 187185

Fax: +49 731 187389

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

24

Stepping On (Clemson, et al.)................................................................................. 27

PROFET (Prevention of Falls in the Elderly Trial) (Close, et al.)............................. 31

The NoFalls Intervention (Day, et al.) ..................................................................... 33

The SAFE Health Behavior and Exercise Intervention (Hornbrook, et al.) ............... 37

Yale FICSIT (Frailty and Injuries: Cooperative Studies of Intervention 

 Techniques) (Tinetti, et al.) ................................................................................. 39

A Multifactorial Program (Wagner, et al.)................................................................. 43

Multifaceted

Interventions
Injury Prevention 

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

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

participants was reduced about 30 percent compared with those who did 

not receive the intervention. The intervention was especially effective for 

men. The fall rate among male participants was reduced almost two-thirds.

Population: Participants were individuals who had fallen in the previous 

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

lived in the community. Most study participants were female. 

Geographic Locale: Sydney, Australia 

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

decisions and learn about fall prevention techniques, and make 

behavioral changes. 

Program Setting: Initial sessions were conducted in easily accessible 

community settings. Refreshments were provided before and after the 

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

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

participants’ homes. 

Content: The program addressed multiple fall risk factors: improving 

lower limb balance and strength, improving environmental and behavioral 

safety in both the home and community, and encouraging visual and 

medical screenings to check for low vision and possible medication problems.

Each session covered a different aspect to reducing fall risk:

•	 Session 1: Risk appraisal; introducing balance and strength exercises

•	 Session 2: Review and practice exercises; how to move safely in 

the home

•	 Session 3: Hazards in and around the home and how to remove 

or reduce them

•	 Session 4: How to move safely in the community; safe footwear 

and clothing

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

and hip protectors

Clemson,

et al.

27

Stepping On
Multifaceted

Interventions

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

safely in the community

•	 Session 7: Review of topics covered in program

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

and modifications, if needed

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

Duration: 

•	 Seven weekly 2-hour program sessions

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

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

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

the home visits. 

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

led the sessions. These included:

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

about safely.

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

sleeping better, and hip protectors.

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

pedestrian safety.

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

to manage medications.

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

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

this session.)

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

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

community settings. 

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

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

community pharmacist who can discuss medications. Other potentially useful content 

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

training in fall prevention. 

28
Key Elements: Using content experts is critical. It is also important to 

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

make sure each focuses on fall prevention. 

The Stepping On manual is essential for all program facilitators and 

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

outlines topic areas and provides the background information for each 

content expert. 

Chapters include: 

•	 Essential background information for understanding the conceptual 

underpinning of the program and the group process

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

can be used to train local experts participating in the program

•	 A guide to useful resources

•	 Handouts for group participants

•	 Ideas on recruitment and evaluation

Work is ongoing to develop training workshops and certification for 

Stepping On program leaders. 

29
Multifaceted

Interventions

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

bfreiberg@cfu.net

2302 W. 1st St.

Cedar Falls, IA 50613

USA

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

School of Occupation & Leisure Sciences

The University of Sydney

P.O. Box 170 

Lidcombe 1825

Australia

Tel: +61 (2) 9351 9372

Fax: +61 (2) 9351 9166

E-mail: L.Clemson@fhs.usyd.edu.au

30
Injury Prevention 

This intervention provided medical assessments for fall risk factors with 

referrals to relevant services and an occupational therapy home hazard 

assessment with recommendations for home modifications. After 12 months,

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

67 percent less likely to fall repeatedly (at least 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 years and older and lived 

in the community. Two-thirds of participants were female. 

Geographic Locale: London, United Kingdom 

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

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

Program Setting: The medical assessment took place in an outpatient 

hospital clinic. The occupational therapy assessment took place in 

participants’ homes. 

Content: The medical assessment was conducted soon after the fall that 

was treated in the emergency room. It included assessments of visual acuity, 

postural hypotension, balance, cognition, depression, and medication 

problems. The results were used to identify and address problems that 

could contribute to fall risk. Participants received referrals to relevant 

services, as appropriate, based on identified risk factors. 

The home assessment was conducted during a single visit. The occupational 

therapist (OT) identified environmental hazards in the home such as 

uneven outdoor surfaces, loose rugs, and unsuitable footwear. Based on 

findings, the OT provided advice and education regarding safety within 

the home, made safety modifications to the home with the participant’s 

consent, and provided minor safety equipment. 

The OT made social service referrals for participants who required hand 

rails, other technical aids, adaptive devices such as grab bars and raised 

toilet seats, and additional support services. 

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

The average length of the home assessment was 60 minutes.

Delivered by: A physician specializing in geriatrics conducted the medical 

assessment. An OT delivered the home hazard assessment. 

Close,

et al.

31

PROFET (Prevention of Falls in the 

Elderly Trial)
Multifaceted

Interventions

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

•	 Appropriately trained geriatricians

•	 General practitioners with a strong interest in older adult health

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

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

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

than a general practitioner is recommended. 

Available Materials:

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

•	 Modified geriatric depression scale (see Supplemental Articles)

•	 Snellen vision assessment chart

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

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

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

for a comprehensive geriatric assessment

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

* See Appendix D-3.

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

Prince of Wales Medical Research Institute

Barker Street, Randwick,

Sydney NSW 2031, Australia

Tel: +61 (2) 9399 1000

Fax: +61 (2) 9399 1082

E-mail: j.close@unsw.edu.au

32
Injury Prevention 

The NoFalls Intervention

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

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

home hazard reduction. The intervention components focused on 

increasing strength and balance, improving poor vision, and reducing 

home hazards. 

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

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

further when vision improvement or home hazard reduction was 

combined with exercise. The most effective combination was the 

group-based exercise with both vision improvement and home hazard 

reduction. Participants who received all three components were 

one-third less likely to fall.

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

community. Sixty percent were female. 

Geographic Locale: City of Whitehorse, Melbourne, Australia 

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

reduce home hazards. 

Program Setting: The exercise program was delivered in community 

settings such as exercise rooms in fitness centers and community health 

centers. The vision intervention was delivered via usual services available in 

the community. Participants went to their optometrist or ophthalmologist 

if they had one. If any further action was required, it was facilitated using 

normal services such as hospitals for cataract surgery, optometrists for 

new glasses, and general practitioners or ophthalmologists for medication 

if required. The home hazard intervention was conducted in 

participants’ homes.

Day, 

et al.

33

The NoFalls Intervention
Multifaceted

Interventions

Content: 

Exercise: The exercise intervention consisted of weekly 1-hour classes plus daily home 

exercises. Classes were designed by a physical therapist to improve flexibility, leg 

strength, and balance. About one-third of the exercises were devoted to balance 

improvement. Exercises were adjusted for participants with limitations. Music was played 

during the sessions.

Leaders provided a social time with coffee and tea after each session to talk informally 

about exercise improvements and opportunities.

Vision improvement: The vision intervention included referral to an appropriate eye care 

provider if a participant’s vision fell below predetermined criteria during the baseline 

assessments for visual acuity, contrast sensitivity, depth perception, and field of view. 

Criteria for referral included more than 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. 

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. 

34
Duration: 

Exercise: Weekly 1-hour group classes for 15 weeks and 25 minutes of 

daily home exercises.

Vision improvement: Duration depended on the specific intervention 

(such as cataract surgery or new glasses).

Home hazard reduction: Duration depended on the length of time the 

home modifications were left in place by the participant.

Delivered by: 

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

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

physical therapist who designed the program.

Vision improvement: Initial assessment was conducted by nurses with up 

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

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

general practitioner, local optometrist, or ophthalmologist.

Home hazard reduction: Home assessments were conducted by research 

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

training required on the home hazard assessment. Modifications were 

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

City of Whitehorse home maintenance program.

Minimum Level of Training Needed:

Exercise: Requires a basic level of exercise leadership training such as that 

received by a physical therapist or certified fitness instructor. 

Vision and home hazard assessments: Nurses or other allied health 

professionals with the appropriate training. 

Key Elements: Although the most effective single component was 

the NoFalls exercise program, the complete program should be followed 

because partial implementation may not reduce falls.

35
Multifaceted

Interventions

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

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

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

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

intervention component by itself was not effective. 

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

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

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

Contact

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

more information:

Lesley Day, PhD, MPH

Accident Research Centre

Building 70, Monash University

Wellington Road

Clayton Victoria 3800, Australia

Tel: +61 (3) 9905 1811

Fax: +61 (3) 9905 1809

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

36
Injury Prevention 

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 years or older and lived in the 

community. About 60 percent of participants were female. 

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

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 1 1⁄2- 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

•	 Strengthen muscles

•	 Improve posture

•	 Improve balance

Hornbrook,

et al.

37

The SAFE Health Behavior and 

Exercise Intervention
Multifaceted

Interventions

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 1 1⁄2-hour classes (including 20 minutes of supervised exercise) over a 

1-month period

Delivered by: 

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

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

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

change experts with various backgrounds including health behavior change and 

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

change expert and a physical therapist. 

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

investigator.

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

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

time of publication. Please contact the principal investigator for information on how to 

obtain the exercise manual.

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

Ory MG. Preventing falls among community-dwelling older persons: Results from a 

randomized trial. The Gerontologist. 1994 Feb;34(1):16-23.

Contact

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

more information:

Mark C. Hornbrook, PhD

Kaiser Permanente Center for Health Research 

3800 N Interstate Ave

Portland, OR 97227

Tel: 503-335-6746

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

38
Injury Prevention 

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 years or older and lived in the community. 

Most participants were female. 

Geographic Locale: Farmington, Connecticut, USA 

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.

Tinetti,

et al.

39

Yale FICSIT (Frailty and Injuries: 

Cooperative Studies of 

Intervention Techniques) 
Multifaceted

Interventions

40
Duration: The intervention was conducted over a 3-month period. The 

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

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

the risk factor assessments. Medication adjustments were undertaken in 

cooperation with the participant’s primary physician who made the final 

decision on medication changes. The PT conducted all physical therapy 

and supervised exercise sessions. 

Minimum Level of Training Needed: The assessment requires at least 

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

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

physical therapy portion requires a physical or occupational therapist, or a 

physical or occupational therapy assistant with supervision by a physical or 

occupational therapist. 

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

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

blood pressure and behavioral recommendations; (2) medication review and 

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

gait assessments and interventions; and (4) environmental assessment and 

modification. 

It is essential that the progressive balance and strength exercise program 

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

Available Materials: Intervention materials including risk factor 

assessments and treatment worksheets, medication reduction strategies, 

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

requested through the intervention Web site: http://www.fallprevention.org.

41
Multifaceted

Interventions

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 American Geriatric 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

Tel: 203-688-5238

Fax: 203-688-4209

E-mail: Mary.tinetti@yale.edu

42
Injury Prevention 

A Multifactorial Program 

This study tested a moderate-intensity intervention that used tailored 

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

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

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

medical care. 

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

community. About 60 percent of participants were female. 

Geographic Locale: Seattle, Washington, USA 

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. 

Wagner,

et al.

43

A Multifactorial Program
Multifaceted

Interventions

Duration: The initial visit consisted of a 1 to 1 1⁄2-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

Center for Health Studies

Group Health Cooperative

1730 Minor Avenue, Ste. 1290

Seattle, WA 98101

Tel: 206-287-2877

E-mail: wagner.e@ghc.org

44

Intervention Study 

Selection Process

Appendix A

46
Injury Prevention 

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

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

research in fall prevention interventions. They conducted a comprehensive 

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

the following selection criteria: (1) included adults aged >65 years; (2) used 

a randomized controlled trial or controlled clinical trial study design; 

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

least 3 months after the start of the intervention. Of the 95 studies, 57 had 

falls as a primary outcome and 38 of the 57 reported either the number 

of subjects who fell at least once, or the monthly rate of falling. Rand 

included these 38 studies in their meta-analyses to determine the effectiveness

of fall prevention interventions (categorized as exercise, education, 

environmental modification, or multiple component interventions.)* 

Beginning with data from 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 (i.e., showed statistically fewer falls 

for intervention participants). As illustrated in Figure 1, CDC excluded 

1 study that focused on nursing home residents, 4 that did not include 

falls as the 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 also identified seven studies 

published after the Rand Report that met the established criteria. In total, 

the Compendium includes 14 studies published before January 2006. 

* Available at http://www.cms.hhs.gov/PrevntionGenInfo/Downloads/

Exercise%20Report.pdf

47

Intervention Study Selection 

Process
Appendix A

Figure 1. Flow chart showing the selection process for 

studies used in the Compendium

826

Fall intervention

studies

95

Relevant & rigorous

studies

57

Falls as an

outcome

37

Community-dwelling

population

8

Met CDC criteria

38

Rand Report:

Data on subjects

who fell at least

once or the

monthly fall rate

14

Compendium

studies

7

Relevant, rigorous

& effective studies

published 2003-2005

1

Reported on

same study

25

Not statistically

significant

positive results

4

Falls not the

primary outcome

1

Nursing home

population

48

Bibliography of

Compendium Studies

Appendix B

50
Injury Prevention 

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

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

Jul;32(4):407-14.

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

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

women 80 years and older. Age and Ageing. 1999 Oct;28(6):513-18.

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. 

BMJ. 1997 Oct 25;315(7115):1065-69. 

*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):850-53. 

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

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

prevention of falls in people aged >75 with severe visual impairment: 

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

Clemson L, Cumming RG, Kendig H, Swann M, Heard R, Taylor 

K. The effectiveness of a community-based program for reducing 

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

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

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

Prevention of falls in the elderly trial (PROFET): A randomized 

controlled trial. Lancet. 1999 Jan 9;353(9147):93-97.

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 Geriatric Society. 1999 

51

Bibliography of Compendium 

Studies and Supplemental Articles
Appendix B

Dec;47(12):1397-1402.

Day L, Fildes B, Gordon I, Fitzharris M, Flamer H, Lord S. Randomized factorial 

trial of falls prevention among older people living in their own homes. British Medical 

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

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

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

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

*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.

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.

*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.

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. 

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 Geriatric 

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

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 Geriatric Society. 2003 Mar;51(3):300-5.

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

people by preventing falls: A meta-analysis of individual-level data. Journal of the 

American Geriatrics Society. 2002 May;50(5):905-11.

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

economic evaluation of a nurse delivered home exercise programme to prevent 

falls. 1: Randomised controlled trial. British Medical Journal. 2001 Mar 24; 

322(7288):697-701.

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

and economic evaluation of a nurse delivered home exercise programme to prevent 

falls. 2: Controlled trial in multiple centres. British Medical Journal. 2001 Mar 

52
Injury Prevention 

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.

*Sheik J, Yesavage J. Geriatric depression scale (GDS): Recent 

evidence and development of a shorter version. Clinical Gerontology.

1986;5(1/2):165-72. 

*Tinetti ME, Baker DI, Garrett PA, Gottschalk M, Koch ML, Horwitz 

RI. Yale FICSIT: Risk factor abatement strategy for fall prevention.

Journal of American Geriatric Society. 1993 Mar;41(3):315-20.

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. 

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

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

population-based randomized trial. American Journal of Public Health.

1994 Nov;84(11):1800-6.

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

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

and computerized balance training. Journal of the American Geriatric 

Society. 1996 May;44(5):489-97.

*Wolf SL, Coogler C, Xu T. Exploring the basis for Tai Chi Chuan 

as a therapeutic exercise approach. Archives of Physical Medicine and 

Rehabilitation. 1997 Aug;78(8):886-92.

*Supplemental article

53
Tables

Appendix C

Table 1 Overall Population Characteristics

Table 2 Study Characteristics

Table 3 Intervention Characteristics

54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
Original Intervention Materials

Appendix D

Appendix D-1 Barnett Materials

Appendix D-2 Wolf Materials

Appendix D-3 Close Materials

70
Appendix D-1

Barnett Materials

71
72
73
74
75
76
77
78
79
80
81
82
Appendix D-2

Wolf Materials

83
84
85
86
Appendix D-3

Close Materials

87
88
8

89
0

90
1 91
92 2
3

93
4

94
95
96
97