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Icon: Multifaceted InterventionsMultifaceted Interventions: The NoFalls Intervention

Day, et al.

This study looked at the effectiveness of group-based exercise in preventing falls when used alone or in combination with vision improvement and/or home hazard reduction. The intervention components focused on increasing strength and balance, improving poor vision, and reducing home hazards.

The group-based exercise was the most potent single intervention; when used alone, it reduced the fall rate by 20 percent. Falls were reduced further when vision improvement or home hazard reduction was combined with exercise. The most effective combination was the group-based exercise with both vision improvement and home hazard reduction. Participants who received all 3 components were one-third less likely to fall.

Population

All participants were aged 70 and older and lived in the community. Sixty percent were female.

Geographic Locale

City of Whitehorse, Melbourne, Australia

Focus

Increase strength and balance, improve poor vision, and reduce home hazards.

Program Setting

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

Content

Exercise: The exercise intervention consisted of weekly 1-hour classes plus daily home exercises. Classes were designed by a physical therapist to improve flexibility, leg strength, and balance. About one-third of the exercises were devoted to balance improvement. Exercises were adjusted for participants with limitations. Music was played during the sessions.

Leaders provided a social time with coffee and tea after each session to talk informally about exercise improvements and opportunities.

Vision improvement: The vision intervention included referral to an appropriate eye care provider if a participant’s vision fell below predetermined criteria during the baseline assessments for visual acuity, contrast sensitivity, depth perception, and field of view. Criteria for referral included more than 4 lines difference between the line of smallest letters read correctly on the high and low contrast sections of the vision chart or any loss of field of view.

A referral was recommended if:

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

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

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

Duration

Exercise: Weekly 1-hour group classes for 15 weeks and 25 minutes of daily home exercises.

Vision improvement: Duration depended on the specific intervention (such as cataract surgery or new glasses).

Home hazard reduction: Duration depended on the length of time the home modifications were left in place by the participant.

Delivered by

Exercise: Classes were led by trainers who were accredited to lead exercise classes for older adults, and were trained in the NoFalls program by the physical therapist who designed the program.

Vision improvement: Initial assessment was conducted by nurses with up to a half-day training required on the vision assessment. Detailed vision assessment was conducted by each participant’s usual eye care provider, general practitioner, local optometrist, or ophthalmologist.

Home hazard reduction: Home assessments were conducted by research nurses who followed the study protocol for assessment with 1 day of training required on the home hazard assessment. Modifications were undertaken by participants, their family or a private contractor, or by the City of Whitehorse home maintenance program.

Minimum Level of Training Needed

Exercise: Requires a basic level of exercise leadership training such as that received by a physical therapist or certified fitness instructor.

Vision and home hazard assessments: Nurses or other allied health professionals with the appropriate training.

Key Elements

Although the most effective single component was the NoFalls exercise program, the complete program should be followed because partial implementation may not reduce falls.

Available Materials

The NoFalls exercise program manual, which was developed for trained professionals, is available free of charge in electronic format at www.monash.edu.au/muarc/projects/nofalls/.

These researchers have not made the home assessment protocol available because this intervention component by itself was not effective.

Study Citation

Day L, Fildes B, Gordon I, Fitzharris M, Flamer M, Lord S. Randomised factorial trial of falls prevention among older people living in their own homes. British Medical Journal. 2002 Jul 20;325(7356):128-33.

Contact

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

Lesley Day, PhD, MPH
Accident Research Centre
Building 70, Monash University
Wellington Road
Clayton Victoria 3800, Australia
Tel: +61 (3) 9905 1811
Fax: +61 (3) 9905 1809
E-mail: NoFalls.enquire@general.monash.edu.au

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