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Icon: Multifaceted InterventionsMultifaceted Interventions: A Multifactorial Program

Wagner, et al.

This study tested a moderate-intensity intervention that used tailored strategies based on assessments of each participant’s risk factors. After 1 year, participants were 10 percent less likely to fall and 5 percent less likely to have an injurious fall, compared with people who received usual medical care.

Population

All participants were 65 or older and lived in the community. About 60 percent of participants were female.

Geographic Locale

Seattle, Washington, United States

Focus

Reduce disability and/or falls by: improving physical fitness, modifying excessive alcohol use, improving home safety, reducing psychoactive medication use, and improving hearing and vision.

Program Setting

Participants received the assessments and interventions from a nurse at local health maintenance organization (HMO) centers. Participants conducted a home assessment or had it done by a family member or volunteer.

Content

The assessments consisted of simple screening tests for 6 risk factors. The intervention content varied based on the individual’s risk factors.

Risk Factor Intervention
Inadequate exercise Participated in a 2-hour exercise orientation class testing fitness, given exercise instruction, and encouraged to begin a program of brisk walking
Use of psychoactive 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

Duration

The initial visit consisted of a 1- to 1½-hour interview. The length and number of subsequent sessions varied by the type of interventions selected for each participant.

Delivered by

The program was delivered by a single nurse educator who received brief training by the research team. There was no formal curriculum because only 1 nurse was involved. Either trained volunteers or participants’ family members completed the home safety assessment using the provided checklist.

Minimum Level of Training Needed

Information was not provided by the principal investigator.

Key Elements

The nurse’s follow-up phone contacts and home visits may have had positive effects on participants’ health that were independent of the interventions for specific risk factors.

Available Materials

No intervention materials were available for distribution at the time of publication.

Study Citation

Wagner EH, LaCroix AZ, Grothaus L, Leveille SG, Hecht J, Artz K, Odle K, Buchner DM. Preventing disability and falls in older adults: A population-based randomized trial. American Journal of Public Health. 1994 Nov;84(11):1800-6.

Contact

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

Edward H. Wagner, MD, MPH
Group Health Research Institute
1730 Minor Avenue, Ste. 1290
Seattle, WA 98101, United States
Tel: 206-287-2877
E-mail: wagner.e@ghc.org

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