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Appendix C: Tables

Table 2. Study Characteristics

Study

Location

Study Population & Recruitment

Inclusion Criteria

Exclusion Criteria

Defined Falls

Barnett
2003

Southwest Sydney, Australia

Recruited while patients in general practice clinics or attending hospital-based physical therapy clinics

Age 65+ & >1 physical impairment associated w/ fall risk (lower limb weakness, poor balance, slow reaction time)

Cognitively impaired or had degenerative or medical conditions that precluded participating in an exercise program

Yes

Method of Recording Falls

Length of Follow-up

Fall Outcomes

Results*

Adverse
Effects

Postal surveys sent to participants each month. If not received within 2 weeks, participant was interviewed by telephone.

12 months

Fall rate

Fall w/ injury

RR = 0.60 (0.36-0.99)

RR = 0.66 (0.38-1.15)

None

Study

Location

Study Population & Recruitment

Inclusion Criteria

Exclusion Criteria

Defined Falls

Campbell 1997

Dunedin, New Zealand

Women registered with a general practice in Dunedin were invited by general practitioner to take part

Age 80+ & able to move around within their own home

Cognitively impaired or receiving physical therapy

Yes

Method of Recording Falls

Length of Follow-up

Fall Outcomes

Results*

Adverse
Effects

Participants given 12 pre-addressed & stamped monthly fall calendar postcards. If one was not received, participant was interviewed by telephone.

12 months

Fall rate

First fall

First fall w/ injury

RR = 0.67 (p<0.05)

HR = 0.81 (0.56-1.16)

HR = 0.61 (0.39-0.97)

None

Study

Location

Study Population & Recruitment

Inclusion Criteria

Exclusion Criteria

Defined Falls

Campbell 2005 

Dunedin & Auckland, New Zealand

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

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

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

Yes

Method of Recording Falls

Length of Follow-up

Fall Outcomes

Results*

Adverse
Effects

Pre-paid, addressed, tear-off monthly postcard calendars. Independent assessors called participants to record circumstances of falls & any resulting injuries.

12 months

Number of falls

Number of fall injuries

 

 

IRR = 0.39 (0.24-0.62)

IRR = 0.56 (0.36-0.87)

None

Study

Location

Study Population & Recruitment

Inclusion Criteria

Exclusion Criteria

Defined Falls

Clemson 2004

Sydney, Australia

Community residents recruited through referrals, advertisements, & community organizations

Age 70+, had a fall in past year or fear of falling, & spoke English

Cognitively impaired or homebound

No

Method of Recording Falls

Length of Follow-up

Fall Outcomes

Results*

Adverse
Effects

Participants mailed in a pre-addressed, stamped calendar each month.

14 months

Fall rate, overall

Fall rate, males

Fall rate, females

RR = 0.69 (0.50-0.96)

RR = 0.32 (0.17-0.59)

RR = 0.96 (0.50-1.85)

None

Study

Location

Study Population & Recruitment

Inclusion Criteria

Exclusion Criteria

Defined Falls

Close
1999

London, United Kingdom

Community residents treated in an ED for a fall, sent letters & contacted by telephone

Age 65+, ambulatory, & had been treated for a fall

Cognitively impaired & had no regular caregiver, or spoke little or no English

Yes

Method of Recording Falls

Length of Follow-up

Fall Outcomes

Results*

Adverse
Effects

Postal questionnaires were sent to participants every 4 months.

12 months

Number of falls

Fall risk

Risk of ≥3 falls

183 vs. 510 (p<0.002)

OR = 0.39 (0.23-0.60)

OR = 0.33 (0.16-0.68)

None

Study

Location

Study Population & Recruitment

Inclusion Criteria

Exclusion Criteria

Defined Falls

Cumming 1999

Sydney, Australia

Recruited while hospital patients or from among people attending outpatient clinics or a local senior center

Age 65+ & ambulatory

Cognitively impaired & not living with someone who could give informed consent & report falls, or planned to have a home assessment by an occupational therapist

No

Method of Recording Falls

Length of Follow-up

Fall Outcomes

Results*

Adverse
Effects

Monthly falls calendar was completed daily & returned by mail each month. If not received within 10 days, participant was interviewed by telephone.

12 months

Fall rate for participants w/ no falls at baseline

Fall rate for participants w/ falls at baseline

 

RR = 1.03 (0.75-1.41)

 

RR = 0.64 (0.50-0.83)

None

Study

Location

Study Population & Recruitment

Inclusion Criteria

Exclusion Criteria

Defined Falls

Davison
2005

 

Newcastle, United Kingdom

Community seniors treated in EDs for a fall were mailed a questionnaire to determine their fall history. Repeat fallers were recruited by telephone.

Age 65+, treated in ED for a fall or fall injury, & had a fall in past year

Cognitively impaired, had >1 previous episode of syncope, immobile, blind, aphasic, or had a clear medical explanation for their fall

Yes

Method of Recording Falls

Length of Follow-up

Fall Outcomes

Results*

Adverse
Effects

Participants completed weekly fall diaries that they returned every month for 12 months. After 1 year, all participants’ hospital records were reviewed for falls.

12 months

Number of falls

% fallers

Number of fallers

Hip fractures

Other fractures

Fall-related ED visit

Fall-related hospital admission

RR = 0.64 (0.46-0.90)

RR = 0.95 (0.81-1.12)

RR = 0.48 (0.04-5.29)

RR = 0.53 (0.20-1.39)

RR = 0.90 (0.55-1.47)

RR = 0.80 (0.41-1.56)

RR = 3.60 (0.10-7.60)

None

Study

Location

Study Population & Recruitment

Inclusion Criteria

Exclusion Criteria

Defined Falls

Day
2002

Melbourne, Australia

Identified from electoral roll & through general practitioners. Subjects were sent letters & then contacted by telephone.

Age 70+, owns or leases home & able to make home modifications

Planning to move within 2 years, recent physical activity with a balance component, unable to walk 10-20 m w/o rest, help, or angina, severe respiratory or cardiac disease, cognitively impaired, had made recent major home modifications, or did not have physician approval

No

Method of Recording Falls

Length of Follow-up

Fall Outcomes

Results*

Adverse
Effects

Monthly calendar postcards completed daily & returned by mail. If not received within 5 working days after end of month, participant was interviewed by telephone.

18 months

Fall rates

Exercise alone:

RR = 0.82 (0.70-0.97)

Exercise + vision:

RR = 0.73 (0.58-0.91)

Exercise + home mod:

RR = 0.76 (0.60-0.95)

Exercise + vision + home mod:
RR = 0.67 (0.51-0.88)

None

Study

Location

Study Population & Recruitment

Inclusion Criteria

Exclusion Criteria

Defined Falls

Freiberger 2007

 

 

Erlangen, Germany

Recruited from a health insurance company membership database

Age ≥70, community-dwelling, & able to walk independently

Unable to walk independently or cognitively impaired

Yes

Method of Recording Falls

Length of Follow-up

Fall Outcomes

Results*

Adverse
Effects

A fall calendar was returned each month. If not returned, participants received a follow-up telephone call. If a fall occurred, the participant was interviewed by telephone.

12 months

Number of fallers
Number of multiple fallers
Fall rate
Time to first fall

RR = 0.77 (0.60-0.97)
RR = 0.87 (0.75-1.01)
RR = 0.64 (0.38-1.06)

337 ±9 days (fitness group) vs. 216 ±15 days (control)

None

Study

Location

Study Population & Recruitment

Inclusion Criteria

Exclusion Criteria

Defined Falls

Hornbrook 1994

Portland, Oregon & Vancouver, Washington metro area, United States

Members of a Kaiser Permanente HMO were recruited by mail

Age 65+ & ambulatory

Blind, deaf, housebound, non-English speaking, severely mentally ill, terminally ill, not willing to travel or lived >20 mi. from research center

Yes

Also “near falls”

Method of Recording Falls

Length of Follow-up

Fall Outcomes

Results*

Adverse
Effects

Fall reported by postcard as soon as it occurred. Participant interviewed by telephone about circumstances & consequences. Monthly diaries monitored quarterly by mail or telephone for self-reported falls & associated injuries & medical care.

24 months

Fall risk, overall

Fall risk, males

Fall risk, males age 75+

OR = 0.85 (p<0.05)

OR = 0.82 (p<0.05)

OR = 0.53 (p<0.05)

None

Study

Location

Study Population & Recruitment

Inclusion Criteria

Exclusion Criteria

Defined Falls

Li
2005

Portland, Oregon, United States

Subjects enrolled in the Legacy Health System in Portland, OR were sent letters from their physicians encouraging them to participate

Age 70+, inactive, ambulatory, no chronic medical problems that would limit participation, had a physician’s clearance to participate

Cognitively impaired, in poor health, or had difficulty with language or transportation

Yes

Method of Recording Falls

Length of Follow-up

Fall Outcomes

Results*

Adverse
Effects

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

12 months

Fall rate

Multiple fall rate

RR = 0.35 (p<0.001)

RR = 0.45 (0.30-0.70)

None

Study

Location

Study Population & Recruitment

Inclusion Criteria

Exclusion Criteria

Defined Falls

Lord
2003

Sydney & Wollongong, Australia

Residents of self-care & intermediate-care retirement villages attended information sessions & then were approached individually

Age 62+

Cognitively impaired, had a medical condition that prevented participation in an exercise program, or already attended exercise classes of equivalent intensity

Yes

Method of Recording Falls

Length of Follow-up

Fall Outcomes

Results*

Adverse
Effects

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

12 months

Fall rate

Fall rate for participants w/ no falls at baseline

Fall rate for participants w/ falls at baseline

RR = 0.78 (0.62-0.99)

RR = 0.88 (0.65-1.20)

 

RR = 0.69 (0.48-0.99)

 

None

Study

Location

Study Population & Recruitment

Inclusion Criteria

Exclusion Criteria

Defined Falls

McKiernan 2005

 

Rural central & northern
Wisconsin, United States

Recruited using a database of people who had fallen in the past year & had been treated in a clinic or ED, one direct mailing or an announcement in local print media

Age 65+, community-dwelling, had a fall in past year, ambulatory w/o a walking aid, capable of putting on Yaktrax® Walker & using it appropriately, able & willing to maintain a fall diary

Incapable of walking w/o a walking aid or unable to use Yaktrax® Walker correctly

Yes

Method of Recording Falls

Length of Follow-up

Fall Outcomes

Results*

Adverse
Effects

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

10,724 observation-days

Outdoor slip
Outdoor fall
Outdoor fall on day walked on snow or ice
Outdoor injurious fall
Outdoor injurious fall on day walked on snow or ice

RR = 0.50 (0.26-0.96)

RR = 0.45 (0.23-0.85)

RR = 0.42 (0.26-0.92)

 

RR = 0.10 (0.02-0.53)

RR = 0.13 (0.03-0.66)

None

Study

Location

Study Population & Recruitment

Inclusion Criteria

Exclusion Criteria

Defined Falls

Nikolaus 2003

Mid-sized town, Southern
Germany

Recruited while inpatients at a geriatric clinic

Lived at home before hospital admission, had multiple chronic conditions or functional deterioration, & were discharged to home

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

Yes

Method of Recording Falls

Length of Follow-up

Fall Outcomes

Results*

Adverse
Effects

Kept a falls diary & also contacted monthly by phone.

12 months

Fall rate

Fall rate for participants w/ ≤1 fall at baseline

Fall rate for participants w/ ≥2 falls at baseline

IRR = 0.69 (0.51-0.97)

IRR = 0.91 (0.72-1.22)


IRR = 0.63 (0.43-0.94)

None

Study

Location

Study Population & Recruitment

Inclusion Criteria

Exclusion Criteria

Defined Falls

Rubenstein 2000

Los Angeles, California, United States

Male patients at VA Ambulatory Care Center recruited through flyers & telephone screening

Age 70+, ambulatory, had at least 1 of 4 risk factors (lower extremity weakness, impaired gait, impaired balance, or >1 fall in past 6 months)

Exercised regularly, had cardiac or pulmonary disease, a terminal illness, severe joint pain, dementia, medically unresponsive depression, or progressive neurologic disease

No

Method of Recording Falls

Length of Follow-up

Fall Outcomes

Results*

Adverse
Effects

Questioned about falls & injuries every 2 weeks by phone or in-person during exercise class.

12 weeks

(at end of intervention)

Activity-adjusted fall rate**

RR = 0.37 (p=0.027)

None

Study

Location

Study Population & Recruitment

Inclusion Criteria

Exclusion Criteria

Defined Falls

Salminen 2009 

Pori, Finland

Announcements in local newspapers, pharmacies, health centers, hospitals, & private clinics; also through written invitations from health professionals

Age 65+, ≥1 fall in past year, little or no cognitive impairment (MMSE ≥17), living in community or in housing that provided occasional assistance

Cognitively impaired, unable to walk 10 m independently w/ or w/o walking aids

Yes

Method of Recording Falls

Length of Follow-up

Fall Outcomes

Results*

Adverse
Effects

Participants mailed fall diaries monthly. If one was not received, participants were reminded by telephone. Participants also reported falls as they occurred by phone to research assistants.

12 months

Fall rate for participants w/ ≥3 falls in previous year

Fall rate for participants w/ more symptoms of depression

IRR = 0.59 (0.38-0.91)

 

IRR = 0.50 (0.28-0.88)

2 participants stopped while exercising because they felt unwell

3 falls w/o injury occurred during the exercise sessions

Study

Location

Study Population & Recruitment

Inclusion Criteria

Exclusion Criteria

Defined Falls

Skelton
2005 

London, United Kingdom

Posters, local & national newspapers, local radio stations

Female, age 65+, ≥3 falls in past year

Acute rheumatoid arthritis, uncontrolled heart failure or hypertension, significant cognitive impairment, significant neurological disease or impairment, or previously diagnosed osteoporosis

Yes

Method of Recording Falls

Length of Follow-up

Fall Outcomes

Results*

Adverse
Effects

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

20 months

Number of falls

Number of injurious falls

IRR = 0.66 (0.49-0.90)

IRR = 0.60 (0.33-1.07)

None

Study

Location

Study Population & Recruitment

Inclusion Criteria

Exclusion Criteria

Defined Falls

Spice
2009

 

Mid Hampshire, United Kingdom

Fallers identified at 18 general practices using a standard fall definition

Age 65+, ≥2 falls in past year

Life expectancy <1 year, plans to move from area within 1 year, abbreviated mental test score <7, non-English speaking w/o available interpreter, or a nursing home resident

Yes

Method of Recording Falls

Length of Follow-up

Fall Outcomes

Results*

Adverse
Effects

Participants kept a monthly fall diary that was returned at the end of each month & indicated how many times they had fallen.

12 months

Number fell during follow-up
Time to first fall

OR = 0.52 (0.35-0.79)
HR = 0.72 (0.56-0.93)

None

Study

Location

Study Population & Recruitment

Inclusion Criteria

Exclusion Criteria

Defined Falls

Tinetti
1994

Southern Connecticut, United States

Members of an HMO, contacted first by letter & then screened by telephone

Age 70+, ambulatory in own home, had at least 1 of 9 risk factors (postural hypotension, used sedatives, ≥4 medications, inability to transfer, gait impairment, loss of strength or range of motion, home hazards)

Cognitively impaired or had participated in vigorous sports or walking for exercise in previous month

No

Method of Recording Falls

Length of Follow-up

Fall Outcomes

Results*

Adverse
Effects

A monthly falls calendar was returned by mail. If a calendar was not received or if it indicated any falls, participant was interviewed by telephone.

12 months

Fall rate

Fall per person-week

RR = 0.76 (0.58-0.98)

RR = 0.69 (0.52-0.90)

None

Study

Location

Study Population & Recruitment

Inclusion Criteria

Exclusion Criteria

Defined Falls

Voukelatos 2007

 

 

 

 

 

 

 

Sydney, Australia

Recruited through advertisements in local community newspapers

Age 60+, had not practiced Tai Chi in past 12 months

Degenerative neurological condition, dementia, severely debilitating stroke, severe arthritis, marked vision impairment, or unable to walk across a room unaided

Yes

Method of Recording Falls

Length of Follow-up

Fall Outcomes

Results*

Adverse
Effects

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

24 weeks

Number of falls

16 weeks follow-up

24 weeks follow-up

Participants w/ ≥2 falls after 24 weeks follow-up

 

IRR = 0.73 (0.50-1.07)

IRR = 0.67 (0.47-0.94)

RR = 0.54 (0.28-0.96)

HR = 0.27 (0.12-0.59)

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

Study

Location

Study Population & Recruitment

Inclusion Criteria

Exclusion Criteria

Defined Falls

Wagner
1994

Seattle, Washington, United States

Random sample of HMO members sent an introductory letter followed by a mail questionnaire

Age 65+, ambulatory, & independent in ADLs

Institutionalized or seriously ill

Yes

Method of Recording Falls

Length of Follow-up

Fall Outcomes

Results*

Adverse
Effects

Mailed questionnaires at baseline, at 1 & 2 years. If not returned, participants were interviewed by telephone. Falls were identified through self-report & hospital discharge files.

24 months

Difference in % falling

Falls, Year 1

Falls, Year 2

Falls w/ injury, Year 1

Falls w/ injury, Year 2

 

-9.3% (4.1-14.5)

+2.2% n.s.

-4.6% (p<0.01)

+3.3% n.s.

None

Study

Location

Study Population & Recruitment

Inclusion Criteria

Exclusion Criteria

Defined Falls

Wolf
1996

Atlanta, Georgia, United States

Community seniors & residents of an independent living facility, recruited through advertisements & direct contact

Age 70+, ambulatory, willing to participate weekly for 15 week program & at 4-month follow-up

Severe cognitive impairment or debilitating condition such as metastatic cancer, Parkinson’s disease, stroke, or profound visual deficits

Yes

Method of Recording Falls

Length of Follow-up

Fall Outcomes

Results*

Adverse
Effects

Monthly calendar or monthly phone calls from staff.

7-20 months

Fall risk

≥1 falls w/ injury

RR = 0.53 (0.32-0.86)

RR = 0.81 (0.33-2.02)

None


Results shown with 95% confidence intervals. *RR = Relative Rate, HR = Hazard Ratio, OR = Odds Ratio, IRR = Incidence Rate Ratio **per 1,000 hrs of activity

 

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