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You are here: Home Modules Module Examples Module 1 Examples Example 8 - Assembling the research evidence: Fall prevention project
Example 8 - Assembling the research evidence: Fall prevention project Print E-mail
Module 1 Examples

Ontario Public Health Practioners

Element of framework

Description of relevant research studies and data

Examples from research on preventing falls

Burden of illness and inequities

Prevalence and incidence of disease

Age- and gender- specific rates of disease.

One in three seniors falls each year and about 25 per cent of falls result in injuries.
Falls are the sixth leading cause of death among seniors in Canada.
Seniors living in publicly- subsidized apartment buildings have worse health status than seniors in privately-owned apartment buildings and they are significantly more likely to have universal access to grab bars (Edwards, Birkett, Nair et al., 2006).
Prevalence of environmental hazards in seniors' homes (Gill, Williams, Robison & Tinetti, 1999).

Socio-ecological determinants of problem

Etiological studies (which look for causes); however, need to warn that many etiological studies focus on immediate determinants of falls.

Look for good sources that examine the influence of policy.

Laboratory studies on the built environment can be a source of data.

Key studies and reviews (Gill, Williams & Tinetii, 2000; Graafmans, Oooms, Hofstee et al., 1996; Rawski, 1998; Sattin, Rodriguez, DeVito & Wingo,1998) indicate that major risk factors for falls among seniors living in the community are:

  • Use of benzodiazepine sedative hypnotics
  • Polypharmacy (using four or more drugs)
  • Problems with balance and peripheral neuromuscular dysfunction
  • Environmental hazards

Qualitative and quantitative studies give seniors’ perspectives of risk factors for falls and identify outcomes important to them (e.g. loss of independence) (Edwards & Aminzadeh, 1998; Pippin & Fernie, 1997).

Laboratory studies identify specific features of the built environment (configuration of grab bars, height of stairs, dimensions of handrails) that may interact with personal variables (e.g. chronic illness, balance, hand strength, cognition) to increase the risk of falls (Sveistrup, Lockett, Edwards & Aminzadeh, 2006; Robinovitch et al).

Community studies identify factors influencing risk of falls (Aminzadeh, Edwards, Lockett & Nair, 2001; Balfour & Kaplan, 2002; Fill, Robison, Williams & Tinetti, 1999).

Policy studies examine the influence of the policy environment on falls (Perdue, Stone & Gostin, 2003; Edwards, Birkett et al., 2006).

Selecting intervention strategies

Effectiveness studies.

U.S. public health review.

Public Health Research and Education Development Program (PHRED) reviews.

Best practices for preventing falls (Scott, Dukeshire, Gallagher & Scanlan, 2001).

Cochrane reviews on strategies to prevent falls (Gillespie et al., 2003; McLure, 2005; Parker, Gillespie & Gillespie, 2006).

PHRED summative review on falls prevention strategies.

Primary studies on the effectiveness of strategies to reduce risk factors or to reduce the risk of falls and injuries (Binder, Schechtman & Ehansi, 2001; Elley, Kerse, Arroll & Robinson, 2003; Li, Fisher & Brownson, 2005).

Community health evaluation reports of fall prevention programs (Gallagher & Scott, 1997).

Studies to examine applying theory to fall prevention, reducing risk factors and implementing interventions (Jackson, 2003; Mesh & Schwirian, 1996; Sampson & Morenoff, 2000; Rogers; Kingdon; Social marketing).

Optimal blend of strategies

Effectiveness studies of multi-strategy and multi-level interventions.

Studies informed by integrated theories.
Studies that examine contextual influences on intervention strategies.

Evidence that exercise programs are effective in combination with modifications to built environment (Gillespie et al. 2003).

Evidence that multi-factor approaches are more effective in reducing falls than single strategies (Tinetti et al., ).

Factors that may explain underutilization of effective interventions (George, Binns, Dlayden & Mulley, 1998; Giles-Corti & Donovan, 2002; Naik & Gill, 2005).


Monitoring and evaluating process, impact, spin-offs and sustainability

Identification of potential indicators, ways of assembling data to support decision-making.

Indicators being used to monitor provincial programs include:

  • Provincial fall-prevention program B.C.
  • Mandatory Core Programs – Ontario




When you’ve filled out the evidence grid, you can compare the socio-ecological determinants you’ve found with the characteristics of your community and policy context to start identifying the levels you’ll work with. Have a look at how we used this step in the Fall Prevention Project:

Socio-ecological determinants of falls among the elderly

Level of socio-ecological modelExample and reference to supporting empirical literature

Patterns and type of exercise (Benjamin et al., 2005). Seniors’ perceptions of barriers to physical activity (Lockett, Willis & Edwards, 2005).

Interpersonal Buddy systems in apartment buildings where neighbours check on each other to see if anyone has fallen and been injured.
Community Coalitions or other groups working to prevent falls by raising awareness and addressing policy change (Edwards et al., chapter on falls, 1999).
Built/physical environment Grab bars in bathrooms, safe stairs (Edwards, Lockett et al., 2003; Aminzadeh et al., 2001).

Social environment

Safe and clean public lavatories near walking paths in parks (Lockett, Willis & Edwards, 2005). Esthetically pleasing and safe walking areas near seniors’ housing (Giles-Corti & Donovan, 2003).

Organizational policy (workplaces, places of worship, housing)


Skilled volunteers organized in the community to make home modifications such as installing handrails on indoor and outdoor stairs (Edwards, Lockett & Benjamin, 2006).

Municipal policy

Traffic-control policies on amount of time allowed for pedestrians to use a crosswalk.
Policies on marking cracks in public sidewalks and the average length of time to fix them (Gallagher & Scott, 1997).

Provincial policy Provincial building codes for private and public housing (Edwards, Birkett, Nair, Murphy et al., 2006).
National policy Recommendations for building codes by the National Research Council (Aminzadeh, 1996).

(Edwards, Etowa, & Kennedy, in press)


Last Updated on Tuesday, 23 June 2009 09:04