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You are here: Home Modules Main Case Examples The Fall Prevention and the Elderly Program Assembling the research evidence for the fall prevention project
Assembling the research evidence for the fall prevention project Print E-mail
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 6th 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 senior’s 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)

Last Updated on Monday, 01 June 2009 07:54