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Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 2001 Aug;55(8):600–606. doi: 10.1136/jech.55.8.600

Economic evaluation of a community based exercise programme to prevent falls

M Robertson 1, N Devlin 1, P Scuffham 1, M Gardner 1, D Buchner 1, A Campbell 1
PMCID: PMC1731948  PMID: 11449021

Abstract

OBJECTIVE—To assess the incremental costs and cost effectiveness of implementing a home based muscle strengthening and balance retraining programme that reduced falls and injuries in older women.
DESIGN—An economic evaluation carried out within a randomised controlled trial with two years of follow up. Participants were individually prescribed an exercise programme (exercise group, n=116) or received usual care and social visits (control group, n=117).
SETTING—17 general practices in Dunedin, New Zealand.
PARTICIPANTS—Women aged 80 years and older living in the community and invited by their general practitioner to take part.
MAIN OUTCOME MEASURES—Number of falls and injuries related to falls, costs of implementing the intervention, healthcare service costs resulting from falls and total healthcare service costs during the trial. Cost effectiveness was measured as the incremental cost of implementing the exercise programme per fall event prevented.
MAIN RESULTS—27% of total hospital costs during the trial were related to falls. However, there were no significant differences in health service costs between the two groups. Implementing the exercise programme for one and two years respectively cost $314 and $265 (1995 New Zealand dollars) per fall prevented, and $457 and $426 per fall resulting in a moderate or serious injury prevented.
CONCLUSIONS—The costs resulting from falls make up a substantial proportion of the hospital costs for older people. Despite a reduction in falls as a result of this home exercise programme there was no significant reduction in healthcare costs. However, the results reported will provide information on the cost effectiveness of the programme for those making decisions on falls prevention strategies.


Keywords: falls; exercise; elderly

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Selected References

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  1. Buchner D. M., Cress M. E., de Lateur B. J., Esselman P. C., Margherita A. J., Price R., Wagner E. H. The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults. J Gerontol A Biol Sci Med Sci. 1997 Jul;52(4):M218–M224. doi: 10.1093/gerona/52a.4.m218. [DOI] [PubMed] [Google Scholar]
  2. Buchner D. M., Hornbrook M. C., Kutner N. G., Tinetti M. E., Ory M. G., Mulrow C. D., Schechtman K. B., Gerety M. B., Fiatarone M. A., Wolf S. L. Development of the common data base for the FICSIT trials. J Am Geriatr Soc. 1993 Mar;41(3):297–308. doi: 10.1111/j.1532-5415.1993.tb06708.x. [DOI] [PubMed] [Google Scholar]
  3. Campbell A. J., Borrie M. J., Spears G. F., Jackson S. L., Brown J. S., Fitzgerald J. L. Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study. Age Ageing. 1990 Mar;19(2):136–141. doi: 10.1093/ageing/19.2.136. [DOI] [PubMed] [Google Scholar]
  4. Campbell A. J., Robertson M. C., Gardner M. M., Norton R. N., Buchner D. M. Falls prevention over 2 years: a randomized controlled trial in women 80 years and older. Age Ageing. 1999 Oct;28(6):513–518. doi: 10.1093/ageing/28.6.513. [DOI] [PubMed] [Google Scholar]
  5. Campbell A. J., Robertson M. C., Gardner M. M., Norton R. N., Buchner D. M. Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial. J Am Geriatr Soc. 1999 Jul;47(7):850–853. doi: 10.1111/j.1532-5415.1999.tb03843.x. [DOI] [PubMed] [Google Scholar]
  6. Campbell A. J., Robertson M. C., Gardner M. M., Norton R. N., Tilyard M. W., Buchner D. M. Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ. 1997 Oct 25;315(7115):1065–1069. doi: 10.1136/bmj.315.7115.1065. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Close J., Ellis M., Hooper R., Glucksman E., Jackson S., Swift C. Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. Lancet. 1999 Jan 9;353(9147):93–97. doi: 10.1016/S0140-6736(98)06119-4. [DOI] [PubMed] [Google Scholar]
  8. Cox M. A., Bowie R., Horne G. Hip fractures: an increasing health care cost. J Orthop Trauma. 1993;7(1):52–57. [PubMed] [Google Scholar]
  9. Cummings S. R., Nevitt M. C., Kidd S. Forgetting falls. The limited accuracy of recall of falls in the elderly. J Am Geriatr Soc. 1988 Jul;36(7):613–616. doi: 10.1111/j.1532-5415.1988.tb06155.x. [DOI] [PubMed] [Google Scholar]
  10. Englander F., Hodson T. J., Terregrossa R. A. Economic dimensions of slip and fall injuries. J Forensic Sci. 1996 Sep;41(5):733–746. [PubMed] [Google Scholar]
  11. Kannus P., Parkkari J., Koskinen S., Niemi S., Palvanen M., Järvinen M., Vuori I. Fall-induced injuries and deaths among older adults. JAMA. 1999 May 26;281(20):1895–1899. doi: 10.1001/jama.281.20.1895. [DOI] [PubMed] [Google Scholar]
  12. Kiel D. P., O'Sullivan P., Teno J. M., Mor V. Health care utilization and functional status in the aged following a fall. Med Care. 1991 Mar;29(3):221–228. doi: 10.1097/00005650-199103000-00004. [DOI] [PubMed] [Google Scholar]
  13. Nevitt M. C., Cummings S. R., Hudes E. S. Risk factors for injurious falls: a prospective study. J Gerontol. 1991 Sep;46(5):M164–M170. doi: 10.1093/geronj/46.5.m164. [DOI] [PubMed] [Google Scholar]
  14. Province M. A., Hadley E. C., Hornbrook M. C., Lipsitz L. A., Miller J. P., Mulrow C. D., Ory M. G., Sattin R. W., Tinetti M. E., Wolf S. L. The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques. JAMA. 1995 May 3;273(17):1341–1347. [PubMed] [Google Scholar]
  15. Rizzo J. A., Baker D. I., McAvay G., Tinetti M. E. The cost-effectiveness of a multifactorial targeted prevention program for falls among community elderly persons. Med Care. 1996 Sep;34(9):954–969. doi: 10.1097/00005650-199609000-00007. [DOI] [PubMed] [Google Scholar]
  16. Rubenstein L. Z., Robbins A. S., Josephson K. R., Schulman B. L., Osterweil D. The value of assessing falls in an elderly population. A randomized clinical trial. Ann Intern Med. 1990 Aug 15;113(4):308–316. doi: 10.7326/0003-4819-113-4-308. [DOI] [PubMed] [Google Scholar]
  17. Salkeld G., Cumming R. G., O'Neill E., Thomas M., Szonyi G., Westbury C. The cost effectiveness of a home hazard reduction program to reduce falls among older persons. Aust N Z J Public Health. 2000 Jun;24(3):265–271. doi: 10.1111/j.1467-842x.2000.tb01566.x. [DOI] [PubMed] [Google Scholar]
  18. Tinetti M. E., Baker D. I., McAvay G., Claus E. B., Garrett P., Gottschalk M., Koch M. L., Trainor K., Horwitz R. I. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med. 1994 Sep 29;331(13):821–827. doi: 10.1056/NEJM199409293311301. [DOI] [PubMed] [Google Scholar]
  19. Tinetti M. E., Mendes de Leon C. F., Doucette J. T., Baker D. I. Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. J Gerontol. 1994 May;49(3):M140–M147. doi: 10.1093/geronj/49.3.m140. [DOI] [PubMed] [Google Scholar]
  20. Tinetti M. E., Williams C. S. Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med. 1997 Oct 30;337(18):1279–1284. doi: 10.1056/NEJM199710303371806. [DOI] [PubMed] [Google Scholar]
  21. Wolf S. L., Barnhart H. X., Kutner N. G., McNeely E., Coogler C., Xu T. Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. J Am Geriatr Soc. 1996 May;44(5):489–497. doi: 10.1111/j.1532-5415.1996.tb01432.x. [DOI] [PubMed] [Google Scholar]

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