Evaluation of a Scaled-Up Fall Prevention Community Program in Older Adults With Previous Hospitalization

Study Objectives: To examine the survival rate and differences in fall-related health service use among community-based participants of the Stepping On fall prevention program compared to controls in the year before and three years after program initiation. Study type: Case-control retrospective study using linked ambulance, emergency department, hospital and mortality data. Methods: 39,014 individuals admitted to hospital in New South Wales between 1 July 2005 and 31 March 2016, including 7,964 from the Stepping On program and 31,050 controls, were matched using propensity score analysis. We used competing risk analysis to assess fall-related mortality and described the patterns in acute and fall-related health service use one year pre-program (index) and three years’ post-Stepping On program completion. Results: Overall Stepping On participants had higher health service use in the pre-index program period compared to controls. Three-year post-index showed a trend towards reduced fall-related mortality (hazard ratio 0.84, 95% CI 0.66-1.05), along with plateau in health service use for the Stepping On program participants compared to the control group, whose service use increased over a three-year follow-up time. Conclusions: Patterns of service use suggest Stepping On program benefits are sustained for a short period of time. The greatest improvements were found in the very old group (85+ years) who undertook the program, which could potentially help reduce the unnecessary use of healthcare services for falls and prolong survival. While interpretation of the results ought to be addressed with caution, they suggest the need for ongoing program refreshment to achieve lasting effects.