Effects of a Fall Prevention Program on Falls Among Older Adults with Multiple Long-Term Conditions: A Secondary Analysis of the FAMILY Trial

Introduction

Falls are a major public health concern in ageing populations. Older adults with multiple long-term conditions are especially vulnerable to falls because of complex and overlapping health needs. We evaluated the effects of a primary care–integrated fall-prevention program on falls among rural Chinese older adults with multiple long-term conditions.

Methods

This secondary analysis was based on the FAMILY trial, an open-label, cluster randomized controlled trial conducted in 128 rural villages in China. Community-dwelling adults aged 60 years or older with a history of falls or concern about falling were enrolled. The intervention consisted of balance and functional exercise plus community-engaged health education; the control group received routine health education only. Multiple long-term conditions were defined as the presence of 2 or more baseline self-reported disease conditions. The primary outcome was the proportion of participants reporting at least 1 fall within 12 months after initiation of the intervention. Secondary outcomes included falls rate, fall-related injury, functional mobility, and health-related quality of life. Mixed-effects logistic regression was used for the primary outcome to account for village-level clustering.

Results

Of 2616 participants recruited between September 19 and November 15, 2023, 6 died before randomization and 2610 were randomized. Among randomized participants, 1451 (55.6%) had multiple long-term conditions, including 724 in the exercise and education group and 727 in the usual care group; 1449 participants (722 and 727, respectively) were included in the primary analysis. The most common dyad disease cluster was hypertension and stroke. Among participants with multiple long-term conditions, the intervention was associated with lower odds of reporting at least 1 fall within 12 months compared with usual care (34.5% vs 45.8%; OR, 0.61; 95% CI, 0.43-0.87). The intervention was also associated with a lower falls rate (RR, 0.68; 95% CI, 0.46-0.99), fewer fall-related injuries (OR, 0.60; 95% CI, 0.43-0.84), and better performance on selected secondary outcomes, including the Chair Stand Test, Four-Stage Balance Test, and EQ-5D-5L.

Conclusion

In this secondary analysis of a cluster randomized clinical trial, a fall-prevention program integrated into the primary health care system was associated with fewer falls among rural Chinese older adults with multiple long-term conditions. These findings support the potential value of integrating fall prevention into routine primary care for older adults with substantial chronic disease burden in resource-constrained settings.