Effects of a Fall Prevention Program on Older People with Various Fall Risks: A Post-Hoc Analysis of the FAMILY Trial

Introduction
With rapidly aging populations, falls are a leading cause of injury, especially in resource-constrained rural settings. This study examined whether rural community-dwelling older adults with higher fall risk received greater benefit from a primary care-integrated fall prevention Program compared to those with lower fall risk.
Methods 
The study was a post-hoc analysis based on the FAMILY trial, an open-label, cluster randomized clinical trial conducted in 128 rural villages in China. The trial recruited older adults aged ≥60 years. Baseline fall risks were assessed using the 12-item Fall Risk Questionnaire, classifying scores <4 as low risk and ≥4 as high risk. Adjusted baseline confounders and village as the random effect, mixed-effects regression models were used to evaluate the effects of intervention between two fall risk levels, with intervention-by-fall-risk interactions, for the primary outcome (≥1 fall in 12 months). Secondary outcomes, including the rate of falls, functional mobility, balance, fall-related injury, and health-related quality of life, were also examined, at the 12-month follow-up visit.
Results 
Of 2,616 participants, 6 died before randomization and 4 were lost. Finally, 2,606 were assessed (low fall risk, n=1,227 and high fall risk, n=1,379). No effects of intervention were identified for both fall risk levels. Compared to participants with low fall risk, those with high fall risk did not achieve greater benefit from the intervention (P = 0.95). No effects were observed for secondary outcomes, except participants with high fall risk received better quality of life (P = 0.04).
Conclusion 
This post-hoc analysis indicated that the fall prevention intervention was equitable for rural community-dwelling population regardless of the fall risks to prevent falls, supporting to scale up this primary care-integrated fall prevention intervention in resource-limited settings.