Implementation and Assessment of a Fall Screening Program in Primary Care Practices

Fall prevention strategies for older adults are underused in primary care. A study was designed to examine the Centers for Medicare and Medicaid Services Physician Quality Reporting System (PQRS) fall measures and to reduce injuries and costs from falls by 10%. This quality improvement project using a pre/post design was implemented in four primary care practices with 2,021 patients aged 65 and older in Asheville, North Carolina. The project used a patient registry, electronic templates, standardized care protocols, a falls clinic to evaluate individuals who reported falling, and patient resource materials. Data were collected from medical records on processes of care, fall‐related injuries, and anticipated payments. Individuals billed for at least one outpatient visit from July 2011 through June 2012 (n = 2,021) constituted the cohort for the intervention and for analysis of injuries from falls requiring hospital visits (before the intervention (T1): July 2010 to March 2011; after the intervention (T2): July 2012 to March 2013). Practice sites properly screened 68.8% of older adults for falls, assessed 87% of those who reported falling, and documented the PQRS required plan of care in 23%. Only 20% self‐reported falls. Numbers of falls requiring a visit to the hospital were small overall and did not decrease (T1, 2.4%; T2, 2.9%; P = .32); 61% of individuals seen in the hospital for fall‐related injuries had not reported previous falls. Incorporating the PQRS fall measures into primary care was challenging, and the program was not robust enough to reduce serious falls and hospital costs.     

Incidence of falls and fear of falling in Japanese patients with rheumatoid arthritis

The objective of this study is to determine the incidence of falls and fear of falling by gender and age in Japanese patients with rheumatoid arthritis (RA). Among the Japanese patients who participated in a single-institute-based prospective observational cohort study of patients with RA, namely the Institute of Rheumatology Rheumatoid Arthritis, 765 men (median age 63 years) and 4,231 women (median age 60 years) with RA responded to questions related to falls. Eight percent of men and 11% of women reported one or more falls during the previous 6 months. At least one fall and multiple falls were significantly more frequent in men (p < 0.05) and in women (p < 0.001) with RA over age 65 and age 75 years, respectively, although there was no significant linear increase in risk with age. Sixteen percent of men and 22% of women reported fear of falling. More men over age 65 tended to report fear of falling than those under age 65 (p < 0.001), although the incidence of women with fear of falling increased with advancing age. Japanese patients with RA over age 65 and age 75 appeared to have a high risk of at least one fall and multiple falls, respectively.     

Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention

OBJECTIVES: Previous cross-sectional studies have shown a correlation between falls and fear of falling, but it is unclear which comes first. Our objectives were to determine the temporal relationship between falls and fear of falling, and to see whether these two outcomes share predictors. DESIGN: A 20-month, population-based, prospective, observational study. SETTING: Salisbury, Maryland. Each evaluation consisted of a home-administered questionnaire, followed by a 4- to 5-hour clinic evaluation. PARTICIPANTS: The 2,212 participants in the Salisbury Eye Evaluation project who had baseline and 20-month follow-up clinic evaluations. At baseline, subjects were aged 65 to 84 and community dwelling and had a Mini-Mental State Examination score of 18 or higher. MEASUREMENTS: Demographics, visual function, comorbidities, neuropsychiatric status, medication use, and physical performance-based measures were assessed. Stepwise logistic regression analyses were performed to evaluate independent predictors of falls and fear of falling at the follow-up evaluation, first predicting incident outcomes and then predicting fall or fear-of-falling status at 20 months with baseline falling and fear of falling as predictors. RESULTS: Falls at baseline were an independent predictor of developing fear of falling 20 months later (odds ratio (OR) = 1.75; P <.0005), and fear of falling at baseline was a predictor of falling at 20 months (OR = 1.79; P <.0005). Women with a history of stroke were at risk of falls and fear of falling at follow-up. In addition, Parkinson's disease, comorbidity, and white race predicted falls, whereas General Health Questionnaire score, age, and taking four or more medications predicted fear of falling. CONCLUSION: Individuals who develop one of these outcomes are at risk for developing the other, with a resulting spiraling risk of falls, fear of falling, and functional decline. Because falls and fear of falling share predictors, individuals who are at a high risk of developing these endpoints can be identified.     

Screening for fall risk in patients with haemophilia

Many risk factors for falls identified in the general population are found in patients with haemophilia. Furthermore, fall risk increases with age and patients with haemophilia are increasingly entering the over 65 age group. After a fall occurs, there are often behavioural changes that have significant health consequences and further increase fall risk. Fall risk can be quickly assessed in the clinical setting with specific questions in the medical history and by a variety of performance‐based screening tools. Identification of fall risk enables early intervention, thereby preventing injury and fear of physical activity, both of which have been associated with falling and may carry an increased risk in patients with haemophilia. Review of the existing literature on assessment of fall risk reveals the importance of screening in the clinical setting, which is commonly done via a fall history and performance‐based assessment tools. Selecting appropriate fall risk screening tools is an important step in identifying and providing optimal interventions for those at risk. Assessments of fall history, fear of falling, gait velocity, gait variability and vestibular dysfunction are suggested as screening tools for patients with haemophilia. Additional research is needed to determine the optimal screening, evaluation and treatment techniques for these patients. The longitudinal physical therapy care provided by Haemophilia Treatment Centres presents a unique opportunity for instituting measures that will reduce the incidence of falling in patients with haemophilia.     

Associated factors for falls and fear of falling in Japanese patients with rheumatoid arthritis

The objective of this is to determine factors associated with falls in Japanese patients with rheumatoid arthritis (RA). Among the patients who participated in a single-institute-based prospective observational cohort study of patients with RA, namely, Institute of Rheumatology Rheumatoid Arthritis, 4,996 (male 765, female 4231, median age 60 years) responded to questions related to falls during the previous 6 months in April or May 2008. Logistic regression was used to determine the association between variables and falls. Five hundred and five (10.1%), 110 (2.2%), and 958 patients (19.2%) reported at least one fall, multiple falls, and fear of falling, respectively. Those who fell tended to report incident fractures during the same 6 months compared to those who did not (14.7% versus 1.1%, P < 0.001). In multivariate models, Japanese health assessment questionnaire (HAQ) scores (odds ratios (OR) 1.52, 2.49, and 3.88), tender joint counts (OR 1.39, 1.72, and 1.36), patient-reported visual analog scale for general health (OR 1.08, 1.16, and 1.20), and body mass index (OR 1.05, 1.08, and 1.04) were associated (P < 0.05) with at least one fall, multiple falls, and fear of falling, respectively. Other clinical variables and medications were also associated with falls and fear of falling. HAQ disability score, tender joint counts, and impaired general health appear to be associated with falls in Japanese patients with RA, as previously reported for patients of other ethnicities.     

Lack of Effect of Tai Chi Chuan in Preventing Falls in Elderly People Living at Home: A Randomized Clinical Trial

OBJECTIVES: To evaluate the effectiveness of Tai Chi Chuan in fall prevention in elderly people living at home with a high risk of falling.
DESIGN: Randomized controlled trial.
SETTING: Two industrial towns in the western part of the Netherlands.
PARTICIPANTS: Two hundred sixty-nine elderly people (average age 77) living at home with a high risk of falling.
INTERVENTIONS: The intervention group received Tai Chi Chuan training for 1 hour twice a week for 13 weeks; the control group received usual care. Both groups received a brochure containing general information on how to prevent fall incidents.
MEASUREMENTS: Primary outcome was the number of falls over 12 months. Secondary outcomes were balance, fear of falling, blood pressure, heart rate at rest, forced expiratory volume during the first second, peak expiratory flow, physical activity, and functional status.
RESULTS: After 12 months, no lower fall risk in the Tai Chi Chuan group was observed than in the control group (adjusted hazard ratio=1.16; 95% confidence interval=0.84–1.60), and there were no significant intervention effects on the secondary outcome measures.
CONCLUSION: These results suggest that Tai Chi Chuan may not be effective in elderly people at a high risk of falling who live at home.     

Fear of falling and falls self‐efficacy and their relationship to higher‐level competence among community‐dwelling senior men and women in Japan

Aim: This cross‐sectional study examined the relationships of fear of falling and falls self‐efficacy with higher‐level competence among community‐dwelling senior citizens in Japan. Methods: Of the 822 registered senior citizens, 731 (89%) community dwellers were requested to participate in the survey using a mailed self‐accomplished questionnaire. Data from 648 respondents with duly accomplished questionnaires were analyzed using R², the coefficient of determination, based on a multivariate regression analysis. Results: Fear of falling, low falls self‐efficacy and higher‐level functional disability were observed among respondents. Of the hypothesized relationships examined by sex, fear of falling was significantly associated with disability among male respondents and low falls self‐efficacy among both sexes. Several confounding variables were strongly associated with competence. Conclusion: While the data underscore the strategic importance of promoting higher‐level competence among the senior citizens, there is much to suggest that their competence is likely to be maintained if their fear of falling and falls self‐efficacy were modified. Programs must also consider a wide array of intervening factors. Geriatr Gerontol Int 2011; 11: 282–289.     

Falling and fall risk factors in adults with haemophilia: an exploratory study

Falls are a particular risk in persons with haemophilia (PWH) because of damaged joints, high risk of bleeding, possible impact on the musculoskeletal system and functioning and costs associated with treatment for these fall‐related injuries. In addition, fall risk increases with age and PWH are increasingly entering the over 65 age group. The aim of this study was to determine the occurrence of falls during the past year and to explore which fall risk factors are present in community‐dwelling PWH. Dutch speaking community‐dwelling adults were included from the age of 40 years with severe or moderate haemophilia A or B, independent in their mobility and registered at the University Hospitals Leuven. They were asked to come to the haemophilia centre; otherwise a telephone survey was conducted. Demographic and social variables, medical variables, fall evaluation and clinical variables were queried. From the 89 PWH, 74 (83.1%) participated in the study. Twenty‐four (32.4%) fell in the past year, and 10 of them (41.7%) more than once with an average of four falls. Living conditions, physical activity, avoidance of winter sports due to fear of falling, orthopaedic status, urinary incontinence and mobility impairments are potential fall risk factors in adult PWH. This exploratory study indicates that PWH are attentive to falling since they are at higher risk for falls and because of the serious consequences it might have. Screening and fall prevention should be stimulated in the daily practice of haemophilia care.     

Cross-sectional and longitudinal risk factors for falls, fear of falling, and falls efficacy in a cohort of middle-aged African Americans

PURPOSE: The purpose of this study is to cross-sectionally and longitudinally identify risk factors for falls, fear of falling, and falls efficacy in late-middle-aged African Americans. DESIGN AND METHODS: We performed in-home assessments on a probability sample of 998 African Americans and conducted two annual follow-up interviews. Multiple logistic regression modeled the associations with falls (any fall or injurious fall) during 2 years prior to the baseline interview, and baseline fear of falling and falls efficacy with 2-year prospective risks for falling and fear of falling. RESULTS: The most consistent association for all outcomes was depressive symptoms. Age was associated with increased risk of prior and prospective falls. Lower-body functional limitations were associated with prior falls, baseline fear of falling, and low falls efficacy, whereas low ability with one-leg stands prospectively predicted fear of falling. The greatest prospective risk for incident falls was having had a prior fall (odds ratio = 2.51), and the greatest prospective risk for fear of falling was having been afraid of falling at baseline (odds ratio = 8.14). IMPLICATIONS: Falls, fear of falling, and low falls efficacy are important issues for late-middle-aged as well as older persons. Interventions should focus on younger adults and attend especially to lower-body function and depressive symptoms as well as building self-efficacy for safe exercise, dealing with falls risks, and managing falls themselves.     

The circumstances,orientations, and impact locations of falls in community-dwelling older women

ObjectiveWe sought to characterize the circumstances, orientations, and impact locations of falls in community-dwelling, ambulatory, older women.MethodsFor this longitudinal, observational study, 125 community-dwelling women age ≥ 65 years were recruited. Over 12-months of follow-up, fall details were recorded using twice-monthly questionnaires.ResultsMore than half (59%) of participants fell, with 30% of participants falling more than once (fall rate = 1.3 falls per person-year). Slips (22%) and trips (33%) accounted for the majority of falls. Approximately 44% of falls were forward in direction, while backward falls accounted for 41% of falls. About a third of all falls were reported to have lateral (sideways) motion. Subjects reported taking a protective step in response to 82% of forward falls and 37% of backward falls. Of falls reporting lateral motion, a protective step was attempted in 70% of accounts. Common impact locations included the hip/pelvis (47% of falls) and the hand/wrist (27%). Backwards falls were most commonly reported with slips and when changing direction, and increased the risk of hip/pelvis impact (OR = 12.6; 95% CI: 4.7–33.8). Forward falls were most commonly reported with trips and while hurrying, and increased the risk of impact to the hand/wrist (OR = 2.6; 95% CI: 1.2–5.9).ConclusionFalls in older ambulatory women occur more frequently than previously reported, with the fall circumstance and direction dictating impact to common fracture locations. Stepping was a common protective recovery strategy and that may serve as an appropriate focus of interventions to reduce falls in this high risk population.     

Perceptions of older people about falls injury prevention and physical activity

Objectives: The purpose of this study was to explore the beliefs and perceptions of older people about falls injury prevention services, and to identify incentives and barriers to attending falls prevention services, including programs targeting physical activity. Methods: Seventy‐five people over age 60 years who were members of community groups completed a 23‐item survey that was returned by mail. Survey items included self‐reported falls and confidence when walking, awareness of falls prevention strategies, desirable programs for a falls prevention service, and incentives and barriers to participation in physical activity programs. Results: Twenty‐eight per cent of respondents had fallen within the previous 6 months, yet just over half (54%) were aware there were strategies to prevent falling, despite the majority of the sample being physically active (81%) and at least reasonably confident about walking (84%). The features that were considered most desirable for a falls prevention service were group exercise programs (61%), educational talks about health issues (57%), and vision/eye glasses assessment (52%). The most commonly reported incentives for attending a physical activity group included having a doctor advise them to attend (61%) or having a friend who attended the group (55%), and the most common barrier to attending a physical activity group was transportation (43%). Conclusions: Despite consistent numbers of older people experiencing falls, there is little awareness among older people that strategies exist to prevent falling. It appears that motivating older people to participate in physical activity with the aim of falls prevention will largely depend on the encouragement of their doctor or their peers.     

Effect of a Risk-Based Multifactorial Fall Prevention Program on the Incidence of Falls

OBJECTIVES: To evaluate the effects of a multifactorial fall prevention program on falls and to identify the subgroups that benefit the most.
DESIGN: Randomized controlled trial.
SETTING: Community-dwelling subjects who had fallen at least once during the previous 12 months.
PARTICIPANTS: Five hundred ninety-one subjects randomized into intervention (IG) (n=293) and control (CG) (n=298) groups.
INTERVENTION: A multifactorial 12-month fall prevention program.
MEASUREMENTS: Incidence of falls.
RESULTS: The intervention did not reduce the incidence of falls overall (incidence rate ratio (IRR) for IG vs CG=0.92, 95% confidence interval (CI)=0.72–1.19). In subgroup analyses, significant interactions between subgroups and groups (IG and CG) were found for depressive symptoms ( P =.006), number of falls during the previous 12 months ( P =.003), and self-perceived risk of falling ( P =.045). The incidence of falls decreased in subjects with a higher number of depressive symptoms (IRR=0.50, 95% CI=0.28–0.88), whereas it increased in those with a lower number of depressive symptoms (IRR=1.20, 95% CI=0.92–1.57). The incidence of falls decreased also in those with at least three previous falls (IRR=0.59, 95% CI=0.38–0.91) compared to those with one or two previous falls (IRR=1.28, 95% CI=0.95–1.72). The intervention was also more effective in subjects with high self-perceived risk of falling (IRR=0.77, 95% CI=0.55–1.06) than in those with low self-perceived risk (IRR=1.28, 95% CI=0.88–1.86).
CONCLUSION: The program was not effective in reducing falls in the total sample of community-dwelling subjects with a history of falling, but the incidence of falls decreased in participants with a higher number of depressive symptoms and in those with at least three falls.     

Square-stepping exercise versus strength and balance training for fall risk factors

BACKGROUND AND AIMS: Feasible and lowcost exercise programmes targeting fall risk factors may decrease the risk of falling in older adults. The purpose of this study was to compare the effects of square-stepping exercise (SSE) training, which is a new and low-cost method designed to improve lower-extremity functional fitness, with strength and balance (SB) training. METHODS: The study included 39 community-dwelling adults aged 65 to 74 years. The participants were randomized to either group SSE (n=20) or SB (n=19). They engaged in 70- min group exercise sessions twice a week for 12 weeks. The efficacy of the program was measured with both a 9- item test battery for assessment of physical performance and self-reported scales (fear of falling, pleasure in exercise, perceived health status). Fall incidence was followed up for 14 months. RESULTS: The results of a 2-way ANOVA revealed that the time effect in 7 of the 9 performance tests was significant, although group-by-time interactions were not. No significant changes were observed in the self reported scales. During the 14-month follow-up period, 7 falls in 6 participants in the SSE group and 12 falls in 11 participants in the SB group were reported. The incidence rate per person in the SSE group (30.0%) was not significantly different from that in the SB group (57.9%). The rate of falls per trip [falls/(falls + trips)] in the SSE group (17.1%) was significantly lower than in the SB group (50.0%). CONCLUSIONS: SSE is as equally effective as SB training in improving lower-extremity functional fitness. SSE may also be recommended for older adults, due to its low cost and effectiveness.     

Predicting falls among Egyptian nursing home residents: A 1-year longitudinal study

Background/PurposeFalls and their related complications are serious health problems among the institutionalized older population. This study aimed to evaluate the incidence of falls and the risk factors among nursing home residents in Cairo, Egypt.MethodsA one-year prospective cohort study was done in three nursing homes in Cairo. Overall, 84 residents aged over 60 years participated in this study. Baseline demographic characteristics and results of comprehensive geriatric assessments, e.g. cognition, depression, functional and nutritional status, previous falls, fear of falling, assistive device use, and assessment by the timed up-and-go test (TUG) test were collected. All falling accidents were recorded by the nursing home staff during the study period.ResultsDuring the study period, 163 incident falls (1940 falls/ 1000 resident-years) were identified in 53 fallers (631 fallers/1000 resident-years) were recorded. On average, fallers may fall twice a year (mean ± SD 2.0 ± 2.1 episodes, range 1–6). Compared to nonfallers, fallers were older, more likely to have hadprevious falls, fear of falling, frailty, impaired instrumental activities of daily living, poor cognitive status, malnutrition or its risk, assistive device use, and slower TUG. The most sensitive (86.8%) and specific (90.3%) predictor for falls in this study was TUG >14 seconds.ConclusionSixty-three percent of Egyptian nursing home residents may fall during one year follow-up with the incidence of 1019 falls/1000 resident-years. The most important predictive factor for falls in this study was the TUG >14 seconds.     

Effectiveness of a falls-and-fracture nurse coordinator to reduce falls: a randomized, controlled trial of at-risk older adults

OBJECTIVES: To assess the effectiveness of a community‐based falls‐and‐fracture nurse coordinator and multifactorial intervention in reducing falls in older people. DESIGN: Randomized, controlled trial. SETTING: Screening for previous falls in family practice followed by community‐based intervention. PARTICIPANTS: Three hundred twelve community‐living people aged 75 and older who had fallen in the previous year. INTERVENTION: Home‐based nurse assessment of falls‐and‐fracture risk factors and home hazards, referral to appropriate community interventions, and strength and balance exercise program. Control group received usual care and social visits. MEASUREMENTS: Primary outcome was rate of falls over 12 months. Secondary outcomes were muscle strength and balance, falls efficacy, activities of daily living, self‐reported physical activity level, and quality of life (Medical Outcomes Study 36‐item Short Form Questionnaire). RESULTS: Of the 3,434 older adults screened for falls, 312 (9%) from 19 family practices were enrolled and randomized. The average age was 81±5, and 69% (215/312) were women. The incidence rate ratio for falls for the intervention group compared with the control group was 0.96 (95% confidence interval=0.70–1.34). There were no significant differences in secondary outcomes between the two groups. CONCLUSION: This nurse‐led intervention was not effective in reducing falls in older people who had fallen previously. Implementation and adherence to the fall‐prevention measures was dependent on referral to other health professionals working in their usual clinical practice. This may have limited the effectiveness of the interventions.     

Environmental assessment and modification to prevent falls in older people

To assess the effectiveness of an environmental falls prevention intervention delivered by qualified occupational therapists or unqualified trained assessors. DESIGN: A pilot three‐armed randomized controlled trial. SETTING: Airedale National Health Service Trust catchment, North and West Yorkshire, England. PARTICIPANTS: Two hundred thirty‐eight community‐dwelling adults aged 70 and older with a history of falls in the previous year. INTERVENTION: Assessment and modification of the home environment of people at greater risk of falls. MEASUREMENTS: Fear of falling was the primary outcome measure, and an analysis of covariance was conducted on the area under the curve at 12 months. As a secondary outcome, falls were analysed using negative binomial regression. Quality of life and independence in activities of daily living (ADLs) were also measured. RESULTS: The intervention had no effect on fear of falling (P=.63). The occupational therapy group had significantly fewer falls than controls 12 months after the assessment (incidence rate ratio (IRR)=0.54, 95% confidence interval (CI)=0.36–0.83, P=.005). There was no significant effect on falls in the trained assessor group (IRR=0.78, 95% CI=0.51–1.21, P=.34). CONCLUSION: Environmental assessment had no effect on fear of falling. Environmental assessment prescribed by an occupational therapist significantly reduced the number of falls in high‐risk individuals whereas that prescribed by a trained assessor did not. Further research in other settings is needed to confirm this, to explore the mechanisms, and to estimate cost‐effectiveness.     

Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people

BACKGROUND: Little is known about the prevalence rates and correlates of fear of falling and avoidance of activity due to fear of falling in the general population of community-living older people. OBJECTIVE: To assess prevalence rates and study correlates of fear of falling and avoidance of activity due to fear of falling in this population. Study design and setting: cross-sectional study in 4,031 community-living people aged > or =70 years. RESULTS: Fear of falling was reported by 54.3% and associated avoidance of activity by 379% of our population. Variables independently associated with fear of falling were: higher age (> or =80 years: odds ratio (OR) =1.79; 95% confidence interval (CI) =1.49-2.16), female gender (OR = 3.23; 95% CI = 2.76-3.79), poor perceived general health (OR = 6.93; 95% CI = 4.70-10.21) and multiple falls (OR = 5.72; 95% CI = 4.40-7.43). Higher age (> or =80 years: OR = 1.92; 95% CI = 1.59-2.32), poor perceived general health (OR = 11.91; 95% CI = 8.38-16.95) and multiple falls (OR = 4.64; 95% CI = 3.73-5.76) were also independently associated with avoidance of activity. CONCLUSIONS: Fear of falling and avoidance of activities due to fear of falling, were highly prevalent in our sample of community-living older people. Particularly, poor perceived general health showed a strong, independent association with both, fear of falling, and related avoidance of activity. Findings of our study may help health care professionals to identify people eligible for interventions aimed at reducing fear of falling and activity restriction.     

Fear of falling among the community-dwelling elderly

To assess the incidence of falls and the prevalence, intensity, and covariates of fear of falling among community-dwelling elderly, the authors surveyed a random sample of 196 residents (> or = 58 years of age) of housing developments for the elderly in Brookline and Plymouth, Massachusetts. Forty-three percent reported having fallen in recent years, 28% in the last year. Of those who had fallen within the year prior to the interview, 65% reported injury, 44% sought medical attention, and 15% required hospitalization as a consequence of their fall(s). Fear of falling ranked first when compared to other common fears (i.e., fear of robbery, financial fears). Self-rated health status and experience of previous falls were significantly associated with fear of falling. Further analysis suggests that fear of falling may affect social interaction, independent of risks for falling.     

Alfacalcidol improves muscle power, muscle function and balance in elderly patients with reduced bone mass

We investigated the effect of daily therapy with 1 mcg alfacalcidol (Doss^?-TEVA/AWD-pharma) on muscle power, muscle function, balance performance and fear of falls in an open, multi-centered, uncontrolled, prospective study on a cohort of patients with reduced bone mass. Among the 2,097 participants, 87.1% were post-menopausal women and 12.9% were men. Mean age was 74.8 years and mean body mass index (BMI) 26.3 kg/m2. A total of 75.3% of the study population had osteoporosis, 81% a diagnosis of “increased risk of falls” and 70.1% had a creatinine clearance (CrCl) of <65 ml/min. Participants underwent muscle function and muscle power tests at onset and after 3 and 6 months: the timed up and go test (TUG) and the chair rising test (CRT). At baseline and after 6 months, participants performed the tandem gait test (TGT) and filled out a questionnaire evaluating fear of falling. Successful performance in the muscle tests is associated with a significantly lower risk of falls and non-vertebral fractures in elderly patients (successful test performance: TUG ≤ 10 s (sec), CRT ≤ 10 s, TGT ≥ 8 steps). A significant improvement in the performance of the two muscle tests was proved already after 3 months of treatment with alfacalcidol and further increased by the end of the therapeutic intervention. There were significant increases in the number of participants able to successfully perform the tests: 24.6% at baseline and 46.3% at the end of trial for the TUG (P < 0.0001) and 21.7% at baseline and 44.2% at the end for the CRT test (P = 0.0001). The mean time used for the TUG was decreased by 3.0 s from the average onset value of 17.0 s and by 3.1 s from the initial average 16.5 s for the CRT. The percentage of participants able to perform the balance test (TGT) increased from 36.0% at onset to 58.6% at the end of the trial (P < 0.0001). An increased fear of falling was reduced by the end of the study in 74.4% of the patients. Throughout the study, there were 26 adverse drug reactions in 11 out of 2,097 patients (incidence 0.52%). No serious adverse drug reactions and no cases of hypercalcemia were documented. We conclude that treatment with alfacalcidol is safe, increases muscle power, muscle function and balance and reduces fear of falls. The significant improvement in the three muscle and balance tests and fear of falls may have a preventative effect on falls and fractures. We suggest that the quantitative risk tests used in this study could be reliable surrogate parameters for the risk of falls and fractures in elderly patients.