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Evidence-Based Disability and Disease Prevention for Elders

Practical Examples

The Application of Research Findings


Dorothy Baker, M.S.N., Ph.D., Research Scientist, School of Medicine, Yale University, New Haven, CT.

Cheryl Rucker-Whitaker, M.D., M.P.H., Assistant Professor, Department of Preventive Medicine, Rush University Medical Center, Chicago, IL.

Why Do We Care About Falls and What Can Be Done About Them?

Thirty percent of community living adults over age 65 fall, and 50 percent of those fall repeatedly. Hip fracture is a major consequence of falls. Falls in hospitals and nursing homes are a significant liability issue and often result in costly litigation.

Research indicates that falls are directly correlated with risk factors that include:

  • Impairments in cognition, vision, or hearing.
  • Lower extremity strength.
  • Balance or gait.
  • Total medication use.

Dr. Baker's research has identified a number of factors that increase the likelihood of falls among community living older adults. She has also identified interventions for addressing these factors.

As part of a program to prevent functional decline in physically frail, elderly persons who live at home, Dr. Baker and her Yale University colleagues conducted a randomized control trial of a fall reduction intervention. The interventions included in the trial addressed seven specific risk factors known to increase falls. The interventions were typically inexpensive (and, therefore, cost effective). Trial results stressed the need to evaluate each person on all the risk factors, not just the one that was presented upon examination. By building interventions that were based on evidence, the trial was able to reduce falls by 30 percent.

How Can Evidence-based Practices Be Used To Improve Chronic Disease Interventions?

By 2011, 77 million baby boomers will begin to turn 65. By 2025 the number of Medicare beneficiaries will reach 69.3 million, 20 percent of the U.S. population, at which time those over 80 will comprise the fastest growing segment of the population. Chronic illness is prevalent among the elderly, and 85 percent of people 65 or older have one or more chronic illnesses. Of those, 25 percent have four or more conditions. Chronic illness accounts for 75 percent of total national health care expenditures.

Dr. Whitaker emphasized the value of self management of chronic disease. People live with chronic illness for many years and can become their own principal caregivers by taking responsibility for their conditions. Self management skills such as medication adherence, exercise, and monitoring are important skills that can be taught to most patients with chronic illness.

A chronic disease self-management program undertaken by Dr. Whitaker among African American communities in Chicago used standardized participant materials and training for leaders that have proved successful in sustaining behavioral change in majority populations. However, no published literature exists about the efficacy of the curriculum with African Americans.

In Chicago, Dr Whitaker modified the training to address the needs and circumstances of those involved in the project, and she evaluated the outcomes.

Her findings related to the successful implementation of interventions include the following:

  • Patients need to be part of developing care plans as this increases their adherence to the plan.
  • Simple self management skills can succeed without full literacy.
  • The participation of peer mentors is key. Dr. Whitaker found that it was important to provide incentives for peer mentors and paid them $20 per hour, or about $50 per session.

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