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The multidisciplinary fall-prevention program was not effective in preventing falls and functional decline in this Dutch healthcare setting. Implementing the program in its present form in the Netherlands is not recommended. This trial shows that there can be considerable discrepancy between the "ideal" (experimental) version of a program and the implemented version of the same program. The importance of implementation research in assessing feasibility and effectiveness of such a program in a specific healthcare setting is therefore stressed.

Objective To evaluate whether a programme of multifactorial home visits reduces falls and impairments in mobility in elderly people living in the community. Design Randomised controlled trial with 18 months of follow up. Setting Six general practices in Hoensbroek, the Netherlands. Participants 316 people aged 70 and over living in the community, with moderate impairments in mobility or a history of recent falls. Intervention Five home visits by a community nurse over a period of one year. Visits consisted of screening for medical, environmental, and behavioural factors causing falls and impairments in mobility, followed by specific advice, referrals, and other actions aimed at dealing with the observed hazards. Main outcome measures Falls and impairments in mobility.Results No differences were found in falls and mobility outcomes between the intervention and usual care groups. Conclusion Multifactorial home visits had no effects on falls and impairments in mobility in elderly people at risk who were living in the community. Because falls and impairments in mobility remain a serious problem among elderly people, alternative strategies should be developed and evaluated.

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