Article Text

Download PDFPDF
Can the provision of a home help service for the elderly population reduce the incidence of fall-related injuries? A quasi-experimental study of the community-level effects on hospital admissions in Swedish municipalities
  1. Carl Bonander1,2,
  2. Johanna Gustavsson1,2,
  3. Finn Nilson1,2
  1. 1Division of Risk Management, Department of Environmental and Life Sciences, Karlstad University, Sweden
  2. 2Centre for Public Safety, Karlstad University, Karlstad, Sweden
  1. Correspondence to Carl Bonander, Division of Risk Management, Department of Environmental and Life Sciences, Karlstad University, Karlstad SE-651 88, Sweden; carl.bonander{at}


Background Fall-related injuries are a global public health problem, especially in elderly populations. The effect of an intervention aimed at reducing the risk of falls in the homes of community-dwelling elderly persons was evaluated. The intervention mainly involves the performance of complicated tasks and hazards assessment by a trained assessor, and has been adopted gradually over the last decade by 191 of 290 Swedish municipalities.

Methods A quasi-experimental design was used where intention-to-treat effect estimates were derived using panel regression analysis and a regression discontinuity (RD) design. The outcome measure was the incidence of fall-related hospitalisations in the treatment population, the age of which varied by municipality (≥65 years, ≥67 years, ≥70 years or ≥75 years).

Results We found no statistically significant reductions in injury incidence in the panel regression (IRR 1.01 (95% CI 0.98 to 1.05)) or RD (IRR 1.00 (95% CI 0.97 to 1.03)) analyses. The results are robust to several different model specifications, including segmented panel regression analysis with linear trend change and community fixed effects parameters.

Conclusions It is unclear whether the absence of an effect is due to a low efficacy of the services provided, or a result of low adherence. Additional studies of the effects on other quality-of-life measures are recommended before conclusions are drawn regarding the cost-effectiveness of the provision of home help service programmes.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors CB was responsible for the collection of the secondary data, conducted the statistical analyses and wrote the majority of the initial version of the manuscript. JG participated in the conception of the study, and provided significant revisions to the introduction and interpretation of the results in the context of previous research. FN participated in the conception of the study, interpretation of the results, wrote the background section of the initial manuscript and made significant contributions to the final manuscript. All authors approved the final manuscript.

  • Funding The project was financed through a research grant from the Swedish Civil Contingencies Agency (grant number 2013-4176).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The raw data used in the article can be made available by the authors upon request. This includes two data sets: a panel data set and a data set used for the regression discontinuity analysis.