The C.A.M. Report
Complementary and Alternative Medicine: Fair, Balanced, and to the Point
  • About this web log

    This blog is intended as an objective and dispassionate source of information on the latest CAM research. Since my background is in pharmacy and allopathic medicine, I view all CAM as advancing through the development pipeline to eventually become integrated into mainstream medical practice. Some will succeed while others fail. But all are treated fairly here.

  • About the author

    John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at www.Vicus.com, a complementary and alternative medicine website.

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    The material on this weblog is for informational purposes. It is not medical advice or counsel. Be smart, consult your health professional before using CAM.

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    Reducing the rate and risk of falling

    Approximately 30% of people over 65 years of age living in the community fall each year.

    This Cochrane review updates what we know.

    First, the details.

    • 159 studies with 79,193 participants were reviewed.
    • Most compared a fall prevention measure(s) with no intervention or a measure not expected to reduce falls.
    • The most common interventions were as follows:
      • Exercise alone (59 studies)
      • Multifactorial programs (40 studies)
    • Most studies were well designed, but only 38% (60/159 studies) attempted to conceal the treatment group assigned to the participants.

    And, the results.

    • Multiple-component group exercise
      • Significantly reduced the rate of falls and risk of falling.
      • Multiple-component home-based exercise also significantly reduced the rate of falls and risk of falling.
    • Tai chi
      • Did not significantly reduce the rate of falls.
      • Did significantly reduce the risk of falling.
    • Multifactorial interventions, which include individual risk assessment
      • Reduced the rate of falls significantly but not risk of falling.
    • Vitamin D
      • Did not reduce the rate of falls or risk of falling.
      • However, it might do so in people with lower vitamin D levels before treatment.
    • Home safety assessment and modification interventions
      • Effective in reducing the rate of falls and risk of falling.
      • More effective in people at higher risk of falling, including those with severe visual impairment.
      • More effective when delivered by an occupational therapist.
    • Treating vision problems
      • Significant increase in the rate of falls and risk of falling.
      • When regular wearers of multifocal glasses were given single lens glasses, all falls and outside falls were significantly reduced in those that regularly took part in outside activities.
      • Conversely, there was a significant increase in outside falls among those who took part in little outside activity.
    • Pacemakers
      • Reduced the rate of falls in people with carotid sinus hypersensitivity but not the risk of falling.
    • Cataract surgery
      • First cataract surgery in women, reduced rate of falls, but second cataract surgery did not.
    • Gradual withdrawal of psychotropic medication
      • Reduced the rate of falls, but not risk of falling.
    • A prescribing modification program by primary care physicians
      • Significantly reduced risk of falling in 1 study.
    • An anti-slip shoe device
      • Reduced the rate of falls in icy conditions in 1 study.
    • Multifaceted podiatry including foot and ankle exercises
      • Reduces the rate of falls vs standard podiatry in people with disabling foot pain, but not the risk of falling.
    • Cognitive behavioral interventions
      • No evidence of effect on rate of falls or risk of falling.
    • Testing to increase knowledge/educate about fall prevention alone
      • Did not significantly reduce the rate of falls or risk of falling.
    • Fall-related fractures
      • No conclusions could be drawn from the 47 trials reporting fall-related fractures.
    • Economic evaluation
      • 3 studies indicated cost savings for their interventions during the study.
        • Home-based exercise in over 80-year-olds
        • Home safety assessment and modification in those with a previous fall
        • One multifactorial program targeting 8 specific risk factors

    The bottom line?

    The authors concluded the following.

    • Group and home-based exercise programs, and home safety interventions reduce rate of falls and risk of falling.
    • Multifactorial assessment and intervention programs reduce rate of falls but not risk of falling.
    • Tai chi reduces risk of falling.
    • Overall, vitamin D supplementation does not appear to reduce falls but may be effective in people who have lower vitamin D levels before treatment.

    9/15/12 13:48 JR

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