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