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