Exercise alone, and in combination with different fall prevention strategies may lower the risk of falls leading to injuries in older adults 65 and over

Tricco A, Thomas S, Veroniki A, et al. Comparisons of interventions for preventing falls in older adults: A systematic review and meta-analysis JAMA. 2017;318:1687-1699.

Review question

What types of fall prevention strategies are effective in reducing falls that result in injuries among older adults over 65 years of age?

Background

As the worldwide population ages, the incidence of falls is expected to increase. Falls are costly to health care systems, and patients who may experience reduced quality of life, increased anxiety and depression, and serious injury or death. It is presently unclear what the key features are for an effective fall prevention program, and an analysis ranking available fall prevention strategies and their combinations has not been done.

How the review was done

This is a systematic review of 283 randomized controlled trials (159,910 participants) published between 1990 and 2017, with a meta-analysis.

• Participants were older adults 65 years of age or older.
• Study participants were exposed to various fall prevention strategies such as: basic falls risk assessment, cognitive behavioural therapy, use of devices (e.g. alarm, hip protector), diet modification, multifactorial assessments and treatment (e.g. comprehensive geriatric assessment), clinical quality improvement (e.g. case management, staff education, reminders), patient quality improvement (e.g. self-management, education, reminders), health system quality improvement (e.g. financial incentives for doctors or patients) use of lavender scent, osteoporosis treatment, social engagement, surgery (e.g. cataract, hip, pacemaker), vision tests and treatment, calcium or vitamin D supplements, exercise, flooring modifications, environmental checks and changes, foot assessments, and electromagnetic field therapy and whole-body vibration (e.g. transferring vibration of any frequency to the body).
• Researchers measured the number of falls that led to injuries, hospitalizations from falls, rate of falls, number of fallers, doctor and emergency department visits from falls, fractures, hip fractures, harms related to the fall prevention strategies, and quality of life.
• Results were compared to people in control groups, which included participants who underwent usual care, other fall prevention approaches, or placebo.

What the researchers found

In older adults over the age of 65, the following fall prevention strategies lowered the risk of falls that led to injuries, compared to usual care:

• exercise (alone);
• combined exercise and vision tests and treatment;
• combined exercise, vision tests and treatment, and environmental checks and changes; and
• combined clinic quality improvement, multifactorial assessment, calcium supplementation, and vitamin D supplementation.

Meanwhile, the following fall prevention strategies lowered the risk of older adults experiencing a fall, compared to usual care:

• exercise (alone);
• combined exercise, patient-level quality improvement strategies, clinic-level quality improvement strategies, and multifactorial assessment and treatment;
• combined exercise, patient-level quality improvement strategies, hip protectors, and environmental assessment and modification;
• combined patient-level quality improvement strategies, clinic-level quality improvement strategies, dietary modifications, calcium supplementation, and vitamin D supplementation; and
• combined orthotics and exercise.

Lastly, combined osteoporosis treatment, calcium supplementation, and vitamin D supplementation lowered the risk of fracture and hip fracture, compared to usual care. There was no effect seen on fall-related hospitalizations and emergency department and outpatient doctor visits when comparing different prevention strategies and usual care. However, combined exercise, environmental assessment and modification, and multifactorial assessment and treatment increased the risk of falls that led to injury, while combined exercise, patient-level quality improvement strategies, and social engagement increased the risk of experiencing a fall.   

Conclusion

Exercise on its own, as well as with various combinations of falls prevention strategies including: vision test and treatment, environmental checks and changes, clinical quality improvement, multifactorial assessment and treatment, calcium supplementation, and vitamin D supplementation can reduce the risk of falls leading to injuries. Combined exercise and vision assessment and treatment may be most beneficial.