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Evidence Summary

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Exercise helps to prevent falls in older people living in the community

Grossman DC, Curry SJ, Owens DK, et al. Interventions to Prevent Falls in Community-Dwelling Older Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319:1696-1704.

Review question

In people 65 years of age and older who live in the community, what can be done to prevent falls and related injuries?

Background

People 65 years of age and older are more likely to fall, and falls often lead to injuries. There are many reasons why someone may fall, including problems with gait, balance, muscle weakness, and poor vision. It is uncertain whether there is anything that can be done to prevent falls.

How the review was done

The researchers did a systematic review based on studies available up to August 2016.

They found 54 randomized controlled trials with thousands of people.

The people in the studies:

  • were 65 years of age or older and lived in the community (at home or with a family member, but not in a nursing home or hospital);
  • had an average or high risk for falls (some already had previous falls); and
  • did not have osteoporosis or vitamin D deficiency.

Activities assessed to prevent falls included:

  • exercise (e.g., general physical activity; tai chi; and gait, balance, functional, resistance, flexibility, and endurance training);
  • personalized assessment followed by an action plan that could include exercise, psychological interventions, nutrition therapy, medication management, education, environmental modification, urinary incontinence management, physical and occupational therapy, social and community services, or referral to specialists; and
  • vitamin D supplements.

What the researchers found

The findings are summarized in the Table below.

Conclusions

Exercise helps to prevent falls in people 65 years of age and older who live in the community. For people who have already had a fall or are at high risk for falling, a personalized assessment by their doctor or a specialist, followed by an action plan, may help to reduce the number of falls. Taking vitamin D does not reduce the risk for falling in people who are not known to have osteoporosis or vitamin D deficiency.

Summary of the evidence for preventing falls in older adults living in the community

Statements

Strength of evidence

Evidence

Exercise helps to prevent falls in people 65 years of age and older who live in the community.

Moderate

Exercise reduced the number of people who fell (15 trials, 4926 people) and the risk for a person to have a fall that resulted in injury (10 trials, 4622 people).

Some people who exercised had minor pain or bruising (8 trials, 4107 people), but they did not have an increased risk for serious injuries (2 trials).

For people who have already had a fall or are at high risk for falls, a personalized assessment by their doctor or a specialist, followed by an action plan, may help to reduce the number of falls.

Low

Personalized assessment followed by an action plan reduced the risk for falls (17 trials, 9737 people).

Taking vitamin D does not reduce the risk for falls in people who are not known to have osteoporosis or vitamin D deficiency.

Moderate to high

Vitamin D did not affect risk for falls (5 trials, 3496 people), the number of people who fell (6 trials, 6519 people), or the risk of dying (6 RCTs, 7084 people).

Risk for falls may be increased with high doses of vitamin D (500,000 IU per year).

 




Glossary

Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

Related Web Resources

  • Too fit to fracture: Managing osteoporosis through exercise

    Osteoporosis Canada
    If you have osteoporosis, it is recommended to exercise regularly. A physical therapist or kinesiologist can give you advice on what type of exercise is best for you. You should do a combination of strength, posture, balance, and aerobic exercise.
  • Improving housing to improve health - warmth and space are key

    Evidently Cochrane
    Poor housing is associated with poor health. Research shows cold, damp and overcrowded homes can have a negative impact on your respiratory health.
  • Evidently Advent - Fear of falling

    Evidently Cochrane
    Try exercise (such as Tai Chi) and home safety changes to help prevent falling. Exercise may have small benefits for improving fear of falling. Resource includes a video.
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