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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.
In people 65 years of age and older who live in the community, what can be done to prevent falls and related injuries?
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.
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
Exercise helps to prevent falls in people 65 years of age and older who live in the community.
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.
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).
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
A comprehensive evaluation of the available research evidence on a particular topic.
Related Evidence Summaries
JAMA: Journal of the American Medical Association (2017)
JBI Database of Systematic Reviews and Implementation Reports (2017)
Cochrane Database of Systematic Reviews (2012)
Related Web Resources
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DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal