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Exercise alone and various combinations of interventions reduces the risk of injurious falls in older adults
Clinical Question
Are there specific interventions that are effective in reducing the risk of injurious falls in older adults?
Bottom line
Exercise alone; exercise combined with vision assessment/treatment; exercise combined with vision assessment/treatment and environmental assessment/modification; and clinic-level quality improvement strategies combined with multifactorial assessment/treatment and calcium and vitamin D supplementation are all effective interventions for reducing the risk of injurious falls in older adults. 1a
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Foundation
Setting: Various (meta-analysis)
Synopsis
These investigators thoroughly searched multiple databases including MEDLINE, EMBASE, the Cochrane Register, Ageline, and reference lists of relevant trials and reviews for randomized controlled trials that examined fall-prevention interventions for adults 65 years or older. Study authors were also contacted for unpublished studies or additional data. Two investigators independently reviewed all potential studies for inclusion criteria and methodologic quality using standard risk-of-bias scoring tools. Conflicts were resolved by consensus agreement with a third reviewer. The primary outcome of interest was the number of injurious falls and fall-related hospitalizations. A total of 283 randomized trials and 20 companion reports (N = 159,910 participants) met inclusion criteria. The overall risk of bias among the studies was moderate, with an unclear risk of bias for allocation concealment, contamination, and selective outcome reporting. A funnel plot analysis found no evidence of publication bias. Four interventions were significantly associated with a reduced risk of injurious falls compared with usual care: exercise alone; combined exercise and vision assessment and treatment; combined exercise, vision assessment and treatment, and environmental assessment and modification; and combined clinic-level quality improvement strategies, multifactorial assessment and treatment, calcium supplementation and vitamin D supplementation. Combined exercise and vision assessment and treatment was the most effective intervention. In a subgroup analysis, the best intervention for reducing the risk of hip fracture was combined osteoporosis treatment, calcium supplementation, and vitamin D supplementation.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
I follow these recommendations
Good poem
In sever cases using cane walker and wheelchair has been more effective , Vision was not significant factor since most of people has regular check up and correction , Low BP and low blood sugar has been important factor These people may complain of feeling dizzy or dark vision when changing position in office , always check for carotid bruit.
This MA makes sense.
The subgroup analysis basically reiterates that osteoporosis treatment makes sense.
The vision bit surprised me as in my practise I always ask and advise when people have had their eyes checked and that they should be current in their examinations. They usually are.
The exercise bit is great - it seems to work. The question is exactly what is the exercise? I think that the simplest that works should be pushed out to everyone!
This is what we do in practise, but it is nice to see the evidence backing it up.