Exercise & Home Modification Most Effective to Prevent Falls in Seniors, New Study Finds

Exercise including strength training & home safety modification most effective to prevent falls in seniors, new study finds.New research published September 12 in The Cochrane Library has found that of several fall-prevention methods studied, exercise including strength and balance training was most effective in reducing the risk of falling for seniors.

Modifications of the home to make it safer were also effective to prevent slips and falls.

In the new study, Lesley D. Gillespie and M. Clare Robertson, both of the University of Otago School of Medicine in Dunedin, New Zealand, and colleagues, reviewed 159 previous randomised controlled trials with 79,193 senior participants, which measured which fall prevention interventions are effective for older adults living in the community.

“The strongest evidence is for exercise that contains multiple components such as strength and balance training, whether carried out in groups or prescribed for people in their homes,” Lesley Gillespie and Clare Robertson, authors of the new research review, told Reuters Health.

“These programs appear to reduce the number of falls experienced by about on average 30 percent and the number of people falling by about 20 percent,” they said.

About a third of Americans over 65 fall each year, resulting in nearly 20,000 deaths and more than two million emergency room visits, according to the U.S. Centers for Disease Control and Prevention (CDC).

The new findings suggest that with the right interventions, those numbers could be much lower.

The Study; Methods

The authors searched the scientific literature and selected 159 previously conducted trials with 79,193 participants. In most of the trials, the participants had been randomly assigned to a fall prevention program, a program not designed to decrease falls, or no intervention. The most common interventions tested were exercise as a single intervention (59 trials) and multifactorial programs (40 trials). Several other interventions were also included in the trials.

After controlling for potential confounding factors, and extracting data to avoid risk of bias, the researchers applied statistical analysis, pooling the data of the trials where they deemed appropriate.

Findings

Exercise

The researchers found that in the studies evaluated, group and home-based exercise programs, usually containing some balance and strength training exercises, significantly reduced falls, as did Tai Chi.

Group exercise reduced the rate of falls by approximately 30% and reduced the risk of falling by about 15%. Home-based exercise, containing some strength and balance training, reduced the rate of falls by 32% and reduced the risk of falling by 17%. Tai Chi reduced the rate of falls by about 28% and reduced the risk of falling by 29%.

Modifications of the Home to Make it Safer

“Home safety assessment and modification interventions” to make the home safer were also effective in reducing falls. These interventions reduced the rate of falls by 19% and reduced the risk of falling by 12%. The researchers found that “these interventions were more effective in people at higher risk of falling, including those with severe visual impairment.” “Home safety interventions appear to be more effective when delivered by an occupational therapist,” the researchers also observed.

According to data released earlier this year by the CDC, nearly 38,000 Americans 65 and older are treated in Emergency Rooms each year after tripping on a rug or a carpet. And, more than a third of the falls happen in the bathroom.

Ways to make your home safer include installing grab bars in the bathroom, and using non-slip mats in the bathtub and non-skid rugs or mats in potentially slippery places, like bathrooms, getting rid of small rugs elsewhere in the house or taping them to the floor, securing electrical and phone cords out of traffic areas, arranging furniture to provide open pathways to walk through, improving lighting around the house, and installing handrails on stairways and porches, according to a Fact Sheet provided by the National Safety Council.

A more comprehensive 8 page Home Fall Prevention Checklist for Older Adults was prepared by The CDC in conjunction with MetLife Foundation.

Other Interventions: Safer Shoes, Reduction of Medications, Cataract Surgery, and Others

Other interventions found effective by the researchers in the new study included wearing an anti-slip device on the shoes in icy conditions, and reviewing medications with family physicians and gradual reduction in sleeping medication and certain types of psychotropic medication.

In addition, the researchers found that “Cataract surgery reduces falls in women having the operation on the first affected eye,” but subsequent cataract surgeries appeared to have no effect on rate or risk of falls.

“Insertion of a pacemaker can reduce falls in people with frequent falls associated with carotid sinus hypersensitivity, a condition which causes sudden changes in heart rate and blood pressure,” the researchers also found.

And, “in people with disabling foot pain, the addition of footwear assessment, customised insoles, and foot and ankle exercises to regular podiatry reduced the number of falls but not the number of people falling,” the researchers wrote.

However, “taking vitamin D supplements does not appear to reduce falls in most community-dwelling older people, but may do so in those who have lower vitamin D levels in the blood before treatment,” the data suggested.

As to the provision of educational materials alone for preventing falls, the authors said the evidence is inconclusive.

Conclusions

In conclusion, the authors wrote:

“Group and home-based exercise programmes, and home safety interventions reduce rate of falls and risk of falling.

Multifactorial assessment and intervention programmes 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.”

“As people get older, they may fall more often for a variety of reasons including problems with balance, poor vision, and dementia,” the authors stated in a summary of their findings.

“If someone is worried about falling they should talk to their family physician or any health professional they are attending as there may be a specific cause or causes that can be addressed,” the researchers told Reuters Health.

More Information

The new study, “Interventions for preventing falls in older people living in the community,” is published and available in its entirety in the September 12, 2012 online edition of The Cochrane Library.

See related HelpingYouCare® reports on:

National Safety Month Focuses on Preventing Slips, Trips & Falls among Older Adults

Dizziness & Balance Disorders Arise from Conditions Common with Aging, Experts Report

Experts Advocate Dancing for Health

Prevent Falls by Older Adults

For more news and information on prevention of falls and mobility loss for seniors, see the HelpingYouCare® resource pages on Falls/ Fractures/ Mobility Loss, including:

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