Effective interventions to reduce falls in the elderly

A Cochrane review of falls prevention in the elderly was recently published, describing effective and ineffective interventions. The authors note that approximately 30% of people over age 65 living in the community fall each year, however fewer than 1 in 10 falls result in fracture.

The authors reviewed 159 trials including over 79,000 participants, and for a number of interventions reported both a rate ratio (RaR) for the rate of falls (falls per person per year) and a risk ratio (RR) for the risk of falling.

Interventions effective reducing falls:

  • Multiple-component group exercise (usually incorporating balance and strengthening activities) (RaR 0.71 [0.63-0.82], RR 0.85 [0.76-0.96])
  • Mulitple-component home-based exercise (usually incorporating balance and strengthening activities) (RaR 0.68 [0.58-0.80], RR 0.78 [0.64-0.94])
  • Home safety assessment and modifications (particularly for patients with visual impairement and when evaluations were completed by occupational therapists) (RaR 0.81 [0.68-0.97], RR 0.88 [0.80-0.96])
  • Pacemaker insertion (for patients with carotid sinus hypersensitivity) (RaR 0.73 [0.57-0.93])
  • Cataract surgery on the first affected eye (although removal of cataract from the second affected eye di not reduce risk further) (RaR 0.66 [0.45-0.95])
  • Participation in Tai Chi (RR 0.71 [0.57-0.87])
  • Gradual withdrawal of psychotropic medication and patient-specific prescription modification by general practitioners
  • Anti-slip shoe devices (for patients walking on icy streets)

Interventions not effective in reducing falls:

  • Vit D (although this may reduce falls in people with low Vit D levels at baseline)
  • New use of multi-focal eyeglasses (risk was increased)
  • Cognitive behavioural interventions and falls prevention education

Source:

Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE. Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD007146. DOI: 10.1002/14651858.CD007146.pub3. Abstract accessed on-line 16 Sept.: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007146.pub3/abstract