Cochrane for Clinicians
Putting Evidence into Practice
Interventions for Preventing Falls Among Older Adults Living in the Community
Am Fam Physician. 2017 Feb 1;95(3):152-153.
Author disclosure: No relevant financial affiliations.
Are interventions for preventing falls effective for older adults living in the community?
Structured exercise programs and home safety interventions reduce both the rate and the risk of falling among community-dwelling adults 65 years and older, whereas multifactorial assessment and intervention programs reduce the rate of falls but not the risk of falling. Vitamin D supplementation does not reduce the rate of falls or risk of falling in all patients. Education about fall prevention does not significantly reduce the rate or risk of falling.1 (Strength of Recommendation: B, based on inconsistent or limited quality patient-oriented evidence.)
One out of every three persons 65 years and older falls each year, and falling once doubles a person's chances of falling again.2 One out of every five such falls causes a serious injury, such as broken bones or a head injury.3 In addition, falls have a large economic impact on society. The average cost of hospitalization for a fall-related injury among persons older than 65 years is more than $17,000, not including indirect costs such as loss of productivity.4 Identified risks include lower body weakness, poor balance, home hazards, vitamin D deficiency, and medication use.3
This updated systematic review included 159 randomized controlled trials with 79,193 participants, all of whom were older adults (generally defined as age 65 years and older) living in the community.1 In this review, the risk of falling refers to the likelihood that a person will experience a fall within one year, whereas the rate of falls is the mean number of falls per year. Group exercise programs, consisting of two or more components of exercise, significantly reduced the rate of falls (rate ratio [RaR] = 0.71; 95% confidence interval [CI], 0.63 to 0.82), as did multicomponent home exercise programs (RaR = 0.68; 95% CI, 0.58 to 0.80). The components of the group and home-based exercise programs included balance
REFERENCESshow all references
1. Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012;(9):CD007146....
2. American Geriatrics Society. Clinical practice guideline: prevention of falls in older persons. http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/prevention_of_falls_summary_of_recommendations. Accessed March 21, 2016.
3. Centers for Disease Control and Prevention. Older adult falls. http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html. Accessed March 21, 2016.
4. Roudsari BS, Ebel BE, Corso PS, Molinari NA, Koepsell TD. The acute medical care costs of fall-related injuries among the U.S. older adults. Injury. 2005;36(11):1316–1322.
These are summaries of reviews from the Cochrane Library.
This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.
A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.
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