Patient-Oriented Evidence That Matters

Exercise Alone and Various Combinations of Interventions Reduce the Risk of Injurious Falls in Older Adults


Am Fam Physician. 2018 May 1;97(9):606-607.

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 and treatment; exercise combined with vision assessment and treatment, and environmental assessment and modification; and clinic-level quality improvement strategies combined with multifactorial assessment and treatment, calcium supplementation, and vitamin D supplementation are all effective interventions for reducing the risk of injurious falls in older adults. (Level of Evidence = 1a)


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 Study authors were also contacted for unpublished studies or additional data.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 supplemen

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.

A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.



Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP

Editor's Collections

Related Content

More in Pubmed


Feb 15, 2019

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article