JAMA Research: Elderly Deaths From Falls Increase

Home-Based Exercise Program Significantly Reduces Subsequent Falls

June 12, 2019 01:40 pm News Staff – Death rates from falls for U.S. adults age 75 and older more than doubled from nearly 52 per 100,000 people in 2000 to 122 per 100,000 in 2016.

The reasons for these increases aren't fully known, the authors said, although they noted that misclassification or incomplete recording of causes of death could have resulted in overestimation or underestimation of deaths from falls.

The research letter said these findings are consistent with data from Europe, although the mortality rates from falls were lower among the oldest population in the United States compared with the Netherlands. The authors said this could possibly be explained by differences between the two countries in both demographic composition (e.g., the population share of non-Hispanic whites) and activity patterns (e.g., rates of outdoor activities such as walking and cycling) of the older populations.

Preliminary communication from a separate study also published in JAMA June 4 may point to a solution for reducing these falls in older adults and related mortality.

This single-blind, randomized clinical trial found that among older adults receiving care at a fall prevention clinic after a fall, use of a home-based strength and balance retraining exercise program significantly reduced the rate of subsequent falls compared with usual care provided by a geriatrician.

During a mean followup of 338 days, 236 falls occurred among 172 participants in the exercise group versus 366 falls among 172 participants in usual care.

Those who participated had a mean age of 81.6; 67% were women.

Conducted from April 22, 2009, to June 5, 2018, the study recruited adults age 70 and older who had fallen within the past 12 months from a fall prevention clinic. Participants were randomly assigned in a 1:1 ratio to receive either the home-based Otago Exercise Program plus usual care or usual care only.

The Otago Exercise Program is an individualized home-based balance and strength retraining program delivered by a physical therapist that includes five strengthening and 11 balance retraining exercises. The physical therapy aim was to progress participants to a greater level of difficulty of each exercise over time.

The physical therapist returned biweekly for three additional visits to adjust the intervention. Visits in the first two months took one hour. The physical therapist's fifth and final visit occurred six months after baseline. Participants were asked to perform exercises three times per week and walk 30 minutes at least twice per week.

Participants were evaluated and treated by geriatricians at baseline and six and 12 months after randomization. To ensure geriatricians remained blinded, participants were reminded not to disclose their group assignment during followup visits.

Mean adherence to the balance and strength retraining component was 63%, while mean adherence to the walking component was 127% (due to exceeding the twice-weekly threshold). No adherence data were obtained from 13 participants who dropped out within two months after randomization.

The authors concluded that these findings support the use of this home-based exercise program for secondary fall prevention but require replication in other clinical settings.