Exercise helps to prevent falls in older people living in the community

Grossman DC, Curry SJ, Owens DK, et al. Les interventions visant à prévenir les chutes chez les personnes âgées vivant dans la communauté: un énoncé de recommandations du U.S. Preventive Services Task Force. JAMA. 2018;319:1696-1704.

Review question

In people 65 years of age and older who live in the community, what can be done to prevent falls and related injuries?

Background

People 65 years of age and older are more likely to fall, and falls often lead to injuries. There are many reasons why someone may fall, including problems with gait, balance, muscle weakness, and poor vision. It is uncertain whether there is anything that can be done to prevent falls.

How the review was done

The researchers did a systematic review based on studies available up to August 2016.

They found 54 randomized controlled trials with thousands of people.

The people in the studies:

• were 65 years of age or older and lived in the community (at home or with a family member, but not in a nursing home or hospital);
• had an average or high risk for falls (some already had previous falls); and
• did not have osteoporosis or vitamin D deficiency.

Activities assessed to prevent falls included:

• exercise (e.g., general physical activity; tai chi; and gait, balance, functional, resistance, flexibility, and endurance training);
• personalized assessment followed by an action plan that could include exercise, psychological interventions, nutrition therapy, medication management, education, environmental modification, urinary incontinence management, physical and occupational therapy, social and community services, or referral to specialists; and
• vitamin D supplements.

What the researchers found

The findings are summarized in the Table below.

Conclusions

Exercise helps to prevent falls in people 65 years of age and older who live in the community. For people who have already had a fall or are at high risk for falling, a personalized assessment by their doctor or a specialist, followed by an action plan, may help to reduce the number of falls. Taking vitamin D does not reduce the risk for falling in people who are not known to have osteoporosis or vitamin D deficiency.

Summary of the evidence for preventing falls in older adults living in the community