Although few falls result in serious injuries, they may have many additional
impacts on an older person's quality of life. For example, after a fall, they
may feel less confident and decide to restrict their own activities to avoid
further accidents. It is therefore important to consider how falls can be prevented
in order to provide peace of mind for those at risk, as well as family members.
Exercise may help to prevent falls by improving strength, flexibility, balance,
and endurance. Programmes that contain a combination of these components reduce
falls. These include exercising in supervised groups, participating in Tai Chi,
and carrying out individually prescribed exercise programmes at home, says lead
researcher Lesley Gillespie, who is based at Dunedin School of Medicine at the
University of Otago in New Zealand. What remains less clear is whether some
other interventions really do reduce falls. Some may be of more benefit to those
at higher risk of falling. There also seem to be differences in the effectiveness
of some kinds of interventions when carried out in different health care settings.
Researchers reviewed data from 111 trials that included 55,303 older people
altogether. As well as trials focused on group and individual home-based exercise
programmes, they considered interventions such as vitamin D for reducing muscle
weakness, home safety improvements, cataract surgery for improving vision, and
combination interventions based on individual assessments.
Those who took part in exercise programmes were less likely to suffer a fall
and individuals fell less frequently than those who did not. Combination interventions
based on individual assessments also reduce falls. There was evidence from single
trials that falls are reduced by some other interventions: gradual withdrawal
from some types of drugs taken to improve sleep, reduce anxiety and treat depression;
bringing forward cataract surgery on the first affected eye, and anti-slip shoes
for icy conditions. Vitamin D showed potential for reducing the risk of falls
only in those with vitamin D deficiencies. Home interventions were relatively
unsuccessful, except in high-risk groups.
Gillespie says further research may help to determine which components are
crucial to an effective exercise programme. We need more research to see which
components of an exercise programme are most important, but the trials would
need to be large trials to discern any differences, she says.
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