You may have seen, and marvelled at, recent video footage of an incredible 86 year old, Johanna Quaas, performing gymnastic feats on the parallel bars and mats of Turnier Der Meister exhibition floor. I sense that fear of falling is not something that’s in her head at all, but it is a significant concern for many older people and fear of falling can lead them to restrict their activities.
I have some good news for older people who hope that exercising will reduce their risk of falling. Evidence from a Cochrane review suggests that it will.The reviewers looked at evidence from 111 randomised controlled trials (RCTs) of a variety of interventions to reduce falls in 55,303 older people living in the community (rather than in institutions). Most of the studies excluded older people with dementia, so the results may not be applicable to that population. Here’s what they found:
- Exercise programmes (43 RTCs) targeted strength, balance, flexibility, or endurance, alone or in combination. Programmes that contained two or more of these components reduced the rate of falls and risk of falling (rate ratio (RaR) 0.78, 95%CI 0.71 to 0.86; risk ratio (RR) 0.83, 95%CI 0.72 to 0.97)
- Exercising in supervised groups, participating in Tai Chi, and carrying out individually prescribed exercise programmes at home were all effective
- Multifactorial interventions (which assess a person’s risk of falling and then refer them for treatment to reduce their risk) reduced the rate of falls but not risk of falling. These are complex interventions and their effectiveness may be dependent on factors yet to be determined
- Vitamin D did not reduce falls but may do so in people with low vitamin D levels
- Overall, home safety interventions did not reduce falls but were effective in people at high risk, including those with a severe visual impairment
- One small RCT found an anti-slip shoe device reduced falls in icy conditions
- Two RCTs found cataract surgery reduced falls in people having surgery on the first eye
- Insertion of a pacemaker reduced falls in people in one trial who had frequent falls associated with carotid sinus hypersensitivity, a condition which may result in changes in heart rate and blood pressure
The authors concluded:
“Exercise interventions reduce risk and rate of falls. Research is needed to confirm the contexts in which multifactorial assessment and intervention, home safety interventions, vitamin D supplementation, and other interventions are effective.”
How good is the evidence?
This systematic review, conducted to Cochrane’s usual high standards, brought together evidence from a large number of trials and participants. On the down side, the authors judged half the included studies to be at high or unclear risk of bias in participants’ recall of falls and many studies did not clearly report their methods. Some lacked a clear definition of the outcome of interest, falling, and there was variation in how falls were identified, analysed and reported.
This review contains some useful suggestions for those designing trials on falls prevention and an optimistic message about exercise for older people, so smile as you head out to your exercise class and take a look at Johanna Quaas to be cheered by what can be achieved at such an age!
Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH. Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD007146. DOI: 10.1002/14651858.CD007146.pub2.
Cochrane summary and podcast of this review.
Time Newsfeed Watch: 86-Year-Old Gymnast Wows Crowds. 1st April 2012