Helping older people in care homes and hospitals to avoid falls: new Cochrane evidence

We all know that falls can have very serious consequences for older people, and there are around three times as many falls amongst the over 65s in care homes and hospitals than out in the community. Back in the summer, I blogged about a Cochrane review on strategies to prevent falls in this population and this has now been updated.

The additional studies have roughly doubled the number of study participants included in the review, more than 60,000 over 65s in 60 randomised controlled trials (RCTs). It’s particularly disappointing, then, that probems with the way many studies were conducted and reported means that the evidence isn’t very good. The RCTs tested a variety of interventions in many different care facilities in 15 countries, but a lack of detail about the level of care and case mix and about the interventions themselves make the results less helpful than they should be.

The main findings are that:

  • High doses of vitamin D supplements (700 to 1000 IU per day) reduced falls in care home residents, who had low levels of vitamin D to start with
  • Interventions with multiple components, linked to each person’s risk profile, reduced the rate of falls in hospitals; the effect in care homes was unclear
  • The results of the 13 RCTs testing exercise strategies were inconsistent

There was much better evidence in the companion review on interventiions for preventing falls in older people living in the community, with exercise programmes and home safety interventions emerging as helpful approaches. You can read my blog on that here.

So something as simple as making sure our senior ones have enough vitamin D can help to keep them on their feet. Old age and lack of  exposure to sunlight are both factors which put people in care homes at high risk of vitamin D deficiency, before we even get onto any factors relating to diet (and we can’t generally get enough vitamin D from our diets alone anyway). The Chief Medical Officer for England issued a reminder about the problem of vitamin D deficiency and the Department of Health recommendations on supplementation back in February and you can read my blog about this here.

It’s a reminder that, sometimes, it’s the little things that really count.

Links:

Cameron ID, Gillespie LD, Robertson MC, Murray GR, Hill KD, Cumming RG, Kerse N. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD005465. DOI:10.1002/14651858.CD005465.pub3. Cochrane summary and podcast of this review.

If you are interested in the Cochrane review on preventing falls in older people living in the community, you can find the review and my blog on it here:

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.

Lifestyle Elf blog: New Cochrane review has strong evidence that some interventions can reduce falls in older people

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Sarah Chapman

My name is Sarah Chapman. I have worked on systematic reviews and other types of research in many areas of health for the past 17 years, for the Cochrane Collaboration and for several UK higher education institutions including the University of Oxford and the Royal College of Nursing Institute. I also have a background in nursing and in the study of the History of Medicine.

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