New Cochrane review has strong evidence that some interventions can reduce falls in older people

The Elf Mother is worried about falling, as well she might be, for a fall can have serious consequences in later life and may mean that a person who had been living independently is no longer able to do so. Around 30% of people aged over 65 and living in the community fall each year. Today’s new evidence from the Cochrane Collaboration’s Bone, Joint and Muscle Trauma Group is important for all those concerned with preventing falls in older people living at home.

I have previously blogged about their review on this topic, but today’s update adds a large body of new evidence which enabled the reviewers to reach more, and firmer, conclusions. The review now includes 159 randomised controlled trials, involving 79,193 people. Most compared a falls prevention intervention with one not expected to prevent falls, or with no intervention. Data were combined where appropriate. Here’s what they found:

  • Multi-component group exercise classes and exercises at home significantly reduced the rate of falls and risk of falling. Tai Chi as a group exercise reduces risk of falling but is less effective in people at higher risk of falling
  • Multifactorial interventions, involving individual assessment and intervention through a multidisciplinary team, reduced the rate of falls but not the risk of falling
  • Home safety interventions reduced the rate and risk of falls and were most effective for people at higher risk of falling, including those with severe visual impairment. They were most effective when delivered by an occupational therapist
  • Giving single lens glasses to wearers of multifocal glasses significantly reduced falls in people who regularly took part in outside activity, but significantly increased falls outdoors in those who took little part in outside activity
  • People with particular heart rate disorders (carotid sinus hypersensitivity) who were given pacemakers fell less often than those without pacemakers
  • First eye cataract surgery in women, but not second eye, reduced the rate of falls
  • Gradual withdrawal of psychotropic medicine reduced the rate of falls
  • An anti-slip shoe device reduced the rate of falls in icy conditions
  • Overall vitamin D did not reduce the rate or risk of falls but may do so in people with lower levels of vitamin D
  • The evidence relating to the use of educational materials alone is inconclusive
  • No evidence of effect for cognitive behavioural interventions on rate or risk of falls
  • Three trials showed that interventions saved more money than they cost

Some limitations:

  • Overall the review provides good evidence of effectiveness, but the reviewers note that falling was not aways defined in the same way, or at all, and that this can alter the significance of the results
  • There was variability in the methods used for recording, analysing and reporting falls
  • Most of the trials excluded people with cognitive impairment so the results may not apply to this important group

The authors concluded:

There is strong evidence that certain exercise programmes prevent falls. Group and home-based exercise programmes, and home saftey interventions, reduce rate of falls and risk of falling. Multifactorial assessment and intervention programmes reduce rate of falls but not risk of falling.  Tai Chi reduces risk of falling.

This review makes a really valuable addition to what is known about preventing falls in this population. The Elf Mother can take heart, for although she has finally given up her gym membership, it looks like starting a programme of exercises at home is really worth doing. I know from my twitter followers that many of you more senior folk feel passionately about your exercise, and it’s great that as well as making you feel better there’s good evidence that it’s helping to keep you on your feet too.

Link:

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.

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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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