A new review of more than 50 clinical trials, designed to update prevention recommendations for physicians, fnds exercise and vitamin D supplements are the most effective ways to prevent falls in older adults. The report says exercise was associated with a 13% reduction in the risk of falling, while trials of vitamin D supplementa- tion saw a 17% reduction in falls. The review will be used to update the US Preventive Services Task Force (USPSTF) recommendations for strate- gies to prevent falls.
Our evidence review shows that exercise and vitamin D supplementa- tion are the most effective primary care interventions to prevent falls, says lead author Yvonne L. Michael, ScD, MS, of the Drexel University School of Public Health. This is important news because falls are extremely common in this population and they are the leading cause of death and injury for the elderly. We need to help primary care clinicians fnd better ways to prevent falls, and this review will help to do that.
Michael and colleagues reviewed 54 randomized controlled trials-out of more than 4,000 studies that were screened-totaling 26,101 participants ages 65 and older. Of these, 18 studied exercise and physical therapy involv- ing nearly 4,000 people. Some of the trials involved group exercise or Thai Chi classes; others involved individu- alized exercise instruction at home. Although a variety of exercises were studied, most were aimed at improving gait, balance, strength and fexibility needed to do everyday activities. The interventions ranged from six weeks to 12 months or longer and the evaluation periods lasted up to 18 months after the programs ended.
When taken individually, most of these trials of exercise and fall preven- tion showed no statistical difference. But when the results were pooled to- gether, the exercisers had a 13% lower risk of falling compared to those who did not exercise.
R esearchers evaluated nine clinical trials of vitamin D supplementa- tion totaling nearly 6,000 partici- pants who received daily oral doses of vitamin D with or without calcium. The supplements ranged up to 1,000 IUs per day, and in one trial partici- pants received a larger single intramus- cular injection of vitamin D. The trials lasted from eight weeks to three years, and follow-up periods ranged from 6 to 36 months. When results from the nine studies were combined, participants who received extra vitamin D had a 17% reduced risk of falling compared to those in control groups.
An expert committee of the Institute of Medicine (IOM), which sets recommended daily levels for nutrients, recently increased its recommendations for vitamin D (see the February 2011 Healthletter). The IOM now says children and adults under age 71 need 600 IU of vitamin D daily, while older adults need 800 IU. Other expert panels have stated that people at risk for vitamin D def- ciency, including patients with osteoporosis, need even higher amounts-which can be diffcult to achieve from diet alone.
Michael and colleagues also looked at other interventions that addressed single risk factors for falls, including vision correction, medication assessment, home hazard modifca- tion, and education and behavioral counseling. These did not signifcantly reduce the risk of falling in the elderly.
Interventions that provided comprehensive risk assess- ment and management did reduce the risk of falling by 11%. In these trials-called multifactorial assessment and manage- ment interventions-healthcare providers evaluated and man-aged multiple risk factors including medication use, visual problems, home environment and gait and balance issues. In many of the successful trials, home health nurses or case managers developed an individual tailored approach.
The Rising Cost of Falls
According to the USPSTF review:
- 30%-40% of community-dwelling Americans ages 65 and older fall at least once a year.
- Falls are the leading cause of injury among seniors.
- In 2003, falls were the number-one cause of injury deaths and ninth leading cause of death overall for people 65 and older.
- In 2004, US hospitals treated more than 1.8 million older adults for fall-related injuries and more than 433,000 were hospitalized.
Annals of Internal Medicine, Dec. 21, 2010; abstract at www.annals.org/content/153/12/815.abstract?aimhp