A systematic review of more than 50 clinical trials finds that exercise and vitamin D supplements are the best ways to reduce the risk of falling in people aged 65 years and older. The review is published in the Annals of Internal Medicine and was commissioned by the U.S. Preventive Services Task Force. A researcher at the Drexel University School of Public Health worked with colleagues at the Kaiser Permanente Center for Health Research, which is part of the Oregon Evidenced-Based Practice Center, to conduct the study.
“Our evidence review shows that exercise and vitamin D supplementation are the most effective primary care interventions to prevent falls,” Yvonne L. Michael, ScD, MS, an associate professor at the Drexel University School of Public Health and lead review author of the report, stated in a press release. “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 find better ways to prevent falls, and this review will help to do that.”
Michael and her colleagues evaluated 18 clinical trials of exercise and physical therapy involving nearly 4,000 people who were aged 65 years or older. Some of the trials involved group exercise or Thai Chi classes; others involved individualized exercise instruction at home. There were a variety of exercises included but most were aimed at improving gait, balance, strength and flexibility needed to do everyday activities. The interventions ranged from 6 weeks to 12 months or longer and the evaluation periods lasted as long as 18 months after the programs ended. When taken individually most of these trials showed no statistical difference, but when the results were pooled together the exercisers had a 13% lower risk of falling compared to those who did not exercise.
For the review of vitamin D supplementation researchers evaluated nine clinical trials involving nearly 6,000 participants who received daily oral doses of vitamin D with or without calcium. The dosage ranged from 10 to 1,000 IU’s per day, in one trial participants received a larger single intramuscular injection of 600,000 IU’s of vitamin D. The trials lasted from 8 weeks to 3 years. Follow up periods ranged from 6 to 36 months. Participants who received vitamin D had a 17% reduced risk of falling, compared to participants who did not receive vitamin D.
Other interventions that addressed single risk factors including vision correction, medication assessment, home hazard modification, and education and behavioral counseling did not significantly reduce the risk of falling in the elderly. Interventions that provided comprehensive risk assessment and management did reduce the risk of falling by 11%. In these trials — called multifactorial assessment and management interventions — health care providers evaluated and managed 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 specifically for that participant. For example, the nurse might conduct a home visit to remove obstacles, help the patient enroll in an exercise class to improve balance, and help the patient get in to see an ophthalmologist to address a vision problem.
