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 Researchers examined data from 238 previously published results with
a total of about 160,000 people age 65 or older. All of the studies
were experiments that randomly assigned participants to receive
exercise or other interventions for fall prevention, usual care such
as education, or no help at all.
Compared to usual care, people who were assigned to exercise
programs were 49 percent less likely to have a fall resulting in
injury, researchers report in JAMA.
Combining exercise with eye exams and treatment of vision problems,
meanwhile, was associated with 83 percent lower odds of a
fall-related injury, and case management along with comprehensive
geriatric assessments and certain vitamin supplements were tied to
88 percent lower odds.
Geriatric assessments look not only at seniors’ health but also at
whether their living environment could be made less hazardous.
“Prior to this study we didn’t know the most effective strategies
for fall prevention,” said senior study author Dr. Sharon Straus of
the University of Toronto.
“Exercise was found to be the intervention that was likely to be
most effective in preventing injurious falls,” Straus said by email.
“Preventing injurious falls is (critical) for older adults as these
falls can impact quality of life for patients.”
In the U.S. alone, an estimated 36 percent of adults over 65 fall
every two years, researchers note. Medicare, the U.S. health program
for people 65 and older, spent $31 billion on falls in 2012.
Many smaller studies have pointed to the potential for exercise to
help prevent falls by improving things like balance, coordination,
strength and flexibility. By looking at results across many of these
smaller studies, however, the current analysis offers a clearer
picture of which interventions may be the most effective for fall
prevention.
“This paper is remarkable,” said Dr. Eric Larson, author of an
accompanying editorial and executive director of the Kaiser
Permanente Washington Health Research Institute.
“Previously a person interested in this question could not possibly
have known what was most effective because there were so many
studies in so many settings,” Larson said by email. “What is new is
the prominence of exercise and the fact that those designing a
program could pick from a menu of just a few elements to add to
exercise - this allows individuals and program developers to focus
and avoid doing or advocating for things that don’t make a
difference.”
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The results add to the evidence that exercise should be recommended
for all older adults, said Saija Karinkanta of the UKK Institute for
Health Promotion Research in Tampere, Finland.
Usual care, which may involve little more than handing patients
flyers with tips on fall prevention, isn’t enough, Karinkanta, who
wasn’t involved in the study, said by email.
Exercise may also have the biggest impact when paired with other
interventions like making sure people can see well and checking
their homes for fall hazards, Karinkanta added.
One limitation of the study is that the many smaller experiments in
the analysis had tested different types of interventions and had
different ways of assessing the effectiveness of various approaches
to fall prevention, the authors note.
Still, it’s clear that exercise helps, said Stephen Lord, a
researcher on falls and injury prevention at Neuroscience Research
Australia (NeuRA) in Sydney who wasn’t involved in the study.
“The take home message is that simple interventions such as
exercise, vision checks and vitamin D supplementation (for those
with vitamin D insufficiency) can not only prevent falls, but also
fall injuries,” Lord said by email.
The type of exercise also matters, Lord added.
“Importantly, to be effective in preventing falls, exercises needs
to challenge balance, and cannot be of a low-intensity type, such as
regular walking,” Lord advised.
SOURCES: http://bit.ly/2zpALAo and http://bit.ly/2zqUfEU JAMA,
online November 7, 2017.
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