Interventions for preventing falls in older people living in the community

As people get older, they may fall more often for a variety of reasons including problems with balance, poor vision, and dementia. Up to 30% may fall per year. Although one in five falls may require medical attention, less than one in 10 results in a fracture. Fear of falling can result in self-restricted activity levels. It may not be possible to prevent falls completely, but people who tend to fall frequently may be enabled to fall less often.
This review looked at which methods are effective for older people living in the community, and includes 111 randomised controlled trials, with a total of 55,303 participants.

Exercise programmes may target strength, balance, flexibility, or endurance. Programmes that contain two or more of these components reduce rate of falls and number of people falling. Exercising in supervised groups, participating in Tai Chi, and carrying out individually prescribed exercise programmes at home are all effective.
Multifactorial interventions assess an individual person’s risk of falling, and then carry out or arrange referral for treatment to reduce their risk. They have been shown in some studies to be effective, but have been ineffective in others. Overall current evidence shows that they do reduce rate of falls in older people living in the community. These are complex interventions, and their effectiveness may be dependent on factors yet to be determined.

Taking vitamin D supplements probably does not reduce falls, except in people who have a low level of vitamin D in the blood. {most of the elderly!}These supplements may be associated with high levels of calcium in the blood, gastrointestinal discomfort, and kidney disorders.

Interventions to improve home safety do not seem to be effective, except in people at high risk, for example with severe visual impairment. An anti-slip shoe device worn in icy conditions can reduce falls.

Some medications increase the risk of falling. Ensuring that medications are reviewed and adjusted may be effective in reducing falls. Gradual withdrawal from some types of drugs for improving sleep, reducing anxiety and treating depression has been shown to reduce falls.

Cataract surgery reduces falls in people having the operation on the first affected eye. Insertion of a pacemaker can reduce falls in people with frequent falls associated with carotid sinus hypersensitivity, a condition which may result in changes in heart rate and blood pressure.