General Content (cms) Extensive Cochrane review shows: fall prevention works

Less falls

Fall prevention training reduces the number of older people that fall by 15% and those who do fall, fall less often. Fall prevention lowered the number of falling incidents with almost a quarter compared to elderly who did not follow a fall prevention program, or an intervention that did not target fall prevention. A fall prevention program is also better than interventions that do not target falls, such as education, a social activity or very easy exercise. Both outcomes have a high degree of certainty, researchers say.

Training form

Especially fall prevention programs in which elderly do balance exercises or functional training, seem effective. Researchers determined with a high degree of certainty, that the number of falling incidents reduced with almost a quarter and the number of fallers with one eighth. Tai chi training also reduced the number of fallers by 20 percent. However, the 19 percent reduction in the number of falling incidents after tai chi was less certain. For strength training, dance training and walking training, researchers could not demonstrate a clear effect.

Supervison

When health care professionals supervised the fall prevention program, the number of falling incidents was 31 percent lower than with supervision of trained instructors who were not health care providers, but in both scenarios the number of falls reduced. For the number of fallers, the supervision did not make any difference. Whether participants were older than 75 years or had a higher risk of falling at the start, made no difference for the effect of fall prevention. Furthermore, the effect was equal for elderly who trained in groups and those who trained individually. The effects were less clear for elderly who were just discharged from the hospital.

Other outcome measures

Besides less falling, fall prevention training could reduce the risk of fall related medical care and fractures in elderly. However, this was not commonly reported, so the authors could not confirm this. The effect on hospital admissions or quality of life remains unclear. Although fall prevention training seems to have little unwanted effects, researchers warn for underreporting: only a quarter of the effect studies reported about this.

Training parameters

The programs differed too much to make a statement about the optimal training dosage. Researchers did notice that most training programs had a duration of at least three months; almost a third had a duration of a year or longer.

Participants

The 23,407 investigated elderly had a mean age of 76 years and more than three quarters was female. They lived independently in the community and had no diseases that could lead to a higher risk of falling, such as a stroke, Parkinson’s disease, MS or dementia.

Expert opinion by Ellen Smulders

Cochrane reviews are very extensive reviews that have to meet a lot of criteria. They are qualitatively well-designed studies, which findings can be valued highly.

The current Cochrane study again shows that exercise therapy is effective for reducing fall incidents in community dwelling older people. Moreover, it demonstrates a reduction in the number of fallers. It is less clear if exercise therapy also leads to less injury and fractures. This is only logical: approximately 10 percent of the falls leads to injuries, of which approximately half are fractures. To specifically investigate the reduction of fractures, the study should be 20 times as large as when only the effects of falling incidents are investigated. These studies are extremely difficult to set up and execute.

The Cochrane review shows that ‘single’ interventions such as dance and walking programs are less effective. Especially the programs with balance and functional exercises, combined with resistance training, show positive effects. Functional exercises are very important for elderly, because these are easier translated to a specific situation and therefore are better implemented in their daily activities of older people.

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Extensive Cochrane review shows: fall prevention works

...but which exercise modalities work best?