Adding other therapy to exercise may be best for fall prevention

8 November 2017: Older adults who exercise may be half as likely to fall as their inactive counterparts, and adding therapies like eye exams, vitamins and home repairs may lower the risk even more, a research review suggests.

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.”

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.