Physical activity interventions to prevent falls among older people: update of the evidence (original) (raw)
Related papers
Preventing falls and subsequent injury in older people
Quality and Safety in Health Care, 1996
This paper is based on Effective Health Care, Vol 2, No 4, which is a systematic review of the evidence for the effectiveness of interventions to prevent falls and subsequent injury in older people.' The relevant literature was identified by a search of several computerised databases (Social Science Citation Index (BIDS), PSYCHLIT, EMBASE, RCN database, AMED, and UNCOVER), citation in identified papers and previous reviews, and contributions from peer reviewers and other experts in the field. Only randomised controlled trials evaluating the effectiveness of preventive interventions which measured the effect on falls, injuries related to falls, or change in a risk factor for falls were included.
Preventing falls among older adults: no "one size suits all" intervention strategy
Journal of rehabilitation research and development, 2008
Physical activity (exercise) serves primary, secondary, and tertiary roles in the prevention of falls among older adults. In its primary role, physical activity can prevent the onset of pathology and system impairments that lead to disability and increased risk for falls. Slowing the progression of disease and system impairments is its secondary role, while its tertiary role lies in the restoration of function to a level that allows for more autonomy in the performance of essential activities of daily living. Whether used as a stand-alone strategy or a core component of a multifactorial intervention approach, exercise constitutes an effective means by which to reduce fall risk and/or fall incidence rates. At low levels of risk, many exercise choices are available to older adults. As the level of risk increases, however, more tailored and progressive exercise programs that target the physical risk factors associated with falls are more effective in lowering fall risk. Adopting a mult...
Prevention of falls and consequent injuries in elderly people
The Lancet, 2005
Falls and fall-induced injuries in elderly people are common worldwide, and ageing populations will further raise the burden and costs (figure 1). 1-8 Around 30% of people aged 65 years or older living in the community and more than 50% of those living in residential care facilities or nursing homes fall every year, and about half of those who fall do so repeatedly. 1,[9][10][11][12] This rate rises with age, with functional impairment and disability being highest in those older than 90 years. 4,13 Although not all falls lead to injury, about 20% need medical attention, 5% result in a fracture, and other serious injuries-such as severe head injuries, joint distortions and dislocations, and soft-tissue bruises, contusions, and lacerations-arise in 5-10% of falls. 1,4,13-16 These percentages can be more than doubled for women aged 75 years or older. 12 Importantly, fall-induced injuries represent one of the most common causes of longstanding pain, functional impairment, disability, and death in elderly populations. 7,15,17-21 Injury is the fifth leading cause of death in elderly adults, and most of these fatal injuries are related to falls. 1,4,7,14, Falls account for over 80% of injury-related admissions to hospital of people older than 65 years. 4,5,25 A fall and related injury, or even a fear of their consequences, such as social withdrawal, loss of independence and confidence, and admission to a long-term care facility, can cause severe depression and anxiety. 4, Prevention of falls and injuries is not easy, however, because they are complex events caused by a combination of intrinsic impairments and disabilities (ie, increased liability to fall) with or without accompanying environmental hazards (ie, increased opportunity to fall) (figure 2). The aim of this review is to update and summarise the evidence-based knowledge of prevention of falls and subsequent injuries in elderly adults.
Journal of Science and Medicine in Sport, 2011
Falls affect a significant number of older Australians and present a major challenge to health care providers and health systems. The purpose of this statement is to inform and guide exercise practitioners and health professionals in the safe and effective prescription of exercise for older community-dwelling people with the goal of preventing falls. Falls in older people are not random events but can be predicted by assessing a number of risk factors. Of particular importance are lower limb muscle strength, gait and balance, all of which can be improved with appropriate exercise. There is now extensive evidence to demonstrate that many falls are preventable, with exercise playing a crucial role in prevention. Research evidence has identified that programs which include exercises that challenge balance are more effective in preventing falls than those which do not challenge balance. It is important for exercise to be progressively challenging, ongoing and of sufficient dose to maximise its benefits in reducing falls. Other (non-exercise) interventions are necessary for certain people with complex medical conditions or recent hospitalisation and risk factors relating to vision and the use of psychotropic medications. Qualified exercise professionals are well placed to implement the research evidence and to prescribe and supervise specific exercise aimed at preventing falls in both healthy older community-dwelling people and those with co-morbidities.
Trials, 2015
Background: Falls are a 'geriatric giant' and are the third leading cause of chronic disability worldwide. About 30% of community-dwellers over the age of 65 experience one or more falls every year leading to significant risk for hospitalization, institutionalization, and even death. As the proportion of older adults increases, falls will place an increasing demand and cost on the health care system. Exercise can effectively and efficiently reduce falls. Specifically, the Otago Exercise Program has demonstrated benefit and cost-effectiveness for the primary prevention of falls in four randomized trials of community-dwelling seniors. Although evidence is mounting, few studies have evaluated exercise for secondary falls prevention (that is, preventing falls among those with a significant history of falls). Hence, we propose a randomized controlled trial powered for falls that will, for the first time, assess the efficacy and efficiency of the Otago Exercise Program for secondary falls prevention.
Falls in older people: epidemiology, risk factors and strategies for prevention
Age and Ageing, 2006
Falls are a common and often devastating problem among older people, causing a tremendous amount of morbidity, mortality and use of health care services including premature nursing home admissions. Most of these falls are associated with one or more identifiable risk factors (e.g. weakness, unsteady gait, confusion and certain medications), and research has shown that attention to these risk factors can significantly reduce rates of falling. Considerable evidence now documents that the most effective (and cost-effective) fall reduction programmes have involved systematic fall risk assessment and targeted interventions, exercise programmes and environmental-inspection and hazard-reduction programmes. These findings have been substantiated by careful meta-analysis of large numbers of controlled clinical trials and by consensus panels of experts who have developed evidence-based practice guidelines for fall prevention and management. Medical assessment of fall risks and provision of appropriate interventions are challenging because of the complex nature of falls. Optimal approaches involve interdisciplinary collaboration in assessment and interventions, particularly exercise, attention to co-existing medical conditions and environmental inspection and hazard abatement.
Role of physical activity in the prevention of falls and their consequences in the elderly
European Review of Aging and Physical Activity, 2008
This work aims to provide an inventory of the risk factors and consequences of falling in the elderly, namely fractures, and to identify strategies to prevent falls and minimise their effects. Falls in elderly people are a major cause of injuries, leading to a general fear of falling, poorer quality of life and even death. The increase in life expectancy brought by developments in the medical and health sciences has not always brought enhanced quality of life. More elderly people live with reduced functional capacities resulting in a higher prevalence of falls and associated problems for themselves and for society. Risk factors for falling, commonly resulting from normal aging processes, have already been identified through multiple studies. Exercise may play an important role in fall prevention and their consequences. Although, effective strategies are usually multi-disciplinary and focus simultaneously on several risk factors. However, only large-scale prevention programmes can ha...
Prevention of falls in older people living in the community
BMJ, 2016
The number of people living into older age (≥65 years) is rising rapidly. Older people are more likely to fall and this has adverse consequences for their quality of life and that of their families. Falls also pose a substantial financial burden on healthcare systems. Extensive research from systematic reviews and meta-analyses has established effective approaches for reducing falls among older people, although uncertainties and controversy remain. The evidence suggests that exercise based and tailored interventions are the most effective way to reduce falls and associated healthcare costs among older people in the community. This review integrates current knowledge on assessment and management strategies to prevent falls in older people living in the community. It summarizes known risk factors for falls in this population and presents assessment strategies that can be used to assess the risk of falls. It discusses the management of risks and interventions to reduce falls among older people in the community, as well as future directions and promising approaches. SOURCES AND SELECTION CRITERIA Studies were identified by a search of English language publications listed in PubMed, Medline, and the Cochrane Library from September 1994 to December 2015. Search terms included falls, falls prevention, falls epidemiology, fall risk assessment and/or management, and community dwelling elderly or older adults. In addition, falls risk assessment and management strategies were searched. Articles reviewed included systematic reviews and metaanalyses, experimental and observational studies, and clinical guidelines. We reviewed the literature identified and selected all articles that focused on risk factors, assessment, and management strategies or interventions (or both) to reduce falls in older people living in the community. Systematic evidence reviews, meta-analyses, and randomized clinical trials were prioritized. We then summarized the peer reviewed literature selected and abstracted the most clinical relevant information on the topic of falls prevention and management. Because of limitations on the number of citations to be included, we prioritized the works that were cited and cross referenced most often. 28 Cardiovascular conditions and syncope Carotid sinus syndrome, vasovagal syncope, orthostatic and postprandial hypotension, arrhythmias 29 Cognitive impairment Reductions in verbal ability, processing speed (executive function), and immediate memory 30 Urinary incontinence Rushing to the bathroom at night 31 Stroke Decreased paretic limb contribution to standing balance control, increased variability of step length, inability to step with the blocked limb 32 Diabetes Peripheral neuropathy, as well as accelerated balance, somatosensory, visual, vestibular and cognitive function decline
Preventing Injuries in Older People by Preventing Falls: A Meta-Analysis of Individual-Level Data
Journal of the American Geriatrics Society, 2000
OBJECTIVES: Our falls prevention research group has conducted four controlled trials of a home exercise program to prevent falls in older people. The objectives of this meta-analysis of these trials were to estimate the overall effect of the exercise program on the numbers of falls and fall-related injuries and to identify subgroups that would benefit most from the program. DESIGN: We pooled individual-level data from the four trials to investigate the effect of the program in those aged 80 and older, in those with a previous fall, and in men and women. SETTING: Nine cities and towns in New Zealand. PARTICIPANTS: One thousand sixteen community dwelling women and men aged 65 to 97. INTERVENTION: A program of muscle strengthening and balance retraining exercises designed specifically to prevent falls and individually prescribed and delivered at home by trained health professionals. MEASUREMENTS: Main outcomes were number of falls and number of injuries resulting from falls during the trials.