Interventions for preventing falls in older people living in the community.
BACKGROUND
Approximately 30% of people over 65 years of age living in the community fall each year.


OBJECTIVE
To assess the effects of interventions to reduce the incidence of falls in older people living in the community.


METHODS
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, CENTRAL (The Cochrane Library 2008, Issue 2), MEDLINE, EMBASE, CINAHL, and Current Controlled Trials (all to May 2008).


METHODS
Randomised trials of interventions to reduce falls in community-dwelling older people. Primary outcomes were rate of falls and risk of falling.


METHODS
Two review authors independently assessed trial quality and extracted data. Data were pooled where appropriate.


RESULTS
We included 111 trials (55,303 participants).Multiple-component group exercise reduced rate of falls and risk of falling (rate ratio (RaR) 0.78, 95%CI 0.71 to 0.86; risk ratio (RR) 0.83, 95%CI 0.72 to 0.97), as did Tai Chi (RaR 0.63, 95%CI 0.52 to 0.78; RR 0.65, 95%CI 0.51 to 0.82), and individually prescribed multiple-component home-based exercise (RaR 0.66, 95%CI 0.53 to 0.82; RR 0.77, 95%CI 0.61 to 0.97).Assessment and multifactorial intervention reduced rate of falls (RaR 0.75, 95%CI 0.65 to 0.86), but not risk of falling.Overall, vitamin D did not reduce falls (RaR 0.95, 95%CI 0.80 to 1.14; RR 0.96, 95%CI 0.92 to 1.01), but may do so in people with lower vitamin D levels. Overall, home safety interventions did not reduce falls (RaR 0.90, 95%CI 0.79 to 1.03); RR 0.89, 95%CI 0.80 to 1.00), but were effective in people with severe visual impairment, and in others at higher risk of falling. An anti-slip shoe device reduced rate of falls in icy conditions (RaR 0.42, 95%CI 0.22 to 0.78).Gradual withdrawal of psychotropic medication reduced rate of falls (RaR 0.34, 95%CI 0.16 to 0.73), but not risk of falling. A prescribing modification programme for primary care physicians significantly reduced risk of falling (RR 0.61, 95%CI 0.41 to 0.91).Pacemakers reduced rate of falls in people with carotid sinus hypersensitivity (RaR 0.42, 95%CI 0.23 to 0.75). First eye cataract surgery reduced rate of falls (RaR 0.66, 95%CI 0.45 to 0.95).There is some evidence that falls prevention strategies can be cost saving.


CONCLUSIONS
Exercise interventions reduce risk and rate of falls. Research is needed to confirm the contexts in which multifactorial assessment and intervention, home safety interventions, vitamin D supplementation, and other interventions are effective.
Department of Medical and Surgical Sciences, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, Otago, New Zealand, 9054. lesley.gillespie@otago.ac.nz
Lesley D
LD
Gillespie
M Clare
MC
Robertson
William J
WJ
Gillespie
Sarah E
SE
Lamb
Simon
S
Gates
Robert G
RG
Cumming
Brian H
BH
Rowe
D000058:Accidental Falls / Q000517:prevention & control*; D000061:Accidents, Home / Q000517:prevention & control*; D000368:Aged; D050071:Bone Density Conservation Agents / Q000008:administration & dosage; D004779:Environment Design; D015444:Exercise; D006801:Humans; D010353:Patient Education as Topic; D016032:Randomized Controlled Trials as Topic; D026302:Tai Ji; D014807:Vitamin D / Q000008:administration & dosage
D050071:Bone Density Conservation Agents; D014807:Vitamin D