title: Exercise Interventions for Preventing Falls Among Older People in Care Facilities: A Meta-Analysis.
abstract: BACKGROUND
  Falls in older people are a common problem, often leading to considerable morbidity. However, the overall effect of exercise interventions on fall prevention in care facilities remains controversial.
  
  
  OBJECTIVE
  To evaluate the effectiveness of exercise interventions on the rate of falls and number of fallers in care facilities.
  
  
  METHODS
  A meta-analysis was conducted of randomized controlled trials published up to December 2014. Eight databases were searched including Ovid-Medline, Embase, CINAHL, Cochrane Library, KoreaMed, KMbase, KISS, and KisTi. Two investigators independently extracted data and assessed study quality.
  
  
  RESULTS
  Twenty-one studies were selected, that included 5,540 participants. Fifteen studies included exercise as a single intervention, whereas the remaining six included exercise combined with two or more fall interventions tailored to each resident's fall risk (i.e., medication review, environmental modification or staff education). Meta-analysis showed that exercise had a preventive effect on the rate of falls (risk ratio [RR] 0.81, 95% CI 0.68-0.97). This effect was stronger when exercise combined with other fall interventions on the rate of falls (RR 0.61, 95% CI 0.52-0.72) and on the number of fallers (RR 0.85, 95% CI 0.77-0.95). Exercise interventions including balance training (i.e., gait, balance, and functional training; or balance and strength) resulted in reduced the rate of falls. Sensitivity analyses indicated that exercise interventions resulted in reduced numbers of recurrent fallers (RR 0.71, 95% CI 0.53-0.97).
  
  
  CONCLUSIONS
  This review provides an important basis for developing evidence-based exercise intervention protocols for older people living in care facilities. Exercise programs, which are combined with tailored other fall interventions and challenge balance training to improve balance skills, should be applied to frail older people with functional limitations in institutional settings.
authors.affiliation: Associate Professor, Department of Nursing Science, College of Nursing, Gacheon University, Incheon, Republic of Korea.
authors.forename: Seon Heui
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Assistant Professor, College of Nursing, Research Institute of Nursing Science, Chonbuk National University, Jeonju, Republic of Korea.
authors.forename: Hee Sun
authors.initials: HS
authors.lastname: Kim
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D005081:Exercise Therapy / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data; D063868:Patient Outcome Assessment; D036301:Qualitative Research; D016032:Randomized Controlled Trials as Topic; D012112:Residential Facilities / Q000706:statistics & numerical data
keywords: aged; care facility; exercise; falls; meta-analysis; systematic review