Exercise may be best intervention to prevent falls among elderly

Exercise alone or in combination with other assessments and interventions appears to be the most effective strategy for preventing falls causing injury among older people, a new study has found.

Exercise alone, such as tai chi, can decrease the risk of injurious falls by 12 per cent in people over age 65, according to a meta-analysis published today in the journal JAMA.

An even greater reduction (38 per cent) was seen in people who exercised and had vision assessment and-or treatment, said the co-lead authors of the paper, Dr. Sharon Straus, a geriatrician at St. Michael's Hospital and Dr. Andrea Tricco, a scientist at the hospital's research institute.

Exercise, along with vision assessment and treatment, as well as an assessment and possible modification of a person's living environment, reduced the risk by 23 per cent.

November is Falls Prevention Month in Canada, drawing attention to the fact that falls are the leading cause of injury among older adults and account for $2 billion in direct health-care costs annually ($31 billion in costs to Medicare in the United States in 2012.)

"Falls have a huge impact on the wellness of our older population and, given the aging of the population worldwide, the incidence of falls continues to rise," said Dr. Tricco, a scientist with the Knowledge Translation Program of the Li Ka Shing Knowledge Institute.

"We have been able to identify the most effective strategies to reduce the risk of falls that cause injuries. Exercise alone, or in conjunction with vision assessments and environmental assessments, is very effective and should be considered by patients, clinicians and policy-makers."

She noted that the choice of falls prevention interventions may depend on the values and preferences of patients and caregivers. For some patients, exercise may actually increase the risk of falls because they become more mobile as their strength increases, but the risks of immobility are far greater to older adults.

The findings on interventions to prevent injurious falls overall were based on an analysis of 54 randomized clinical trials involving almost 42,000 people and 39 interventions.

The researchers also looked at 68 randomized clinical trials involving more than 85,000 people and 43 interventions to prevent falls that caused fractures. They found that osteoporosis treatment for those at risk -- taking a class of drugs called bisphosphonates that keep the body from breaking down bone, combined with calcium and vitamin D supplements -- was associated with an 11 per cent reduction in the risk of fractures.