What Works to Prevent Falls in

Community-Dwelling Older Adults?

Physical Therapy Journal
August 2015; Volume 98; Pgs. 1095-1110

Article Review
Alexis Porter, SPTA
Salt Lake Community College
PTA Program

Article Eligibility Criteria

& Search Procedure
Population
Community-dwelling older adults
Mean age 60 years

Intervention
Any intervention aimed to prevent falls

Key Words

falls, fall, recurrent falls, injurious fall, fall prevention

randomized control trial, RCT, systematic review, meta-analysis
older adult, elderly, age
vitamin D supplementation, mulifactorial

Quality
Medium to high quality based on AMSTAR scores

Search Results
16 meta-analyses, 47 pooled analyses

Fall Prevention Interventions

Exercise
Vitamin D Supplementation
Environmental Interventions
Surgery
Education
Multifactorial Interventions

Exercise
13 out of 14 pooled analyses showed exercise significantly reduced falls
The study that showed a non-significant reduction in falls was considered lowquality.

Overall findings:
Exercise significantly reduces the odds of falling.23
Exercise significantly reduces the rate of injurious falls.24
Exercise focused on gait, balance, or functional training reduces the rate of
falls.4
Physical therapy-based exercises results in a reduction in risk of falls.29
The Otago exercise program significantly reduces the rate of falls.30

There is consistent evidence (93%) to support the effectiveness of exercise

as a single intervention to prevent falls.

Vitamin D Supplementation
7 out of 12 pooled analyses support that vitamin D supplementation
significantly reduce falls.
Overall Findings:
Vitamin D supplementation when combined with calcium reduces the odds of
falling, but vitamin D alone does not.23
Vitamin D supplementation has no significant effect on fall rates.4
Vitamin D supplementation with or without calcium respectively reduces the
risk and odds of falls.14, 29

There is conflicting evidence (58.3%) regarding the effectiveness of

vitamin D supplementation and decreased falls.
Vitamin D appears to be more effective when combined with calcium.

Environmental Interventions
4 out of 7 pooled analyses demonstrated that environmental
interventions significantly reduce falls.
Overall Findings:
Environmental and assistive technologies do not significantly reduce
the odds of falling.23
Home visits and modifications significantly reduce the odds of falling.23
Home safety interventions are significantly effective when delivered by
OT, but not when delivered by a non-occupational therapist.4
Interventions that adapt and modify an environment result in a
reduction of the risk of falls.31

There is conflicting evidence (57%) to suggest that environmental

interventions reduce falls.

Surgery
There is limited evidence to suggest that surgical
interventions reduce falls.

Education
As a single intervention, education does not significantly
reduce the odds of falling.23

Multifactorial Interventions
5 out of 6 pooled analyses report that multifactorial
interventions significantly reduce falls.
Overall Findings:
Multifactorial interventions reduce the risk of falls.25
The rate of falls is significantly reduced using multifactorial
interventions.24
Multifactorial interventions reduces the risk of falls.28

There is consistent evidence (83%) that multifactorial

interventions reduce falls.

The Take-Away
Exercise and multifactorial interventions are effective in preventing falls.
A balanced program including endurance, balance training, and
strengthening exercises can be recommended.35
Aside from frequency, intensity, and duration, the patients preference
should also be considered when providing an exercise program.
Exercise has a wide range of health benefits and is comparable to
medication interventions on preventing mortality.36

Exercise interventions are the most consistently effective interventions in

reducing the risk of falls.
Future research is needed to address the frequency, intensity, and type of
exercises and their effectiveness in clinical practice and fall prevention.

References
(4) Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev.
2012;9: CD007146.
(14) Murad MH, Elamin KB, Abu Elnour NO, et al. Clinical reviewthe effect of vitamin D on falls: a systematic review and meta-analysis. J Clin Endocrinol
Metab. 2011;96:29973006.
(23) Guo JL, Tsai YY, Liao JY, et al. Interventions to reduce the number of falls among older adults with/without cognitive impairment: an exploratory metaanalysis. Int J Geriatr Psychiatry. 2014;29: 661 669.
(24) El-Khoury F, Cassou B, Charles MA, Dargent-Molina P. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling
older adults: systematic review and metaanalysis of randomised controlled trials. BMJ. 2013;347:f6234.
(25) Choi M, Hector M. Effectiveness of intervention programs in preventing falls: a systematic review of recent 10 years and meta-analysis. J Am Med Dir
Assoc. 2012; 13:188.e113e121.
(28) Campbell AJ, Robertson MC. Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial
interventions. Age Ageing. 2007;36:656 662.
(29) Michael YL, Whitlock EP, Lin JS, et al. Primary care-relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S.
Preventive Services Task Force. Ann Intern Med. 2010;153:815 825.
(30) Thomas S, Mackintosh S, Halbert J. Does the Otago exercise programme reduce mortality and falls in older adults? A systematic review and metaanalysis. Age Ageing. 2010;39:681 687.
(31) Clemson L, Mackenzie L, Ballinger C, et al. Environmental interventions to prevent falls in community-dwelling older people: a meta-analysis of
randomized trials. J Aging Health. 2008;20:954 971.
(35) Landi F, Marzetti E, Martone AM, et al. Exercise as a remedy for sarcopenia. Curr Opin Clin Nutr Metab Care. 2014;17:25 31.
(36) Naci H, Ioannidis JPA. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. BMJ.
2013;347:f5577.