Douglas P. Kiel, MD, MPH
Do primary care interventions reduce risk for falls in older adults living in the community? What are the adverse effects?
Included studies compared fall-prevention interventions with a control group in community-dwelling, older adults (mean age ≥ 65 y); were conducted in primary care or similar settings; assessed falling or falls as primary or secondary outcomes; and were good or fair quality (US Preventive Services Task Force quality criteria). Outcomes were number of participants who fell and harms.
MEDLINE, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessments, and Web sites (1991 to Oct 2007) were searched for good-quality systematic reviews; 1 was selected. MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (2002 to Feb 2010) were searched for English-language, randomized, controlled trials (RCTs) published after the selected systematic review and reporting intervention efficacy. MEDLINE and CINAHL (1992 to Feb 2010) were searched for trials reporting harms. 54 RCTs (n = 26 102) met the selection criteria: 19 (n = 7099) assessed multifactorial assessment and management programs, 18 (n = 3986) assessed exercise or physical therapy, 9 (n = 5809) evaluated vitamin D (daily oral dose range, 10 IU to 1000 IU; median, 800 IU), 4 (n = 1437) assessed vision correction procedures, 3 (n = 2348) assessed home-hazard modification, and 1 each assessed medication assessment and withdrawal (n = 48) or clinical education or behavioral counseling (n = 310).
The main results are shown in the Table. Vision correction procedures did not reduce falls (data not reported). Harms were not consistently reported.
In older community-dwelling adults, exercise/physical therapy and vitamin D each reduce risk for falls; results for other primary care interventions are mixed.
Fall-prevention interventions vs control for reducing proportion of older community-dwelling adults who fall*
*Abbreviations defined in Glossary. RRR and CI calculated from data in article.
§Michael YL, Lin JS, Whitlock EP, et al. Interventions to prevent falls in older adults: an updated systematic review. Evidence Synthesis No. 80. Rockville, MD: Agency for Healthcare Research and Quality; Dec 2010.
Douglas P. Kiel. Review: Exercise/physical therapy and vitamin D each reduce risk for falls in older community-dwelling adults. Ann Intern Med. 2011;154:JC4–5. doi: 10.7326/0003-4819-154-8-201104190-02005
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Published: Ann Intern Med. 2011;154(8):JC4-5.
Geriatric Medicine, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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