Cochrane collective reviews falls prevention

University of Sydney’s Professor Lindy Clemson co-authored the Sept 2012 Cochrane review on falls prevention

By Yasmin Noone

The ever-growing mountain of falls prevention research from around the world has been condensed into one high quality and comprehensive literature review, detailing the best in evidence-based falls prevention interventions.

The large-scale worldwide review, published this month in the Cochrane Database of Systematic Reviews, combines research results from 159 small, extensive, low and high quality trials involving more than 79,000 participants from Australia, the UK and New Zealand.

Titled, Interventions for preventing falls in older people living in the community, the review analysis the vast volumes of literature available on the topic for the benefit of community care staff, allied health workers, general practitioners and other clinical professionals who work with older people in preventing and reducing falls rates.

The meta-analysis sheds light on falls in older people and concludes which interventions effectively prevent community-dwellers from falling.

“Group and home-based exercise programs, usually containing some balance and strength training exercises, effectively reduced falls, as did Tai Chi,” the review states.

“Multifactorial interventions assess an individual’s risk of falling, and then carry out treatment or arrange referrals to reduce the identified risks. Overall, current evidence shows that this type of intervention reduces the number of falls in older people living in the community but not the number of people falling during follow-up.

“These are complex interventions, and their effectiveness may be dependent on factors yet to be determined.”

The reviewers found that interventions to improve home safety are effective, especially in people at higher risk of falling and when carried out by occupational therapists. An anti-slip shoe device worn in icy conditions can also reduce falls.

Medication changes and surgery also reduced falling, with people fitted for pacemakers for particular heart rate disorders (carotid sinus hypersensitivity) falling less often than those without the pacemakers.

Women receiving cataract surgery on the first eye also had a reduced rate of falling, although removing the cataract from the second eye had no further effect.

“Taking vitamin D supplements does not appear to reduce falls in most community-dwelling older people, but may do so in those who have lower vitamin D levels in the blood before treatment.

“Some medications increase the risk of falling. Three trials in this review failed to reduce the number of falls by reviewing and adjusting medications. A fourth trial involving family physicians and their patients in medication review was effective in reducing falls.

“Gradual withdrawal of a particular type of drug for improving sleep, reducing anxiety, and treating depression (psychotropic medication) has been shown to reduce falls.”

According to the review, older people may be at an increased risk of falling while adjusting to new glasses or major changes in prescriptions. However, the risk reduced when people wearing multifocal glasses who took part in activities outside the home swapped their multifocals for two separate pairs of glasses for distance and close vision tasks.

Meta-analysis of current reserach finds falls interventions reduce cost

The review was led by the University of Otago in New Zealand, and involved researchers from the University of Sydney, University of Hull and the University of Warwick in the UK.

“Falls have debilitating and isolating social consequences for older people, not to mention the increasing economic cost they present in our ageing population,” said review co-author from the University of Sydney’s Faculty of Health Sciences, Professor Lindy Clemson.

“Falls can start a downward spiral of immobility, reduced confidence, and incapacity leading to institutionalisation, so it’s really important we tackle the issue to prevent as many falls as possible.”

Falls expert and Neuroscience Research Australia (NeuRA) research fellow, Dr Kim Delbaere, said that she believes the Cochrane falls prevention interventions review is “invaluable”.

“There are a large amount of studies that have come out, recently, about falls prevention. Some studies are successful, some are not, some are of a high quality and quite a few are low quality.

But the main take-home message from this meta-analysis of the available research, she said, “is that exercise is the main single intervention that has been consistently found to prevent falls in older people”.

“If people in the community are happy to take up the evidence-based advice of doing more exercises and doing the right kind of exercises as well…we think we can prevent falls.”

According to the review, up to 30 per cent of older people fall a year; one in five falls require medical attention; and less than one in 10 results in a fracture.

Three trials in the review also found that interventions could save more money than they cost.

“If we can even reduce fractures from falls, then it’d be a big step for the community and it would have an affect on the economy through [the reduction of] health and social care costs,” Dr Delbaere said.

“The economic cost of falls [to society and government] are multiple…If people take up falls prevention [interventions], then I am absolutely convinced that it will save money.”