Evidence statement
A Cochrane review of 159 randomised controlled trials (RCTs) reported that multiple-component group exercise significantly reduces risk of falling (relative risk [RR]: 0.85, 95% confidence interval [CI]: 0.76–0.96, 22 trials, 5333 participants), as does multiple-component home-based exercise (RR: 0.78, 95% CI: 0.64–0.94, six trials, 714 participants).1 Multifactorial interventions, which include individual risk assessment, were also found to reduce the rate of falls (Rate ratio [RaR]: 0.76, 95% CI: 0.67–0.86, 19 trials, 9503 participants).1 Another systematic review of community-based falls prevention exercise programs found a significant reduction in the risk of fracture (RR: 0.39, 95% CI: 0.22–0.66, six trials).2 A further recent meta-analysis indicates that exercise interventions prevent fall-related fractures in men and women 50 years of age and older (RR: 0.604, 95% CI: 0.453–0.840, P = 0.003, 15 studies, 3136 participants) and reduce risk factors for fall-related fractures (leg strength and balance).3 An RCT of home-based interventions teaching principles of balance and strength training and integrated selected activities into everyday routines (Lifestyle-integrated Functional Exercise [LiFE] program) was found to reduce the rate of falls by 31% (RaR: 0.69, 95% CI: 0.48–0.99).12
Overall, vitamin D supplements were not found to reduce risk of falling, but may do so in people with lower vitamin D levels before treatment.1 Home-safety assessment and modification interventions were effective in reducing risk of falling (RR: 0.88, 95% CI: 0.80–0.96, seven trials, 4051 participants). These interventions were more effective in people at higher risk of falling, including those with severe visual impairment and implemented by an occupational therapist. An intervention to treat vision problems (616 participants) resulted in a significant increase in the risk of falling (RR: 1.54, 95% CI: 1.24–1.91). When regular wearers of multifocal glasses (597 participants) were given single-lens glasses, both inside and outside falls were significantly reduced in the sub-group that regularly took part in outside activities. Conversely, there was a significant increase in outside falls in intervention group participants who took part in little outside activity. Pacemakers reduced the rate of falls in people with carotid sinus hypersensitivity (RaR: 0.73, 95% CI: 0.57–0.93, three trials, 349 participants). First eye cataract surgery in women reduced the rate of falls (RaR: 0.66, 95% CI: 0.45–0.95, one trial, 306 participants), but second eye cataract surgery did not. Gradual withdrawal of psychotropic medication reduced the rate of falls (RaR: 0.34, 95% CI: 0.16–0.73, one trial, 93 participants), but not the risk of falling. A prescribing modification program for primary care physicians significantly reduced the risk of falling
(RR: 0.61, 95% CI: 0.41–0.91, one trial, 659 participants). One trial (305 participants) comparing multifaceted podiatry, including foot and ankle exercises, with standard podiatry in people with disabling foot pain significantly reduced the rate of falls (RaR: 0.64, 95% CI: 0.45–0.91) but not the risk of falling.1
A complementary Cochrane review of falls prevention interventions for people residing in residential agedcare facilities included 43 trials (30,373 participants).11 The results from 13 trials testing exercise interventions were inconsistent. Overall, there was no difference between the intervention and control