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Care of older people

Exercise interventions reduce falls in older adults

Using data from nearly 20,000 adults aged 65 years and over, researchers found a 23% overall reduction in the number of falls over time in those assigned to exercise interventions.

The rate of falls in older adults living in the community can be effectively reduced with exercise interventions, the authors of a recent Cochrane review have concluded (31 January 2019)[1].

The analysis used data from 81 randomised controlled trials involving a total of nearly 20,000 adults aged 65 years and over who were assigned to an exercise intervention or a control intervention not thought to reduce falls. Most exercise programmes lasted at least 12 weeks.

Overall, the researchers found a 23% reduction in the number of falls over time in the intervention groups compared with control groups, as well as a 15% reduction in the number of people experiencing one or more falls. But, there was insufficient evidence to make conclusions about the effect of exercise on other outcomes, such as fractures, hospitalisations or quality of life.

The authors also noted that effective interventions focused on balance and functional training, rather than flexibility or endurance.

“The importance of exercise in fall prevention suggests that greater attention be given to the widespread implementation of a life course approach to healthy ageing, i.e. lifelong exercise to maximise physical functioning in older age, as suggested by the World Health Organization,” the researchers said.

Citation: Clinical Pharmacist DOI: 10.1211/CP.2019.20206264

Readers' comments (1)

  • The population with intellectual/learning disabilities is particularly vulnerable in relation to falls and poor bone health. Many assessment tools are not validated in the population with intellectual/learning disabilities.

    Falls are a major cause of serious injuries and fractures in adults with intellectual/learning disabilities . Fractures are estimated to occur 1.7-3.5 times more frequently among people with intellectual disabilities. Studies showed the prevalence rate of falls among adults with intellectual/learning disabilities ranging from 12.1%-61%.

    People with intellectual/learning disabilities tend to have higher levels of physical inactivity and poor physical fitness and poorer dietary habits (e.g., reduced calcium intake, higher fat consumption) compared to the general population. These risk behaviours may be associated with reduced muscle mass, bone mineral density (i.e., osteopenia or osteoporosis) and increased body fat .

    Research in risk factors for falls among adults with intellectual disabilities is limited. The few studies that examined risks for falls among adults with intellectual disabilities found that these risks included older age, ambulatory status, seizure disorder, visual deficits, and abnormal gait. These studies included adults with intellectual disabilities from nursing home settings, and young adults with intellectual disabilities living in the community.

    One published large scale study (N= 511) conducted in Scotland found that incident falls were associated with urinary incontinence and that the presence of Down syndrome was a protector from falls.

    Research evidence indicates that falls in the population with intellectual disabilities are associated with use of an assistive aid (with the exception of using a wheelchair), difficulty walking 3 blocks, having foot pain, and taking 4 or more medications. Adults with intellectual disabilities have been found to have much poorer measures for both strength and balance.

    Fear of falling (FOF) has emerged as an important health concern in all older adults given its demonstrated association with restrictions in daily activity and in many cases activity avoidance. Measurement tools for FOF have only been validated in the general population .

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