Source: Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD007146. Review. PubMed PMID: 19370674.
Efficacy Endpoints: Fall prevention
Harm Endpoints: None known
Narrative: As we experience the grey tsunami that is the evolving demographic of our era, the number of fragile elderly who suffer falls and who subsequently experience a downward spiral in their health is also rising. A great deal of research activity has been invested in fall prevention both for identifying high risk individuals and in developing both simple and complex interventions to mitigate this risk.
Benefits: The evidence as assessed in this Cochrane review which did not revise its search since 2003 reports on 62 trials having enrolled nearly 22 000 patients. The most robust evidence on fall prevention pertains not to the simple intervention of strength and balance training reported here but rather multidisciplinary, multifactorial, health and environmental risk factor screening and interventions programmes i.e. a well established fall prevention outreach program. This latter approach demonstrates efficacy in both high risk groups and in terms of a broader outreach program to all community-dwelling elderly. This NNT summary focuses on the single intervention of strength and balance training as it is a more feasible recommendation for healthcare providers to make and have followed. Also of note is that these findings extend to not only simple falls but falls resulting in injury.
Harms: With the exception of a single trial within the systematic review that reported adverse events with a program of brisk walking in women with recent osteoporotic fractures, there are no reported downsides to this intervention aside from cost and the invested effort that it demands of both subjects and their caregivers. 1
Caveats: While the total population sample in the few trials included for the intervention of strength and balance training in high risk community-dwelling elders, a recent "From Evidence to Action" review in JAMA2 conducted a more up to date search which confirmed these benefits and suggested that they are even more robust. Another systematic review looking at a broad range of exercise-based interventions across a wider spectrum of patients noted the same effect size with fair precision around the degree of benefit.3
There are some methodological weaknesses in the component studies of the Cochrane review namely the way in which a fall is defined and potential problems with recall bias influencing the manner in which the outcomes were measured. However, until such time that we are conducting fall prevention trials with closed circuit TV monitoring and fall sensors attached to study subject wrists the benefits of this simple intervention are likely to outweigh the harms.
Author: Eddy Lang, MD
Published/Updated: September 23, 2010
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