What’s the Best Way to Prevent Falls in Older Adults?

Journal of the American Geriatrics Society Research Summary

An international team of experts compared practices that research has shown to help older adults prevent falls. Their new study, published in the Journal of the American Geriatrics Society, suggests that:

  • Exercise is the most effective method for decreasing the rate of falls in adults aged 65 and older who live independently. It is especially effective in adults aged 75 and older.
  • Exercise and a basic falls risk assessment by your healthcare provider can reduce your risk of breaking bones in a fall. In a falls assessment, your healthcare provider asks you about whether you’ve fallen, the details of the fall, and whether your home environment contributed to the fall. They also evaluate how well you walk and move around, along with your balance and other walking-related issues.

These strategies can also help prevent falls:

  • Using assistive technology and devices. These can include canes, walkers, and devices that can call for help at the touch of a button.
  • Making homes safer by:
    • removing clutter, throw rugs, and other falling hazards
    • improving lighting
    • installing grab bars
    • making other home improvements.

Falls: A Serious Health Problem for Older Adults

Falling, or accidentally and unexpectedly landing on the ground, usually happens in familiar environments while you are doing your normal, daily activities. You may fall when something pushes you, you trip, you lose consciousness (from a seizure, stroke, or other health problem), or you are experiencing the symptoms of a new illness.

Falls have serious consequences. One out of five falls does causes a serious injury, such as a broken bone or a head injury.[1] In older adults, they are the number one cause of hospital admissions for injuries. The older you are, the more likely falls are to threaten your ability to live at home and increase your risk of an early death.

Falls are very common among older adults, especially those who have multiple chronic conditions. An older person falls every second of the day, and one out of three older adults living at home falls every year.

Why the Researchers Studied Fall Prevention Strategies

Falls are such a big problem for older adults that many researchers have studied ways of preventing them. In order to get the big picture of what works best to prevent falls, the researchers of this study did what is called a systematic review and meta-analysis. This means that the researchers looked at the results of multiple studies all at once.

Most of the studies they looked at evaluated programs that used more than one strategy at the same time to prevent falls. Researchers say this study is the first to look at how effective the individual falls prevention strategies are when they are examined separately, instead of together. Understanding and comparing the effects of each strategy can make it easier for healthcare professionals to offer older adults personalized help.

Earlier studies have also failed to include people over the age of 75 and older adults with multiple chronic conditions. Because people in these groups have an especially high risk of falling, it is important to learn more about which falls prevention methods are most effective for them.

What the Researchers Learned

The researchers examined 192 studies that included nearly 100,000 older adults who live independently. Of those studies, 128 included adults between the ages of 75 and 84 years old.  Eleven of the studies included people 85 or older. The studies compared the effects of 63 fall prevention strategies—some individual strategies and some combinations of strategies—to the effects of the care the participants usually received.

Researchers found that that exercise is the most effective individual strategy for decreasing the rate of falls and number of falls in adults aged 65 and older who live independently. It seems to be especially effective in adults aged 75 and older. Strategies that work in combination include exercise, falls risk assessments, the use of assistive devices, and making changes to your home that make it safer.

Study findings also suggest that older adults who exercise and have had falls risk assessments may be less likely to break bones if they fall.

Study Limitations

Over half the studies that the researchers looked at used methods that may have caused biased results.

What This Study Means for You

If you do only one thing to prevent falls and fall-related broken bones, make it exercise.

This summary is from “Interventions for preventing falls and fall-related fractures in community-dwelling older adults: a systematic review and network meta-analysis.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Lauren Dautzenberg, MD, MSc; Shanthi Beglinger, MD, MBiolSci; Sofia Tsokanid, MSc; Stella Zevgitid, PhD; Renee CMA Raijmanna, MD, MSc; Nicolas Rodondib, MD, PhD; Rob JPM Scholtene, MD, PhD; Anne WS Rutjesc, PhD; Marcello Di Nisiog, MD, PhD; Marielle Emmelot-Vonka, MD, PhD; Andrea C Tricco, PhD; Sharon E Straush, MD, MSc; Sonia Thomash, MSc; Lisa Bretagneb, MD, MSc; Wilma Knola, MD, PhD; Dimitris Mavridis, PhD; and Huiberdina L Koeka, MD, PhD.

[1] https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

Don’t Let Social Isolation Keep You from Being Active

Journal of the American Geriatrics Society Research Summary

By now, we’re all aware that COVID-19 is especially dangerous for older adults—the older you are, the higher your risk for serious illness and even death if you contract the virus. Because there is no treatment or a vaccine yet, it’s vitally important that we practice social distancing and wear masks to protect ourselves from disease.

But as we work to keep ourselves safe, we also need to be sure we’re not falling into physical inactivity. When we cut ourselves off from shopping, walking in malls, and going to the gym and other places where we can exercise, we can become sedentary. Older adults who don’t get regular exercise may become prone to chronic diseases, weakened muscles, and frailty.

Researchers from the University of Sao Paulo in Brazil recently reported on the dangers of physical inactivity for older adults during COVID-19. Their paper was published in the Journal of the American Geriatrics Society. Continue reading

Regular Physical Activity Can Maintain or Improve Frailty

Journal of the American Geriatrics Society Research Summary

Frailty is the medical term for becoming weaker or experiencing lower levels of activity or energy. Becoming frail as we age increases our risk for poor health, falls, disability, and other serious concerns.

Aging increases the risks for becoming frail. As more of us live longer, it’s likely that frailty will pose a larger public health problem in the near future. Experts in geriatrics (the field of health care focused on care for older adults) suggest that maintaining a healthy lifestyle may reduce your chances of becoming frail.

One aspect of a healthy lifestyle is getting regular physical activity. However, studies on the association between physical activity and frailty among older adults show different results. Some studies suggest that regular physical activity could delay frailty and reduce its severity, but other studies do not. And most of the studies have examined people aged 50 to 70, so the information we have for people over age 70 is limited.

To address this gap, researchers conducted a new study as part of a European project that promotes healthy aging in older adults. They examined the benefits of assistance that helps older adults follow their prescribed medications and prevent falls, frailty, and loneliness. The participants received care at study sites in five European countries (Spain, Greece, Croatia, the Netherlands, and the United Kingdom). The study results were published in the Journal of the American Geriatrics Society. Continue reading

Keep Moving to Prevent Major Mobility Disability

Journal of the American Geriatrics Society Research Summary

Having trouble getting around on your own—such as difficulty walking, climbing steps, or being able to get in and out of a chair—can lead to physical disability and losing your independence.

According to research, being physically inactive is the strongest risk factor for disability as we age.

We know that physical activity has proven health benefits, especially moderate-to-vigorous physical activity such as walking to the store or many types of gardening. But perhaps surprisingly, we don’t know much about the benefits of lighter forms of physical activity or the effects of spreading our physical activity throughout the day. Understanding the benefits of moving more often and engaging in even lighter forms of physical activity is important for older adults’ health. These types of physical activity may be easier for older adults to practice regularly, especially those who are frail.

That’s why a team of researchers created a study to examine the effects of performing light physical activity and moderate-to-vigorous physical activity on older adults. The researchers were interested in studying how participating in these different intensities of activity, and whether a person spreads their physical activity throughout the day, affects the chances for developing a major mobility disability. The participants in the study were older adults who had challenges with physical function and who participated in the Lifestyle Interventions and Independence for Elders (LIFE) study. The researchers published their study in the Journal of the American Geriatrics Society. Continue reading

Aerobic Exercise and Heart-Healthy Diet May Slow Development of Memory Problems

Journal of the American Geriatrics Society Research Summary

Cognitive impairment without dementia (CIND), or mild cognitive impairment, is a condition that affects your memory and may put you at risk for Alzheimer’s disease and dementia. According to the U.S. National Library for Medicine, signs of mild cognitive impairment may include frequently losing things, forgetting to go to events and appointments, and having more trouble coming up with words than other people of your age.

Sine experts believe that risk factors for heart disease also are risk factors for dementia and late-life cognitive decline and dementia. Recently, researchers examined two potential ways to slow the development of CIND based on what we know about preventing heart disease. They published the results of their study in the Journal of the American Geriatrics Society.

The research team had a theory: That the healthy lifestyle behaviors that slow the development of heart disease could reduce heart disease risk and also slow cognitive decline in older adults with CIND. These behaviors include regular exercise and a heart-healthy diet, such as the DASH (Dietary Approaches to Stop Hypertension) diet.

In order to investigate their theory, the researchers designed a study titled “Exercise and NutritionaL Interventions for coGnitive and Cardiovascular HealTh EnhaNcement” (or ENLIGHTEN for short). The goal of the study was to examine the effects of aerobic exercise (sometimes known as “cardio” or “cardiovascular” exercise because it involves activities that increase the circulation of oxygen through the blood) and the DASH diet on cognitive functioning in older adults with CIND.

The ENLIGHTEN study examined 160 adults 55-years-old or older. The study participants were older adults who didn’t exercise and had memory problems, difficulty thinking, and making decisions. They also had at least one additional risk factor for heart disease, such as high blood pressure (also known as hypertension), high cholesterol, diabetes, or other chronic conditions.

Participants took a number of tests to measure their heart disease risk factors and cognitive ability. Researchers also assessed participants’ dietary habits and ability to perform daily activities. The participants were then randomly assigned to one of four groups: a group doing aerobic exercise alone, a group following the DASH diet alone, a group doing aerobic exercise and following the DASH diet combined, or a group receiving standard health education.

People in the exercise group did 35 minutes of moderate intensity aerobic exercise (including walking or stationary biking) three times per week for six months. They were supervised for three months and then exercised unsupervised at home for three months. Participants in the exercise group did not receive any counseling in the DASH diet and were encouraged to follow their usual diets for six months.

People in the DASH eating plan group received instruction about how to meet DASH guidelines in a series of weekly sessions for three months and then bi-weekly for the remaining three months. Participants in the DASH group were asked not to engage in regular exercise until the completion of the six-month study.

People in the exercise and DASH group followed the exercise and DASH programs for six months. The participants who were enrolled in the health education group received weekly educational phone calls for three months and then bi-weekly calls for three months. Phone calls were conducted by a health educator on health topics related to heart disease. Participants were asked to maintain their usual dietary and exercise habits for six months until they were re-evaluated.

At the conclusion of the six-month intervention and assessment, participants were free to engage in whatever activity and dietary habits they desired, with no restrictions.

The results of the research team’s study showed that exercise improved the participants’ ability to think, remember, and make decisions compared to non-exercisers, and that combining exercise with the DASH diet improved the ability to think, remember, and make decisions, compared to people who didn’t exercise or follow the diet—even though they didn’t perfectly follow the programs they were assigned to during the six-month interventions.

The researchers concluded that their findings are promising proof that improved ability to think, remember, and make decisions can last one year after completing a six-month exercise intervention. They suggested that further studies would be needed to learn more.

This summary is from “Longer Term Effects of Diet and Exercise on Neurocognition: One Year Follow-Up of the ENLIGHTEN Trial.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are: James A. Blumenthal, PhD; Patrick J. Smith, PhD; Stephanie Mabe, MS; Alan Hinderliter, MD; Kathleen Welsh-Bohmer, PhD; Jeffrey N. Browndyke, PhD; P. Murali Doraiswamy, MBBS, FRCP; Pao-Hwa Lin, PhD; William E. Kraus, MD; James R. Burke, MD; and Andrew Sherwood, PhD.