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

Physical Activity Reduces Your Risk for Falls

Journal of the American Geriatrics Society Research Summary

Experiencing a fall is one of the most common accidents older adults face: Each year, one-third of people over the age of 65 will fall. Half of these falls cause injuries, including serious ones such as hip fractures and others that require hospitalization.

Researchers have shown that higher levels of physical activity can reduce your risk for a fall. Although you might think that being inactive, or sedentary, is safer for you than being active, it actually contributes to falling.

Common sedentary behaviors include sitting while watching television, using a computer, or riding in a car. To reduce sedentary time, you can use a standing desk, and try devices that remind you when it’s time to get up and move around a bit.

Older adults who are mostly sedentary are likely to suffer poor physical function and other signs of ill health, but we don’t have much research about how sedentary time contributes to your risk for falls. In theory, being sedentary could lead to weakness or loss of stability in your legs and hips, could harm the interaction of your nerves and muscles, or lessen your strength and balance — all of which can lead to falls. Continue reading

Medications Used to Treat Atrial Fibrillation May Raise Risk of Falls and Fall-Related Injuries

Journal of the American Geriatrics Society Research Summary

For older adults, fainting and falls are serious health concerns. They can lead to injury, hospitalization, and other severe consequences. Having certain chronic conditions, as well as taking certain medications, can raise your risk of experiencing falls and fall-related injuries.

One condition that contributes to fainting and falls is atrial fibrillation. Atrial fibrillation occurs when the upper (atrial) part of your heart contracts rapidly and irregularly (fibrillates). Atrial fibrillation may be continuous or occasional and is the most common irregular heart rhythm in older adults. It occurs in three to five percent of people over age 65.

To prevent atrial fibrillation symptoms, health professionals may treat patients with medications to control their heart rate or rhythm. However, these medications can potentially raise the risk for falls and fainting, though the connection hasn’t studied significantly in the past.

To learn more, researchers in Denmark designed a study to learn more about the potential risk for falls and fainting among older adults taking medication for atrial fibrillation. Their study was published in the Journal of the American Geriatrics Society. Continue reading

For Older Women, Taking High Blood Pressure Medication May Not Raise Risk for Falls

Journal of the American Geriatrics Society Research Summary

High blood pressure (also known as hypertension) is the medical term for when the force of blood against your blood vessel walls is too high. We know that using medication to lower high blood pressure can prevent heart attacks and strokes. But healthcare professionals often worry that prescriptions for lowering high blood pressure can sometimes lower it too much. This can put you at risk for becoming dizzy and falling.

Falls are a serious problem in older adults. In 2014, falls caused 2.8 million emergency room visits, 800,000 hospitalizations, and 27,000 deaths, and cost Medicare an estimated $31.3 billion.

Although some healthcare experts suspect that taking high blood pressure medication over time is linked to falls and fractures, very little research supports that belief. In fact, at least two major studies examining blood pressure reduction did not find an increased risk for falls among people taking medication to reduce high blood pressure. Other studies have not shown an increase in fracture risk for people taking medication for high blood pressure—in fact, some studies suggest that high blood pressure medicines may actually reduce the risk for fractures.

Researchers decided to learn more about the links between falls, high blood pressure, and high blood pressure medication in older women. They published their study in the Journal of the American Geriatrics Society. Continue reading

Having Poor Vision Can Raise Risk for Falls Among Older Adults

Journal of the American Geriatrics Society Research Summary

Vision impairment and blindness affect one in 11 Americans age 65 and older. Because our population is aging, the number of older adults with vision problems is predicted to rise. Older adults who have impaired vision may be at risk for decreased independence, poorer well-being, and an increased risk of falls. For example, in any given year, approximately 30 percent of adults over age 65 will fall. Having impaired vision more than doubles this risk.

For older adults, falls are a major cause of illness and death. Even having a fear of falling is a challenge that can limit activity and worsen quality of life and independence as you age.

However, we don’t have much information on how often visually impaired older adults experience a fall, and we have even less information about what happens to them after a fall. A team of researchers suggested that we need this information in order to understand the scope of the problem and create ways to prevent falls in visually impaired older adults.

To learn more, the research team examined information from the National Health and Aging Trends Study (NHATS). They published their study in the Journal of the American Geriatrics Society. Continue reading