Prevention: How can older people reduce their chances of falling?

Not every fall can be avoided. But there are several things that might be able to help reduce the risk, like reducing hazards around the home, particular muscle and balance training, and stopping use of unnecessary psychotropic medication.

Falls can happen at any age. Thankfully they are nearly always minor, and there are no serious consequences. That's true of falls in people over 65 as well. Nevertheless it can be worthwhile, particularly for older people, to take some actions that could reduce their risk of falling at home or on the street.

It is estimated that every year somewhere between three and 10 out of every 100 people over the age of 65 have a fall (30-50%). The rate for people living in nursing homes is higher. About 9 out of 10 of these falls have no further consequences (90%). Only sometimes is there an injury that requires medical attention. Less than one in 10 falls causes a broken bone (10%).

Because a broken bone can have such serious consequences, it can be worthwhile to try to reduce some of the causes of falls. This means that there is a lot of advice given about how to avoid falls through simple measures at home, for example. Researchers did a systematic review to test if any of these strategies offer the chance of success. They evaluated 62 trials with over 21,000 people older than 65.

This showed that the potential value of a particular strategy depends on the personal and health situation of the individual older person. This is one of the reasons why there is no one piece of advice that offers protection in all circumstances.

The researchers separated the strategies into two groups. The first group included those that might be worth trying, even though there is no guarantee that they could prevent every fall. These included:

• Assessment of safety in the home and reducing potential hazards
• Individual muscle and balance training programmes provided by specially trained instructors
• Reducing the use of psychotropic, or mind-altering, medications that might increase the risk of falling over
• Cardiac pacemakers for people with particular heart rhythm disturbances.

The second group were strategies which are not supported by reliable evidence:

• General and group training
• Training to strengthen only the legs
• Dietary supplements
• Menopausal hormone therapy
• Correction of vision problems.

Some doctors suggest that a vitamin D deficiency weakens the muscles and so might increase the risk of falling. There is conflicting evidence about whether or not vitamin D with or without calcium can prevent falls. There is good evidence, though, from another systematic review, that daily doses of vitamin D between 700 to 800 IU/d can reduce the chances of breaking a bone when a person does fall. There are also other ways to try to prevent broken bones, but these were not the subject of this study.

Overall the authors concluded that there are strategies that can reduce falls and they are worth trying. Many of them, though, need more detailed testing.

© IQWiG (Institute for Quality and Efficiency in Health Care)