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Falls-prevention exercise programs reduce falls in older adults living in care facilities

Lee SH and Kim HS. Exercise interventions for preventing falls among older people in care facilities: A meta-analysis Worldviews on Evidence-Based Nursing. 2017;14:74-80.

Review question

Do exercise programs designed to prevent falls actually reduce falls in older adults living in care facilities? Are certain types of exercise, such as strength, endurance and balance training, more effective at reducing falls?

Background

Older adults have a high risk of falling because they tend to have weaker joints, bones and muscles. They are also more likely to break a bone because of a fall, and fall-related injuries can lead to disability and even death. Older adults who live in care facilities have a greater risk of falling than those who live in their own homes. Research has suggested that exercise may prevent falls in older adults, specifically by improving their strength, balance and endurance.

How the review was done

This is a review of 21 randomized control trials, including a total of 5540 participants. All of these studies were combined in a meta-analysis.

• All participants were over the age of 65 and lived in care facilities. The average age of participants was 83 years and more than 80% were women. Most of the participants had limitations in their ability to carry out daily activities.
• Study participants took part in exercise programs specifically designed to prevent falls. The frequency of exercise sessions ranged from three times per day to once a week. Duration of exercises ranged from 2 minutes to 90 minutes, and over a time period of ten weeks to one year.
• Types of exercise varied across studies. Some programs focused on walking, balance, function, and strength, others used Tai Chi and mechanical devices (specialized treadmills and platforms to improve balance). Several programs combined exercise with other fall-prevention strategies, such as educating facility staff about falls and changing participants’ medications to ones less likely to cause falls.
• Researchers measured the rate of falls and the number of participants who experienced falls.
• Results were compared to control groups who did not participate in an exercise program or who participated in an exercise program not specifically designed to reduce falls.

What the researchers found

Overall, fall-prevention exercise programs reduced the rate of falls in participants. The programs also reduced the number of people who fell more than two times per year. Programs that combined exercise with other fall-prevention strategies helped to decrease the number of participants who fell and the number of falls, whereas programs that used a single type of exercise decreased the number of falls, but not number of fallers. The types of exercise programs that worked to reduce falls were those involving balance and strength training or using mechanical devices to improve gait, balance and function. Exercises that included a walking component increased risk of falls for this at-risk group of frail older adults. Further research is needed to determine if fall-prevention exercise programs are cost-effective and how exactly the programs should be applied in care facilities.

Conclusion

Programs that combine exercise and other fall-prevention strategies are an effective way to reduce falls in older adults living in care facilities. These programs work best when they apply balance and strength training or mechanical training devices.