A systematic review of more than 50 clinical trials finds that exercise and Vitamin D supplements are the best ways to reduce the risk of falling in people aged 65 and over.

The review is published in the December 21 issue of Annals of Internal Medicine and was commissioned by the US Preventive Services Task Force. A researcher at the Drexel University School of Public Health, Philadelphia, worked with colleagues at the Kaiser Permanente Center for Health Research, which is part of the Oregon Evidenced-based Practice Center, to conduct the study.

Yvonne L. Michael, ScD, MS, an associate professor at the Drexel University School of Public Health and lead review author of the report, and her colleagues evaluated 18 clinical trials of exercise and physical therapy involving nearly 4,000 people who were 65 or older. Some of the trials involved group exercise or tai chi classes; others involved individualized exercise instruction at home. There were a variety of exercises included but most were aimed at improving gait, balance, strength, and flexibility needed to do everyday activities. The interventions ranged from 6 weeks to 12 months or longer and the evaluation periods lasted up to 18 months after the programs ended. When taken individually, most of these trials showed no statistical difference, but when the results were pooled together the exercisers had a 13% lower risk of falling compared to those who did not exercise.

For the review of Vitamin D supplementation researchers evaluated nine clinical trials involving nearly 6,000 participants who received daily oral doses of Vitamin D with or without calcium. The dosage ranged from 10 to 1,000 IU’s per day; in one trial participants received a larger single intramuscular injection of 600,000 IU’s of Vitamin D. The trials lasted from 8 weeks to 3 years. Follow-up periods ranged from 6 to 36 months. Participants who received Vitamin D had a 17% reduced risk of falling, compared to participants who did not receive Vitamin D.

Other interventions that addressed single risk factors including vision correction, medication assessment, home hazard modification, and education and behavioral counseling did not significantly reduce the risk of falling in the elderly. Interventions that provided comprehensive risk assessment and management did reduce the risk of falling by 11% In these trials—called multifactorial assessment and management interventions—health care providers evaluated and managed multiple risk factors including medication use, visual problems, home environment, and gait and balance issues. In many of the successful trials, home health nurses or case managers developed an individual tailored approach specifically for that participant.

Michael received her ScD in epidemiology and health and social behavior from the Harvard School of Public Health, master of science degree in health and social behavior from the Harvard School of Public Health, and bachelor of arts degree in government from the College of William and Mary. Her research areas include the impact of social characteristics of communities and individuals on population health, particularly as it relates to active aging, women’s health, and health disparities.

[Source: Drexel University]