Exercise, vitamin D may prevent falls: guidelines
Older adults who are at high risk of falls should have physical therapy and take vitamin D supplements to reduce their chance of injury, according to new recommendations from a government-backed panel.
Falling is “a common problem and it’s often overlooked because doctors may not be aware of their patients’ fall risk,” said Dr. Albert Siu, a professor at Mount Sinai School of Medicine in New York and vice co-chair of the U.S. Preventive Services Task Force (USPSTF), which came out with the recommendations on Monday.
“By asking about falls and by observing the patient in terms of walking, we might be able to asses who might be at risk and who can benefit from preventive measures,” Siu told Reuters Health.
Falls are a leading cause of injury among older adults, he added.
According to the new guidelines, published in the Annals of Internal Medicine, 30 to 40 percent of people age 65 or older fall at least once each year, and five to 10 percent of them will have a serious injury such as a hip fracture.
The USPSTF makes recommendations on a range of prevention and treatment issues, and its guidelines on reducing the risk of falls in the elderly had not been updated since 1996.
Preventing Falls in the Elderly
Quick Facts…
- The risk of falling increases with age and is greater for women than for men.
- Two-thirds of those who experience a fall will fall again within six months.
- A decrease in bone density contributes to falls and resultant injuries.
- Failure to exercise regularly results in poor muscle tone, decreased strength, and loss of bone mass and flexibility.
- At least one-third of all falls in the elderly involve environmental hazards in the home.
Causes and Prevention
The causes of falls are known as risk factors. Although no single risk factor causes all falls, the greater the number of risk factors to which an individual is exposed, the greater the probability of a fall and the more likely the results of the fall will threaten the person’s independence.
Many of these risk factors are preventable. As obvious as it may sound, a lack of knowledge about risk factors and how to prevent them contributes to many falls. Some people believe that falls are a normal part of aging, and as such are not preventable. Lack of knowledge leads to lack of preventive action, resulting in falls.
Discussed below are five key risk factors of falls among older adults. Preventive measures for each factor are briefly listed. No attempt is made to provide a comprehensive description of preventive measures. Refer to the references listed at the end of this fact sheet for more detailed information.
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by K.R. Tremblay Jr., and C.E. Barber1 (12/05)
There has been considerable research done since then on what seniors can do to prevent falls - and what doesn’t seem to work. For instance, correcting vision, wearing a shield called a hip protector, stopping some medications or taking protein supplements do not reduce the risk that someone will have a fall, according to the guidelines.
Vitamin D, exercise and physical therapy, however, are moderately beneficial, reducing the risk of falling by 13 to 17 percent (see Reuters Health report of December 21, 2010).
A 13 percent reduction in falls would mean that instead of 30 out of 100 older adults having a fall each year, that number would drop to 26.
Osteoporosis
Osteoporosis is a condition wherein bones become more porous, less resistant to stress, and more prone to fractures. Caused by hormonal changes, calcium and vitamin D deficiency, and a decrease in physical activity, osteoporosis is a chief cause of fractures in older adults, especially among women.
What is debatable is whether brittle bones break after a fall, or break when stressed and in turn cause a fall. In either event, a decrease in bone density contributes to falls and resultant injuries.
Prevention Tips
- Eat or drink sufficient calcium. Postmenopausal women need 1,500 mg of calcium daily. Calcium-rich foods include milk, yogurt, cheese, fish and shellfish, selected vegetables such as broccoli, soybeans, collards and turnip greens, tofu and almonds.
- Get sufficient vitamin D in order to enhance the absorption of calcium into the bloodstream. Vitamin D is formed naturally in the body after exposure to sunlight, but some older adults may need a supplement.
- Regularly do weight-bearing exercises.
In the USPSTF’s review of the evidence on vitamin D, the panel found that to prevent one elderly person from falling, 10 would have to take vitamin D supplements.
Siu said the usual dose is 800 international units (IUs) per day, and studies suggest people should take vitamin D for one year to see any benefit.
For exercise or physical therapy, one person would be spared a fall among every 16 people who participate in a program for 12 weeks.
Siu said there’s not one particular exercise regimen that works best for preventing falls, and that people should talk to their doctors about finding an exercise or physical therapy program they’ll stick to over the long run.
“I know from experience, if you recommend something someone had very little interest in, it’s not going to get done,” he said.
Siu said doctors can pick out patients who are at a higher risk of falling by informal assessments, such as watching how steady they are on their feet and asking them whether they’ve had a fall recently.
Physicians can also use a more formal test that includes timing how quickly people can get up from a chair, walk a few paces and return to the same spot.
The USPSTF recommends against more detailed assessments of these higher risk patients, such as evaluating their balance and if their homes have tripping hazards.
There seems to be only a minor benefit from doing an in-depth examination of risks and how to manage them, according to Siu - and such an undertaking should be reserved for just those patients that a doctor feels would truly benefit, rather than widely applied to all patients at risk of falling.
SOURCE: Annals of Internal Medicine, May 28, 2012
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Prevention of Falls in Community-Dwelling Older Adults: U.S. Preventive Services Task Force Recommendation Statement
Methods: The USPSTF reviewed new evidence on the effectiveness and harms of primary care–relevant interventions to prevent falls in community-dwelling older adults. The interventions were grouped into 5 main categories: multifactorial clinical assessment (with or without direct intervention), clinical management (with or without screening), clinical education or behavioral counseling, home hazard modification, and exercise or physical therapy.
Recommendations: The USPSTF recommends exercise or physical therapy and vitamin D supplementation to prevent falls in community-dwelling adults aged 65 years or older who are at increased risk for falls. (Grade B recommendation)
The USPSTF does not recommend automatically performing an in-depth multifactorial risk assessment in conjunction with comprehensive management of identified risks to prevent falls in community-dwelling adults aged 65 years or older because the likelihood of benefit is small. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of the circumstances of prior falls, comorbid medical conditions, and patient values.
Virginia A. Moyer, MD, MPH, on behalf of the U.S. Preventive Services Task Force
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