Task Force Reviewed More Than 50 Studies
By Salynn Boyles
WebMD Health News
Reviewed by Laura J. Martin, MD
The U.S. Preventive Services Task Force panel found "convincing evidence" that exercise or physical therapy and vitamin D supplementation can help reduce the risk of falls in people aged 65 and older.
Researchers reviewed more than 50 clinical trials to assess the benefits and harms of different strategies for preventing falls in older adults living in the community outside of nursing homes and other assisted-living centers.
Falls in the Elderly Underreported
Falls are a leading cause of serious injury and the leading cause of nursing home entry among the elderly.
Risks for falls include older age, a history of falls, and difficulty getting around.
As many as 40% of people aged 65 and older living outside of nursing homes fall at least once a year, and up to 10% of those who fall will suffer fractures, lacerations, or head injuries.
Falls are also widely underreported, geriatric physician Gisele Wolf-Klein, MD, tells WebMD.
Wolf-Klein is director of geriatric education at the North Shore-LIJ Health System in New Hyde Park, N.Y.
"Elderly people who fall often don't tell their doctor or their children or even their spouse," she says. "They are often ashamed or fearful that they will be perceived as frail and dependent."
Exercise, Vitamin D 'Modestly Beneficial'
Among the major findings:
- Vitamin D supplementation had a modest impact on fall risk, with analysis of nine studies showing its use to lower this risk by 17% over six to 36 months of follow-up.
- A review of 18 studies found that exercise or physical therapy reduced fall risk by about 13%, which was also considered a modest benefit.
- The task force recommended against routine, in-depth, multiple risk factor assessment and intervention in all people 65 and older, concluding that decisions about such assessment should be made on a case-by-case basis.
- The data were also insufficient to recommend behavioral counseling or home hazard modification to prevent falls.
The task force did not specify what types of exercises older people should do or how much vitamin D supplementation they should take to reduce their risk for falls.
Task force member Albert L. Siu, MD, MSPH, tells WebMD that the analysis suggested a benefit for balance exercise, such as tai chi; strength and resistance exercise; and general exercise.
"Exercise recommendations need to be customized to individual patients, especially since adherence is such an important component," he says. "If you prescribe an exercise that a patient won't do, there is no benefit."
Docs Should Ask Patients About Falls
The task force did not weigh in for or against the use of calcium, which is often taken with vitamin D.
Siu says government researchers are in the process of evaluating the research on calcium supplementation and bone health.
Although the report did not address vitamin D dosage, recommendations recently published by the American Geriatrics Society (AGS) call for people at increased risk for falls to take a supplement of at least 800 international units (IU) of the vitamin a day.
"Most multivitamins have this much vitamin D, so people who take a multivitamin every day may not need more," Wolf-Klein says.
She adds that more doctors need to ask their elderly patients if they have fallen recently.
The AGS recommends that doctors ask all their older patients about falls at least once a year.
The U.S. Preventive Services Task Force panel included independent health experts appointed by the Department of Health and Human Services.
The report was published online May 28 and it will appear in the August 7 issue of the Annals of Internal Medicine.
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