Fall Prevention

Last Updated: August 16, 2022

Falling presents a significant risk to older adults that can increase the chance of a bone fracture, disability, and loss of independence. Fall prevention refers to exercises or interventions that reduce the risk or occurrence of falls in elderly individuals.

Fall Prevention falls under theHealthy Aging & Longevitycategory.

What is fall prevention?

About one in three older adults experience a fall each year. Older adults are also more likely to experience fall-related injuries, including fractures, head injury, long-term mobility issues, and reduced independence. Therefore, fall prevention is typically targeted at older adults, and involves person-specific strategies to manage modifiable risk factors. Fall prevention methods can include environmental modifications (e.g., putting railings in the shower), management of any chronic conditions that increase fall risk, and physical training.[1][2] Since falls in older adults are a serious public health problem, organizations like the https://www.cdc.gov/steadi/index.html and the [https://ncoa.org/professionals/health/center-for-healthy-aging/national-falls-prevention-resource-center/falls-free-initiative](National Council of Aging) have developed fall prevention initiatives.

How is the need for fall prevention measured?

Accurately identifying people that need a fall prevention intervention is a challenge.[2] It’s recommended that the risk for falls be determined by asking people whether they’ve fallen in the past, whether they are afraid of falling, or whether they experience gait and/or balance difficulties. People who may be at risk for falls can have their gait and balance measured with the [https://www.cdc.gov/steadi/pdf/TUG_test-print.pdf](Timed Up and Go Test (TUG). Other less-commonly-used assessments include the Berg Balance Scale and the Tinetti Performance-Oriented Mobility Assessment Tool.[1]

How does physical activity affect fall prevention?

Many older adults, especially those with a history or a fear of falling, reduce and restrict their physical activity with the intention to reduce their risk of falls. Unfortunately, this usually results in physical deconditioning and conversely increases the risk of falls.[2] Consequently, most research has linked expert-directed moderated physical activity as a factor that reduces the risk of falls.[2] Meta-analyses of over 10,000 participants show that exercise reduces fall risk by 23% compared to control.[3] [4] Many exercise regimens have been studied, including functional balance training, resistance training, flexibility, patterned movement (Tai Chi/dance), and endurance training. Exercise can help to improve functional stability (e.g. by increasing lower body strength) and balance, providing additional layers of defense against a fall.[3][5]

Have any supplements been studied for fall prevention?

Supplements for fall prevention are usually targeted at managing conditions that increase the risk for fracture or other acute conditions during a fall. For example, vitamin D and calcium have been studied for preventing fall-related injuries, as these nutrients help to stave off osteoporosis.[6] However, some evidence suggests that high-dose vitamin D may actually be associated with an increased risk of falls when compared to lower doses, although it’s not clear why that would be the case.[7][8].

How can diet affect fall prevention?

Dietary interventions have not been directly studied for fall prevention. However, diet can have many indirect effects on fall risk. For example, a nutritionally balanced diet that promotes a healthy weight may help to prevent falls and fall-related injuries in older adults and in people with osteosarcopenic obesity syndrome.[9] Correcting malnutrition, such as inadequate dietary protein and calcium intake, in the elderly may also reduce the risk of falls.[10][11]

Which other factors help prevent falls?

In addition to exercise, other interventions to prevent falls include strategies to avoid hypotension, managing medications that increase the risk of falls, reducing foot and vision problems, and increasing home safety.[6][4] Strategies to reduce the severity of fall-related injuries include osteoporosis management, hip protectors, and digital technology or wearables.[1] Managing environmental factors such as lighting, stair and bath rails, clutter, and weather conditions can also help to prevent falls.[2]

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  1. ^Montero-Odasso MM, Kamkar N, Pieruccini-Faria F, Osman A, Sarquis-Adamson Y, Close J, Hogan DB, Hunter SW, Kenny RA, Lipsitz LA, Lord SR, Madden KM, Petrovic M, Ryg J, Speechley M, Sultana M, Tan MP, van der Velde N, Verghese J, Masud T,Evaluation of Clinical Practice Guidelines on Fall Prevention and Management for Older Adults: A Systematic Review.JAMA Netw Open.(2021-Dec-01)
  2. ^Lusardi MM, Fritz S, Middleton A, Allison L, Wingood M, Phillips E, Criss M, Verma S, Osborne J, Chui KKDetermining Risk of Falls in Community Dwelling Older Adults: A Systematic Review and Meta-analysis Using Posttest Probability.J Geriatr Phys Ther.(2017)
  3. ^Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, Clemson L, Hopewell S, Lamb SEExercise for preventing falls in older people living in the community.Cochrane Database Syst Rev.(2019-Jan-31)
  4. ^Dautzenberg L, Beglinger S, Tsokani S, Zevgiti S, Raijmann RCMA, Rodondi N, Scholten RJPM, Rutjes AWS, Di Nisio M, Emmelot-Vonk M, Tricco AC, Straus SE, Thomas S, Bretagne L, Knol W, Mavridis D, Koek HLInterventions for preventing falls and fall-related fractures in community-dwelling older adults: A systematic review and network meta-analysis.J Am Geriatr Soc.(2021-Oct)
  5. ^Kim Y, Vakula MN, Bolton DAE, Dakin CJ, Thompson BJ, Slocum TA, Teramoto M, Bressel EWhich Exercise Interventions Can Most Effectively Improve Reactive Balance in Older Adults? A Systematic Review and Network Meta-Analysis.Front Aging Neurosci.(2021)
  6. ^Stevens JA, Phelan EADevelopment of STEADI: a fall prevention resource for health care providers.Health Promot Pract.(2013-Sep)
  7. ^Lawrence J Appel, Erin D Michos, Christine M Mitchell, Amanda L Blackford, Alice L Sternberg, Edgar R Miller 3rd, Stephen P Juraschek, Jennifer A Schrack, Sarah L Szanton, Jeanne Charleston, Melissa Minotti, Sheriza N Baksh, Robert H Christenson, Josef Coresh, Lea T Drye, Jack M Guralnik, Rita R Kalyani, Timothy B Plante, David M Shade, David L Roth, James Tonascia, STURDY Collaborative Research GroupThe Effects of Four Doses of Vitamin D Supplements on Falls in Older Adults : A Response-Adaptive, Randomized Clinical TrialAnn Intern Med.(2021 Feb)
  8. ^Zittermann A, Trummer C, Theiler-Schwetz V, Pilz SLong-term supplementation with 3200 to 4000 IU of vitamin D daily and adverse events: a systematic review and meta-analysis of randomized controlled trials.Eur J Nutr.(2023-Jun)
  9. ^Hita-Contreras F, Martínez-Amat A, Cruz-Díaz D, Pérez-López FROsteosarcopenic obesity and fall prevention strategies.Maturitas.(2015-Feb)
  10. ^S Iuliano, S Poon, J Robbins, M Bui, X Wang, L De Groot, M Van Loan, A Ghasem Zadeh, T Nguyen, E SeemanEffect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care: cluster randomised controlled trialBMJ.(2021 Oct 20)
  11. ^Trevisan C, Crippa A, Ek S, Welmer AK, Sergi G, Maggi S, Manzato E, Bea JW, Cauley JA, Decullier E, Hirani V, LaMonte MJ, Lewis CE, Schott AM, Orsini N, Rizzuto DNutritional Status, Body Mass Index, and the Risk of Falls in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis.J Am Med Dir Assoc.(2019-May)
  12. ^Institute of Medicine (US) Division of Health Promotion and Disease Prevention, Robert L. Berg, Joseph S. CassellsThe Second Fifty Years: Promoting Health and Preventing Disability
  13. ^Paliwal Y, Slattum PW, Ratliff SMChronic Health Conditions as a Risk Factor for Falls among the Community-Dwelling US Older Adults: A Zero-Inflated Regression Modeling Approach.Biomed Res Int.(2017)
  14. ^Moncada LVV, Mire LGPreventing Falls in Older Persons.Am Fam Physician.(2017-Aug-15)
  15. ^Kim SB, Zingmond DS, Keeler EB, Jennings LA, Wenger NS, Reuben DB, Ganz DADevelopment of an algorithm to identify fall-related injuries and costs in Medicare data.Inj Epidemiol.(2016-Dec)
  16. ^Moreland B, Kakara R, Henry ATrends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years - United States, 2012-2018.MMWR Morb Mortal Wkly Rep.(2020-Jul-10)
Examine Database References
  1. Fall Risk - Broe KE, Chen TC, Weinberg J, Bischoff-Ferrari HA, Holick MF, Kiel DPA higher dose of vitamin d reduces the risk of falls in nursing home residents: a randomized, multiple-dose studyJ Am Geriatr Soc.(2007 Feb)
  2. Fall Risk - Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, Wong JB, Egli A, Kiel DP, Henschkowski JFall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trialsBMJ.(2009 Oct 1)
  3. Fall Risk - Michos ED, Kalyani RR, Blackford AL, Sternberg AL, Mitchell CM, Juraschek SP, Schrack JA, Wanigatunga AA, Roth DL, Christenson RH, Miller ER, Appel LJThe Relationship of Falls With Achieved 25-Hydroxyvitamin D Levels From Vitamin D Supplementation: The STURDY Trial.J Endocr Soc.(2022-Jun-01)
  4. Functionality in Elderly or Injured - Guralnik JM, Sternberg AL, Mitchell CM, Blackford AL, Schrack J, Wanigatunga AA, Michos E, Juraschek SP, Szanton S, Kalyani R, Cai Y, Appel LJ,Effects of Vitamin D on Physical Function: Results From the STURDY Trial.J Gerontol A Biol Sci Med Sci.(2022-Aug-12)