As we explained in our last post, falls represent one of the greatest burdens on the population over 65 years, and consequently, the entire healthcare system. While not all falls result in serious injury, those that do can have significant long–term implications that results in reduced mobility and activity, fear of moving, and a greater risk for other adverse health outcomes. Experiencing a fall can also cause some older adults to enter long–term care facilities like nursing homes and long–stay hospitals, where the risk for falls is generally higher because of a more sedentary lifestyle.
This highlights the urgent need for interventions that can reduce the risk and incidence of falls in the aging population. One of the most effective strategies to accomplish this is the use of exercise–based programs intended to improve strength, flexibility, mobility, balance, and proprioception (how a person senses the position and location of their body in space.) Many of these programs have been implemented for older adults in long–term care facilities, which can generally be classified into the following groups:
- Single interventions: consists only of various exercise
- Multifactorial interventions: consists of a customized combination of various exercises and other interventions, such as reducing medication use, modifying one’s home environment, and managing low blood pressure
- Multiple component interventions: consists of a fixed combination of exercises and other interventions that are intended to promote mobility, prevent muscle loss, and improve muscle coordination during physical tasks
Research on the effectiveness of these types of programs for preventing falls in older adults is mixed, with some identifying benefits and others failing to do so. Therefore, a powerful study called a systematic review was conducted to evaluate the current evidence on various exercise-based programs for reducing falls in community-dwelling older adults.
Most studies support the use of exercise–based prevention programs
Researchers performed a comprehensive search of four major medical databases for high–quality studies that assessed the impact of exercise–based programs (single interventions, multifactorial interventions, or multiple component interventions) for preventing falls and fall risk in older adults. This search led to 34 studies fitting the necessary criteria for inclusion in the systematic review.
Twelve of the included studies were themselves systematic reviews that reported outcomes on the reduction of falls, and of these, 11 reviews concluded that exercise–based interventions significantly reduced the incidence of falls. In addition, 10 systematic reviews discussed fall risk factors as outcomes, and eight of these reviews concluded that there was a significant improvement in various risk factors, including balance, muscle strength, functional mobility, heart and lung health, gait speed, or fear of falling. Only six papers evaluated negative outcomes among patients, and most of these cases were minor, suggesting that these programs were generally safe. Further analysis revealed that the most effective exercise programs were those that accounted for the specific needs and risks of each participant with a personalized rather than a one–size–fits–all approach.
Based on these findings, it appears that various types of programs with single interventions, multifactorial interventions, or multiple component interventions that include light to moderate exercise training can reduce fall risk factors and the incidence of falls in older adults living in long–term care facilities. Physical therapists can design and implement prevention programs of this nature at these facilities or in an office setting and provide additional advice and assistance on how to manage fall risk in this population. In our next post, we’ll discuss why education should also be involved in fall prevention.