Interventions for preventing falls in older people living in the community

The Paper
Gillespie, L. D., Robertson, M. C., Gillespie, W. J., Sherrington, C., Gates, S., Clemson, L. M., & Lamb, S. E. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev, 9(11).

The Problem
Falls are a major health risks and occupational performance issue for older adults in the community.  

They happen for a variety of reasons that include weakness and frailty, vision issues, poor balance or mobility, cognitive challenges, and more. About 30% of seniors experience a fall each year, with up to 20% of those requiring medical attention.

As an OT, the chances you’ll work with a patient susceptible to falls is high.

So how can you support your practice in falls prevention?

The Research Review
If you haven’t heard of the Cochrane Review (you're missing out...and may have been living under a rock:), their mission is to review important healthcare issues and present clear findings in an accessible way: To improve healthcare decisions through good evidence.

Reviews done by Cochrane tend to be expansive and include large numbers of studies and participant.  In this case, they looked at 159 randomised controlled trials with 79,193 participants related to fall prevention.

*The full review is available from some sources for free and contains a hefty 329 page PDF.  The plain language summary does a nice job boiling things down if you’re in a rush.

Key Findings
Exercise works!
Level of physical function is a huge factor in falls - so exercise based intervention are supported in preventing falls. Exercise even improves outcomes even when people fall (eg. fewer fractures and hospitalizations).  Side note: Positive results have been found for tai chi and home/community exercise programs, but the key is around helping your patient get stronger and engage in positive activities that challenge their balance.

Home assessment:
Removal of hazards from high-risk people’s homes does prevent falls.

Ensuring low vision concerns are addressed (including getting glasses if needed) reduces falls.

Using non-slip devices during inclement (especially icy) weather conditions prevents falls.

When done on it’s own, education and CBT for falls don’t appear to be effective.

Multiple Interventions? 
Multifactorial interventions generally included exercise coupled with something else (like education, or vision assessment).  These mash-ups can be effective, and it may be the exercise doing the heavy lifting!

Popping pills: 
In adults without substantial deficiencies, supplements like vitamin D or hormone replacement don’t seem to help reduce falls. Psychotropic medications likely increase rates of falls.

Keeping people upright is cost effective:
We all know how expensive a night in hospital is. Preventing falls can reduce hospital admissions and save money - which is supported by research...this fact alone can help you justify your OT work in this important area.

Great news: Falls can be a much more straightforward area for you as an OT!

In general, it comes down to getting people moving and grooving, while addressing key safety concerns in the home (including vision deficits and general hazards).

Keep the education light, get people off their keisters and engaged in meaningful physical activity of their choice, and help them take action based steps to reduce falls in their own lives!

Finally, don’t forget that all interventions should be tailored specifically to each person you work with as neurological, cardiovascular or orthopaedic issues deserve their own considerations - a thorough home assessment can also help uncover important issues.

P.S To rapidly integrate the above evidence and more into your practice you can check out our OT Falls Prevention Package.