Review: interventions targeting intrinsic and environmental risk factors reduce falls in older persons.

In community-dwelling or institutionalized older persons, which interventions are effective for reducing the incidence of falls? D a t a s o u r c e s Studies were identified by searching Cochrane reference lists of articles; and contacting researchers in the field. S t u d y s e l e c t i o n a n d a s s e s s m e n t Studies in any language were selected if they were randomized controlled trials (RCTs) comparing interventions designed to minimize the effect of or exposure to any risk factors for falling with usual care in elderly persons living in the community or in institutional care. Methodological quality of individual studies was assessed by 2 reviewers independently using a predetermined scoring system (11 items). Number of persons who fell, number of falls, and severity of falls (number of falls resulting in injury, medical attention, or fracture). 62 RCTs met the inclusion criteria. The trials included 21 668 participants, and follow-up ranged from 3 months to 10 years. Fewer community-dwelling persons who received individually targeted exercise or physical therapy consisting of strength training, balance , and walking fell or sustained injury from falling than did those who received a control intervention (Table). Home safety interventions also reduced the number of falls among community-dwelling fallers (Table). Multidisciplinary, multifactorial, health, or envronmental risk-factor screening or intervention programs reduced the number of fall-ers both in unselected community-dwelling elderly persons (fallers and nonfallers); and in targeted community-dwelling elderly persons who either had a history of falling or were selected because of known risk factors (Table). In community-dwelling or institutionalized elderly persons, intervention programs that target intrinsic and environmental risk factors reduce the incidence of falls. ©ACP 17 C o m m e n t a r y Falls are a serious health concern in older persons. Although most falls are noninjurious, they have a major effect on quality of life (restriction of activities for fear of falling), morbidity (approximately 20% require medical attention and 1% to 2% result in hip fractures), and mortality (unintentional injuries are the 5th most common cause of death in this population) (1). The relative importance of functional decline and disease and environmental factors, which may contribute to falls, varies according to the population studied: community dwellers, hospitalized patients, or nursing home residents. The heterogeneity of the geriatric population and the difficulty of teasing …