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Falls In The Elderly

Falls and the injuries they cause are of major medical importance in the elderly. A recent planned meta-analysis of trials of short-term exercise in over 2,000 elderly people in the United states show that exercise can help prevent falls over the next 2-4 years.

The size of the problem

In the United States it has been estimated that 30% of people over 65 years have a fall in any one year, and half of these 30% have more than one fall.

The consequences of a fall in the elderly can be serious. Perhaps one in 10 falls results in serious injuries, with up to 1% of falls resulting in a broken hip and a further 5% resulting in other broken bones. The injuries elderly people sustain result in impaired movement and life quality, and the pain and disability can continue for a median of seven months in 40% of elderly people going to hospital after a fall. Apart from the pain and distress for the individuals, falls in the elderly are sufficiently common to comprise a major part of health care costs.

Setting

Independent randomised controlled trials were carried out in two nursing homes and five community dwelling sites in the USA. Numbers of elderly people included varied from 100 to over 1,300 (minimum ages varied from 60 to 75 years). The studies each included a control group. Those in the treatment groups had 10 to 36 weeks of one of a number of different interventions, including different exercise regimes with resistance and/or endurance training, nutritional instruction, meditation, and Tai Chi.

Outcome

The number of falls experienced by the participants, and injuries sustained, was obtained for up to 2 to 4 years.

Results

This report has some complicated statistics, but the highlights were as follows:-

  • 1,049 controls suffered 1,499 falls, an average of 1.43 falls per person.
  • 1,255 treated persons suffered 1,506 falls, an average of 1.20 falls per person.
  • the adjusted fall incidence ratio for treatment arms which included general exercise was 0.9 (95% confidence intervals 0.81 - 0.99).
  • the adjusted fall incidence ratio for treatment arms which included balance was 0.83 (95% confidence intervals 0.70 - 0.98).
  • Tai Chi appeared, on small numbers, to be the best intervention with about a 35% reduction in fall incidence.

Comment

The effect sizes in this study were not large, with effective treatments producing reductions in fall incidence of 10 and 17%, though Tai Chi was notable in being more effective, but in small numbers. These effects, applied to the very large proportion of elderly people in today's society, would produce very significant benefits in falls and injury avoided, would reduce disability, and would allow considerable health care spending to be applied to more useful ends.

This is an important and interesting public health subject, worthy of more study in UK settings.

Reference:

MA Province, EC Hadley, MC Hornbrook et al. The effects of exercise on falls in elderly patients. Journal of the American Medical Association 1995 273: 1341-7.




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