From the Guidelines
Preventing falls in older adults requires a comprehensive approach that includes exercise interventions, particularly those that target strength and balance, as the most effective strategy to reduce the rate of falls by 23% compared to controls 1.
Key Interventions
To effectively prevent falls, the following interventions should be considered:
- Exercise programs that focus on balance, strength, and gait training, which have been shown to be effective in preventing falls when delivered in a group-based setting or on an individual basis 1
- Multicomponent programs that target both strength and balance, as well as programs that include balance training, which appear to be particularly effective in preventing falls 1
- Vitamin D supplementation (800-1000 IU daily) for those with deficiency, as recommended by the American Geriatrics Society (AGS) and the American Academy of Family Physicians 1
- Review and modification of medications that increase fall risk, particularly psychotropics, antihypertensives, and sedatives 1
- Environmental interventions, such as removing tripping hazards, installing grab bars in bathrooms, improving lighting, securing rugs, and adding handrails on stairs 1
Additional Considerations
Other important considerations in preventing falls include:
- Conducting a comprehensive fall risk assessment for all older adults and those with mobility issues 1
- Implementing post-fall protocols that include immediate assessment for injuries and investigation of fall causes to prevent recurrence 1
- Providing vision correction, proper footwear, and assistive devices like canes or walkers when properly fitted to reduce falls 1
- Managing orthostatic hypotension through gradual position changes and adequate hydration 1 By prioritizing these interventions and considering the individual needs and risk factors of each patient, healthcare providers can effectively reduce the risk of falls and improve outcomes for older adults.
From the FDA Drug Label
The risk is increased in those taking concomitant sedatives (including alcohol), and in the elderly. There have been reports of falls and fractures in benzodiazepine users.
The interventions that may be effective in preventing falls are not directly stated in the label. However, it can be inferred that:
- Avoiding concomitant sedatives (including alcohol) may help prevent falls.
- Extra caution should be taken when prescribing benzodiazepines to the elderly. However, these are not direct answers to the question, and the label does not provide explicit information on effective interventions for preventing falls. 2
From the Research
Effective Interventions for Fall Prevention
The following interventions are effective in preventing falls among older adults:
- Exercise interventions, such as balance and functional exercises, which have been associated with a reduced rate of falls 3
- Multifactorial interventions that address multiple risk factors, including gait and balance disorders, orthostatic hypotension, sensory impairment, medications, and environmental hazards 3, 4
- Surgery to remove cataracts, which has been shown to decrease the risk of falls 3
- Multicomponent podiatry interventions, which have been associated with a reduced risk of falls 3
- Environmental modifications, such as home-hazard assessment and modification, which can reduce the risk of falls among individuals at high risk 3, 4
- Regular physical activity, which can reduce fall risk 5
- Use of anti-slip shoe devices in icy conditions, which can be beneficial for older people walking outdoors 4
- Hip protectors, which are effective in nursing home residents and potentially among other high-risk individuals 4
Components of Multicomponent Interventions
Multicomponent interventions typically include:
- Exercise component, such as balance and strength training 4
- Individually tailored measures focused on high-risk populations 4
- Risk factor assessment 6, 5
- Dietary supplements 4
- Elements of physical therapy 4
- Optimization of care of chronic medical conditions, such as diabetes mellitus, hypertension, osteoporosis, pain, urinary urgency and incontinence, and depression 5
- Polypharmacy and drug management to avoid medications that increase the risk of falls 5
- Optimization of vision and hearing correction 5
- Podiatry care 5
- Appropriate use of ambulation devices 5