What intervention has the strongest evidence for preventing falls according to the US Preventative Services Task Force (USPSTF) recommendations?

Exercise Interventions Have the Strongest Evidence for Preventing Falls According to USPSTF

According to the US Preventive Services Task Force (USPSTF) recommendations, exercise interventions have the strongest evidence for preventing falls in community-dwelling older adults. 1

Evidence for Exercise Interventions

The USPSTF found convincing evidence that exercise interventions provide moderate benefit in reducing falls in older adults:

• Exercise interventions reduced the number of persons experiencing a fall (relative risk [RR], 0.89 [95% CI, 0.81 to 0.97]) 1
• Exercise interventions reduced the number of injurious falls (incidence rate ratio [IRR], 0.81 [95% CI, 0.73 to 0.90]) 1
• The USPSTF concluded with high certainty that exercise confers a moderate benefit in fall reduction 1

Specific Exercise Components

The most effective exercise interventions typically include:

• Group-based exercise (versus individual-based exercise) 1
• Multiple exercise components (versus single component) 1
• Strength or resistance exercises 1
• Gait, balance, or functional training (including tai chi) 1

The number needed to treat with exercise for approximately 12 weeks to prevent one person from falling was 16, with greater benefit seen in high-risk populations 1.

Comparison to Other Interventions

Vitamin D Supplementation

In the 2012 USPSTF recommendations, vitamin D supplementation was found to reduce fall risk by approximately 17% 1. However, in the updated 2018 recommendations, the USPSTF found:

• Vitamin D supplementation does not prevent falls 1
• Pooled analyses showed no effect on the number of falls or persons experiencing falls 1
• The USPSTF concluded with moderate certainty that vitamin D supplementation offers no net benefit 1

Multifactorial Interventions

Multifactorial interventions show less robust evidence compared to exercise:

• Multifactorial interventions reduced the number of falls (IRR, 0.79 [95% CI, 0.68 to 0.91]) 1
• However, they did not significantly reduce the number of persons experiencing a fall (RR, 0.95 [95% CI, 0.89 to 1.01]) 1
• The USPSTF concluded with moderate certainty that multifactorial interventions confer only a small net benefit 1

Identifying High-Risk Individuals

To identify older adults who would benefit most from exercise interventions, clinicians should consider:

• History of prior falls 1
• Physical function or mobility limitations 1
• Gait and balance impairments 1
• Chronic disease status 1
• Use of psychotropic medications 1

Implementation Considerations

For optimal effectiveness, exercise interventions should:

• Include a minimum dose of 50 hours to protect against falls 2
• Be delivered by a health professional, preferably a physiotherapist 3
• Focus on moderate to high-intensity balance exercises 2
• Include multiple components, particularly balance and strength training 4

Potential Harms and Limitations

The potential harms of exercise interventions are generally small:

• Possible paradoxical increase in falls during initial implementation 1
• Increased physician visits 1
• Self-reported musculoskeletal symptoms 1

Biological Plausibility

Exercise interventions work by addressing key fall risk factors:

• Improving muscle weakness 1
• Correcting gait disturbances 1
• Enhancing balance 1

These improvements in physical function directly address the physiological factors that contribute to falls in older adults.