What Works to Prevent Falls in Community-Dwelling Older Adults? An Umbrella Review of Meta-analyses of Randomized Controlled Trials.
Phys Ther. 2015 Feb 5. [Epub ahead of print]
Stubbs B1, Brefka S2, Denkinger MD3.
BACKGROUND: Preventing falls is an International priority. There is a need to synthesise the highest quality falls prevention evidence in one place for clinicians.
PURPOSE: To conduct an umbrella review of meta-analyses (MA) of randomised controlled trials (RCTs) of falls prevention interventions in community dwelling older adults.
DATA SOURCES: MEDLINE, EMBASE, CINAHL, AMED, BNI, PsycINFO, Cochrane Library, PubMed and the PEDro database.
STUDY SELECTION: MA with one pooled analysis containing ≥ 3 RCTs investigating any intervention to prevent falls in community dwelling older adults aged ≥ 60 years of age were eligible. 16 MA representing 47 pooled analyses were included.
DATA EXTRACTION: Two authors independently extracted data.
DATA SYNTHESIS: Data was narratively synthesised. The methodological quality of the MA was moderate. 3 MA defined a fall and 3 reported adverse events (although minor). There is consistent evidence that exercise reduces falls (including the rate, risk and odds of falling) with 13/14 pooled analyses (93%) from 7 MA demonstrating a significant reduction. The methodological quality of meta-analyses investigating exercise were medium/ high and effect sizes ranged from 0.87 (relative risk (RR) 95% CI 0.81-0.94, N=18, n=3568) to 0.39 (rate ratio (RaR) 95% CI 0.23 - 0.66, N=6). There is consistent evidence that multifactorial interventions reduce falls (5/6, 83% reported significant reduction). There is conflicting evidence regarding the influence of vitamin d supplementation (7/12, 58.3% reported significant reduction).
LIMITATIONS: MA often used different analysis and reporting of key characteristics was often lacking (e.g. participants, heterogeneity, publication bias). There may be some overlap between included MA.
CONCLUSIONS: There is consistent evidence that exercise and individually tailored multifactorial interventions are effective in reducing falls in the community.
© 2015 American Physical Therapy Association. PMID: 25655877
- Overview Fractures and Falls and Vitamin D
- All items in category Falls or Fractures and Vitamin D
- Hip fractures not prevented by Vitamin D (800 IU daily or large quarterly or annual doses) – meta-analysis – Dec 2019
- Vitamin K (any amount and any kind) reduced bone fractures by 24 percent – meta-analysis – May 2019
- Vitamin D not help fractures and falls if not vitamin D deficient – meta-analysis Oct 2018
- Fractures not reduced by small amounts of vitamin D - meta-analysis Dec 2017
- Preventing Falls in Older Adults – Vitamin D combination is the best - JAMA Meta-analysis Nov 2017
- Hip fracture 58 percent more likely if low vitamin D – meta-analysis March 2017
- Fracture risk reduced somewhat by 800 IU of vitamin D and Calcium – meta-analysis Oct 2015
- Acute fracture patients – 70 percent were vitamin D deficient – meta-analysis Sept 2015
- Falls not prevented by vitamin D given every 3 months or less often – meta-analysis Jan 2015
- Vitamin D prevents falls – majority of meta-analyses conclude – meta-meta analysis Feb 2015
- Vitamin D and fractures – 24 meta-analyses and counting – Dec 2014
- Bone fractures reduced by a minimum of 800 IU vitamin D and Calcium – meta-meta-analysis March 2014
- Fractures reduced with any amount of vitamin D and some Calcium - Cochraine April 2014
- Fallers often had less than 20 ng of vitamin D – meta-analysis April 2014
- Hip fractures greatly reduced by sunshine, vitamin D, and vitamin K – meta-analysis Sept 2012
- Vitamin D may prevent falls and fractures without Calcium – an overview of 9 meta-analysis – Oct 2012
- Hip fractures reduced 30 percent with 800 IU of vitamin D – meta-analysis July 2012
- Vitamin D reduces falls – meta-analysis Oct 2011
- Active form of vitamin D (calcitriol) cut in half the fractures following organ transplant – meta-analysis Aug 2011
- 1000 IU minimum to decrease falls and fractures Swiss - 2009
- Meta-analysis of falls and 800+ IU of vitamin D found good results – June 2010
- 800 IU vitamin D reduces falls - Dec 2009
- Grip strength following wrist fracture increased by 50,000 IU Vitamin D monthly – May 2019
- Hip fracture recovery best with home exercise plus Vitamin D – RCT Dec 2018
- Fell more often with higher doses of vitamin D (felt so good that moved more) – Oct 2017
- Less bone loss if take 100,000 IU vitamin D monthly – RCT Nov 2017
- Probably Fractures of the Tibia can be healed with 100,000 IU of vitamin D weekly – RCT 2023
- Perhaps fewer bone non-unions with 100,000 IU weekly of vitamin D – RCT 2018
- 1 in 3 died after hip fracture but only 1 in 14 if add Vitamin D and exercise – RCT April 2017
- Added 1 lb of muscle to sarcopenia adults in 13 weeks with just 800 IU vitamin D and protein – RCT Jan 2017
- Monthly 100,000 IU of vitamin D decreased respiratory infection but increased falls – Nov 2016
- Elderly falls reduced 3.6 times by 900 IU of vitamin D and simple exercise – RCT Nov 2016
- Vitamin D and exercise after hip fracture surgery – far fewer deaths – July 2016
- Falls cut in half by 100,000 IU vitamin D monthly - RCT 2016
- 2X fewer Senior falls in group getting 100,000 IU vitamin D monthly via Meals-on-Wheels – RCT Aug 2015
- Rate of injuries from falls cut in half by just 800 IU of vitamin D and exercise – RCT May 2015
- Seniors need at least 4,000 IU vitamin D, no test needed – Consensus Jan 2014
- Hip fractures reduced 2X to 6X with just 10 minutes of sunlight daily – RCT 2003-2010
- Hip fracture reduced 38 percent with Calcium and just 400 IU of vitamin D – RCT Feb 2013
- Hip bone loss stopped with 1000 IU of vitamin D, while 400 IU similar to placebo – RCT April 2013
- 39% fewer falls with 2000 IU than 800 IU – RCT June 2010
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