Comparisons of Interventions for Preventing Falls in Older Adults – A Systematic Review and Meta-analysis
JAMA. 2017;318(17):1687-1699. doi:10.1001/jama.2017.15006
Meta-analysis in JAMA concludes that Vitamin D combination prevents falls 8X
They finally agree with many previous meta-analyses
- Overview Fractures and Falls and Vitamin D
- Vitamin D and Muscles – Major review: Feb 2013
- Vitamin D prevents falls – majority of meta-analyses conclude – meta-meta analysis Feb 2015
- Falls cut in half by 100,000 IU vitamin D monthly - RCT 2016
- Fast twitch muscles increased by Vitamin D in athletes and seniors (reduce falling) – Oct 2016
- Death of older hip fracture patients at least 1.6X more likely if low vitamin D – May 2018
Unsure if the Calcium is actually needed - Calcium might actually be harmful
- Calcium supplements proven to NOT reduce fractures, but are proven to INCREASE heart problems – July 2015
- Vitamin D may prevent falls and fractures without Calcium – an overview of 9 meta-analysis – Oct 2012
Vitamin D also decreases fractures
Andrea C. Tricco, PhD1,2; Sonia M. Thomas, MSc1; Areti Angeliki Veroniki, PhD1; et al Jemila S. Hamid, PhD1; Elise Cogo, ND1; Lisa Strifler, MSc1,3; Paul A. Khan, PhD1; Reid Robson, MSc1; Kathryn M. Sibley, PhD4,5; Heather MacDonald, MSc1; John J. Riva, DC6,7; Kednapa Thavorn, PhD1,8; Charlotte Wilson, MSc1; Jayna Holroyd-Leduc, MD9; Gillian D. Kerr, MD1; Fabio Feldman, PhD10; Sumit R. Majumdar, MD11; Susan B. Jaglal, PhD12; Wing Hui, MSc1; Sharon E. Straus, MD, MSc1,13
- Question What types of fall-prevention programs may be effective for reducing injurious falls in older people?
- Findings In a network meta-analysis including 54 studies and 41 596 participants,
- exercise (odds ratio [OR], 0.51),
- combined exercise, vision assessment and treatment, and environmental assessment and modification (OR, 0.30),
- combined exercise, and vision assessment and treatment (OR, 0.17), and
- combined clinic-level quality-improvement strategies, multifactorial assessment and treatment, calcium supplementation, and vitamin D supplementation (OR, 0.12) were significantly associated with reductions in injurious falls.
- Meaning The analysis identified combinations of interventions likely to be more effective than usual care for preventing injurious falls.
Importance Falls result in substantial burden for patients and health care systems, and given the aging of the population worldwide, the incidence of falls continues to rise.
Objective To assess the potential effectiveness of interventions for preventing falls.
Data Sources MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Ageline databases from inception until April 2017. Reference lists of included studies were scanned.
Study Selection Randomized clinical trials (RCTs) of fall-prevention interventions for participants aged 65 years and older.
Data Extraction and Synthesis Pairs of reviewers independently screened the studies, abstracted data, and appraised risk of bias. Pairwise meta-analysis and network meta-analysis were conducted.
Main Outcomes and Measures Injurious falls and fall-related hospitalizations.
Results A total of 283 RCTs (159 910 participants; mean age, 78.1 years; 74% women) were included after screening of 10 650 titles and abstracts and 1210 full-text articles. Network meta-analysis (including 54 RCTs, 41 596 participants, 39 interventions plus usual care) suggested that the following interventions, when compared with usual care, were associated with reductions in injurious falls: exercise (odds ratio [OR], 0.51 [95% CI, 0.33 to 0.79]; absolute risk difference [ARD], −0.67 [95% CI, −1.10 to −0.24]); combined exercise and vision assessment and treatment (OR, 0.17 [95% CI, 0.07 to 0.38]; ARD, −1.79 [95% CI, −2.63 to −0.96]); combined exercise, vision assessment and treatment, and environmental assessment and modification (OR, 0.30 [95% CI, 0.13 to 0.70]; ARD, −1.19 [95% CI, −2.04 to −0.35]); and combined clinic-level quality improvement strategies (eg, case management), multifactorial assessment and treatment (eg, comprehensive geriatric assessment), calcium supplementation, and vitamin D supplementation (OR, 0.12 [95% CI, 0.03 to 0.55]; ARD, −2.08 [95% CI, −3.56 to −0.60]). Pairwise meta-analyses for fall-related hospitalizations (2 RCTs; 516 participants) showed no significant association between combined clinic- and patient-level quality improvement strategies and multifactorial assessment and treatment relative to usual care (OR, 0.78 [95% CI, 0.33 to 1.81]).
Conclusions and Relevance Exercise alone and various combinations of interventions were associated with lower risk of injurious falls compared with usual care. Choice of fall-prevention intervention may depend on patient and caregiver values and preferences.