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Vitamin D One of Few Things that Help Prevent Falls – Cochraine Jan 2010

By Kristina Fiore, Staff Writer, MedPage Today January 20, 2010
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.

Vitamin D supplements may combat falls among nursing home residents, but exercise and multifactorial interventions aren't as likely to be helpful, researchers say.
In a large meta-analysis, vitamin D significantly reduced the rate of falls, Ian D. Cameron, MD, of the University of Sydney in Australia, and colleagues reported online in Cochrane Reviews. The same held true for a review of patients' medication lists by pharmacists. But results for other interventions were mixed at best.
Falls are common among older patients in nursing homes and hospitals, and contribute greatly to morbidity and mortality.

Clinicians have proposed a variety of interventions to reduce these falls, including exercise, medication optimization, vitamin D supplementation, education, and environmental modifications.

A broad literature has grown around these interventions, and the researchers conducted a review to assess their efficacy. They covered 41 trials totaling 25,442 participants. Of these, 30 were conducted in nursing care facilities, and 11 in hospitals.

The researchers found that vitamin D significantly reduced the rate of falls among patients in nursing care facilities — although the same was not necessarily true for hospital patients.

The nursing home results were not so encouraging for other methods. The researchers found inconsistent results for exercise in reducing both the rate of falls and the risk of falling. They wrote that this "may relate to the type and intensity of exercise, the diversity of study populations, or possible variation in methodological quality."
They subsequently cautioned that exercise programs among nursing home residents should "carefully assess each individual's sustainability, as there is the possibility that exercise programs may increase their risk of falls."

The researchers also warned about paying attention to the type of exercise selected.
For larger, multifactorial interventions — which sometimes included exercise — pooled data did not show a significant reduction in the rate of falls, or in the risk of falling, among nursing home residents.

Yet when the researchers conducted a post-hoc analysis of pooled data from five multifactoral interventions that were delivered by a multidisciplinary team and included exercise, they did find a significant reduction in the rate of falls and risk of falling.

"We have more confidence in recommending multifactoral programs in nursing care facilities that are delivered by a multidisciplinary team," the researchers wrote.
In hospitals, multifactoral interventions did show a significant reduction in the rate of falls and risk of falling, but the researchers noted that the interpretation of the multifactoral interventions is complex because their component parts vary.

The researchers concluded that in general, interventions "targeting multiple risk factors seem more likely to be effective than those targeting single risk factors."
However, they wrote, "interventions in nursing care facilities targeting the single risk factor of vitamin D insufficiency are effective, and targeting inappropriate medications may be effective."

They noted that the study was limited by a small number of hospital studies, difficulty isolating the effects of individual components of the treatments that involved multiple components, and the variability of interventions.