Fall Prevention

About one in three older adults experience a fall each year. Older adults are also more likely to experience fall-related injuries, including fractures, head injury, long-term mobility issues, and reduced independence. Therefore, fall prevention is typically targeted at older adults, and involves person-specific strategies to manage modifiable risk factors. Fall prevention methods can include environmental modifications (e.g., putting railings in the shower), management of any chronic conditions that increase fall risk, and physical training.^[1][2] Since falls in older adults are a serious public health problem, organizations like the https://www.cdc.gov/steadi/index.html and the [https://ncoa.org/professionals/health/center-for-healthy-aging/national-falls-prevention-resource-center/falls-free-initiative](National Council of Aging) have developed fall prevention initiatives.

Accurately identifying people that need a fall prevention intervention is a challenge.^[2] It’s recommended that the risk for falls be determined by asking people whether they’ve fallen in the past, whether they are afraid of falling, or whether they experience gait and/or balance difficulties. People who may be at risk for falls can have their gait and balance measured with the [https://www.cdc.gov/steadi/pdf/TUG_test-print.pdf](Timed Up and Go Test (TUG). Other less-commonly-used assessments include the Berg Balance Scale and the Tinetti Performance-Oriented Mobility Assessment Tool.^[1]

Many older adults, especially those with a history or a fear of falling, reduce and restrict their physical activity with the intention to reduce their risk of falls. Unfortunately, this usually results in physical deconditioning and conversely increases the risk of falls.^[2] Consequently, most research has linked expert-directed moderated physical activity as a factor that reduces the risk of falls.^[2] Meta-analyses of over 10,000 participants show that exercise reduces fall risk by 23% compared to control.^{[3] [4]} Many exercise regimens have been studied, including functional balance training, resistance training, flexibility, patterned movement (Tai Chi/dance), and endurance training. Exercise can help to improve functional stability (e.g. by increasing lower body strength) and balance, providing additional layers of defense against a fall.^[3][5]

Supplements for fall prevention are usually targeted at managing conditions that increase the risk for fracture or other acute conditions during a fall. For example, vitamin D and calcium have been studied for preventing fall-related injuries, as these nutrients help to stave off osteoporosis.^[6] However, some evidence suggests that high-dose vitamin D may actually be associated with an increased risk of falls when compared to lower doses, although it’s not clear why that would be the case.^[7][8].

Dietary interventions have not been directly studied for fall prevention. However, diet can have many indirect effects on fall risk. For example, a nutritionally balanced diet that promotes a healthy weight may help to prevent falls and fall-related injuries in older adults and in people with osteosarcopenic obesity syndrome.^[9] Correcting malnutrition, such as inadequate dietary protein and calcium intake, in the elderly may also reduce the risk of falls.^[10][11]

In addition to exercise, other interventions to prevent falls include strategies to avoid hypotension, managing medications that increase the risk of falls, reducing foot and vision problems, and increasing home safety.^[6][4] Strategies to reduce the severity of fall-related injuries include osteoporosis management, hip protectors, and digital technology or wearables.^[1] Managing environmental factors such as lighting, stair and bath rails, clutter, and weather conditions can also help to prevent falls.^[2]