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JAMA Clinical Evidence Synopsis | Clinician's Corner

Fall Prevention in Community-Dwelling Older Adults

M. Clare Robertson, PhD; Lesley D. Gillespie, MMSc
JAMA. 2013;309(13):1406-1407. doi:10.1001/jama.2013.3130.
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Published online

Clinical Question Which types of interventions reduce falls in older people living in the community?

Bottom Line Fall-prevention exercise programs, usually including muscle strengthening and balance retraining, were associated with lower fall rates in community-dwelling older people whether or not individuals were selected on the basis of fall risk. Home safety interventions, vitamin D supplementation in people with lower vitamin D levels, and individually targeted multifactorial interventions were associated with fewer falls in community-dwelling people with risk factors for falling.

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Figure. Rate Ratios (All Falls) for Selected Fall-Prevention Interventions vs Control in Community-Dwelling Older Peoplea
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aBased on data from Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Sys Rev. 2012;(9):CD007146. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007146.pub3/abstract doi:R10.1002/14651858.CD007146.pub3. Absolute numbers for analyses are not provided because the absolute number of falls in each group was not always available. For these analyses, the “absolute number” was a rate of falls, eg, falls per person-year, or in some cases a reported rate ratio.
bControl groups received no intervention, usual care, or an intervention that was not expected to reduce falls, eg, social visits.
cThe number of trials does not add to 159 because not all of the trials evaluated in the Cochrane review are summarized here.
dVariation across the results from individual studies due to clinical and/or statistical diversity. A P value <.10 represents a statistically significant variation. I2 measures the variation in results between studies that is due to heterogeneity rather than sampling error (chance) (range, 0%-100%).
eFor people with carotid sinus hypersensitivity and history of syncope and/or falls.

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