This is not a trivial finding. About one-third of Americans over age 65 experience a fall in any given year. Injuries are the fifth-leading cause of death among people 65 and older, and two-thirds of injuries are caused by falls. An AARP study found that in the year 2000, 1.8 million elderly Americans who fell required emergency room treatment, at a cost of $16.4 billion.
The new study looked at three different approaches to preventing falls."It was done to test multifactorial interventions and was done in a way that allowed us to determine the effect of each," says Lesley Day, a senior research fellow at the Accident Research Center of Monash University in Australia, who reports the study results in this week's British Medical Journal.
One method was exercise, given in one-hour sessions every week, designed to improve flexibility and balance. Participants worked out with ankle weights, balanced themselves on rocker boards, and performed exercises that "challenged some normal system we use to maintain balance, such as walking in opposite directions to two lines of people walking past you," Day says.
A second approach was to look for hazards in the home -- steps and stairs, handrails or the absence thereof, lighting, slippery or uneven surfaces, and kitchen cupboards that were too high or too low.
A final focus was on vision -- whether people had the early, undetected signs of vision loss from glaucoma, how well they did on a variety of tests of visual acuity, with referrals to specialists if needed.
A total of 1,090 people between the ages of 70 and 84 took part in the study. They were divided into eight groups. Three groups got one intervention, three got all possible combinations of two interventions, one group got all three and one group was just left alone. They sent in postcards monthly to report any falls.
"When we looked at all three interventions, exercise was the only one that showed a significant effect on its own," Day says. "All the combinations that included exercise showed a positive effect."
The best result, a 14 percent reduction in falls, was in the group that had the benefit of all three interventions. Neither home hazard management nor treatment of poor vision had positive results when used alone.
The Australian study is "a good contribution to the literature" on fall intervention, says Andrew Kochera, the AARP senior policy advisor who did that organization's report on the problem. AARP, formerly the American Association of Retired Persons, focuses on issues affecting the elderly.
"Research on falls goes back a couple of decades," Kochera says. "The tendency is to approach it from different angles, looking at the effect of exercise, or medication, of education about hazards alone. There hasn't been a single dominant big study of what the marginal effects of each of these interventions would be."
The Australian study comes the closest so far to what Kochera calls "my dream study, one with 10,000 participants looking at specific types of interventions. A study like that would be needed to give us some statistical results. That being said, this is a very promising study."
Day says she hopes to put the results to work in Australia. "We are currently negotiating with a health promotion foundation to develop materials for an exercise program," she says."
What To Do
You can get a comprehensive position paper on the problem of falls among the elderly from the American Geriatrics Society. (To read the paper, you'll need the Adobe Acrobat Reader, which you can download by clicking here.) Or read this article from American Family Physician.