Home' Australian Ageing Agenda : AAA Jul-Aug 2012 Contents Evidence-based falls
prevention research is
meant to make a difference.
It's supposed to challenge
current ways of thinking,
inform practitioners about what they
shouldn't do, and improve the way things
are already being done.
The reality is however, that keeping
up-to-date with all that is happening in
the research world is time consuming.
The literature available is also vast, can
be complicated and, may overlap.
So to make sense of the latest falls
prevention research into what works
and what does not, AAA sought the
advice of senior principal research fellow
at Neuroscience Research Australia
(NeuRA), Professor Stephen Lord, to help
make sense of the available evidence.
From studies into various exercise
programs, improving vision, floor
surfaces and how not to fall, Prof Lord
translates key findings from 10 major falls
1. PHYSICAL FITNESS
"Exercise is the most studied falls
intervention. Exercise can indeed prevent
falls but the evidence shows that not all
exercise interventions are equal. The ones
that are more effective are the ones that
challenge balance and that are ongoing --
at least six months. Short-term programs
won't fix people up.
The other thing that recent research
has found is that a walking program can
be less effective in preventing falls. They
are not intense enough and take away
from the time that a person has where
they could be doing an effective exercise
activity, such as balance training.
But, the last thing I want to do is
suggest that people should reduce
their walking. Instead, in order to reap
optimal outcomes, walking should be
done in addition to a balance-type of
"The three big factors of gerontology
are cognitive impairment, falls and
incontinence. And they are all related...
According to the research, there might
be some aspects of incontinence that
relate to undiagnosed brain changes
that might put a person at an increased
risk of a fall. Incontinence might also
be the direct cause of rushing to the
toilet which could increase the risk of a
fall. But nobody has specifically looked
at a continence management program
for falls in residential aged care as an
"Most of the research in this area has been
about the importance of vitamin D, with a
number of studies showing that low levels
of vitamin D is a risk factor for falls...So,
if you replace vitamin D, you can prevent
falls and fractures in people with vitamin
D deficiency, particularly those living
in residential aged care. Vitamin D is
primarily provided by the sun but is also
supplemented by certain types of foods
But no studies I am aware of have
looked at nutrition beyond vitamin D.
Nutrition has been included as a factor
in multifactorial trials but it has not been
isolated as a prime risk factor of falls.
"Poor vision increases the risk of a falls.
There are all sorts of benefits to be
reaped from restoring vision -- reducing
the risk of falls is one good outcome.
The interventions in place to improve
vision have been positive overall. Two
studies from the UK show that cataract
surgery can reduce the risk of falls by
Another intervention researched was
updating spectacles. Yet this has achieved
mixed results. A study in Sydney showed
that where new spectacles were provided
to an older person, there was an increased
rate of falls.
The results don't make a lot of sense...
but it is possible that new spectacles instil
a false sense of confidence when they
haven't actually addressed the issue of
balance and have increased exposure. But
that is speculative.
The main conclusions from the
research are that the main vision-related
falls interventions are cataract surgery
How do we know what works and what
doesn't, when trying to prevent an older
person from falling? Professor Stephen
Lord condenses the latest evidence in falls
prevention research into 10 major areas.
Yasmin Noone reports.
Professor Stephen Lord
Professor Stephen Lord works on a falls
intervention with a client, Pat Kelly, at NeuRA.
Photos by Anne Graham.
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