Clinical Review State of the Art Review

Prevention of falls in older people living in the community

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i1419 (Published 28 April 2016) Cite this as: BMJ 2016;353:i1419
  1. Edgar R Vieira, assistant professor and graduate program director1,
  2. Richard C Palmer, associate professor2,
  3. Paulo H M Chaves, director3
  1. 1Department of Physical Therapy, Nicole Wertheim College of Nursing and Health Sciences, and Department of Neuroscience, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
  2. 2Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
  3. 3Benjamin Leon Center for Geriatric Research and Education, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
  4. Correspondence to: E R Vieira, 11200 SW 8st, AHC3-430, Miami, FL 33199, USA Edgar.Vieira@fiu.edu

The number of people living into older age (≥65 years) is rising rapidly. Older people are more likely to fall and this has adverse consequences for their quality of life and that of their families. Falls also pose a substantial financial burden on healthcare systems. Extensive research from systematic reviews and meta-analyses has established effective approaches for reducing falls among older people, although uncertainties and controversy remain. The evidence suggests that exercise based and tailored interventions are the most effective way to reduce falls and associated healthcare costs among older people in the community. This review integrates current knowledge on assessment and management strategies to prevent falls in older people living in the community. It summarizes known risk factors for falls in this population and presents assessment strategies that can be used to assess the risk of falls. It discusses the management of risks and interventions to reduce falls among older people in the community, as well as future directions and promising approaches.

Introduction

A fall is an event during which a person inadvertently comes to rest on the ground or other lower level.1 According to the World Health Organization, 28-35% of older people (≥65 years) fall each year globally and prevalence increases with age.1 Falls are the main cause of injury, injury related disability, and death in older people.2 The severity of resulting injuries varies, and 40-60% of falls result in major lacerations, fractures, or traumatic brain injuries.3 A longitudinal study found that 68% of people who fell reported some injury; healthcare was needed in 24% of cases, functional decline was reported by 35%, and social and physical activities were impaired for more than 15%.4 Close to 95% of all hip fractures are caused by falls; 95% of patients with a hip fracture are …

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