Intended for healthcare professionals

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

MEEF: Caring for the older people away from falls. Re: Prevention of falls in older people living in the community

The State-of-the-Art Review [1] addresses an important issue of preventing falls as the population aging. Indeed, falls might be one of the top indications of Orthopaedic surgery for people aged 65 years other than degenerative diseases. Hip fractures [2], cervical spinal cord injuries with neurologic deficits [3], dens fractures [4] can result in morbidity and mortality threatening the welfare of the elders. Salient prevention measures yield twice the result with half the effort in terms of clinical outcome and economic burden. Fortunately, scientific community are paying more and more attention to the prevention [5].
The Review proposes targeting the modifiable risk factors and exercises as efficacious prevention measures with convincing lines of evidence. The issue is the implementation of the scientific essence in practice. After all, the aim of scientific research is from bench to bedside, from bedside to public. Accordingly, mindfulness, education, exercise and fitness (MEEF) might be the implementation principles for prevention of falls and pain for the elders.
There has been an increasing tread for mindfulness meditation, in particular for non-pharmacologic treatments. As the representatives of the tread, Mindfulness-Based Stress Reduction (MBSR) and Cognitive Behavioral Therapy (CBT) have been validated for prevention of low back pain [6 7]. These programs might be helpful to eliminate the risk factors for falls, including fear of falling, balance problems and pain. Accumulating evidence indicates that exercise alone or in combination of education is effective for preventing low back pain [5]. In addition to the Otago Exercise Programme and the FaME programme in the Review, Mensendieck Exercise Program [8] and Active Back School Program [9] supplement the options of exercise.
Tailored for the elders in the community, “the 10 keys to healthy aging” is an excellent model for the fulfillment of Education and Fitness [10]. The 10 keys have been validated as follows: (a) blood pressure control (systolic blood pressure, <140 mmHg), (b) cholesterol control, (c) glucose control, (d) smoking cessation, (e) flu and pneumonia immunization, (f) breast and colon cancer screening, (g) osteoporosis screening and adequate muscle strength, preventive for osteoporotic fractures due to falls, (h) maintaining physical activity over 2.5 hr weekly, (i) participating social and community activities weekly, (j) optimism rather than depression.
As the academic editor-in-chief of Orthopedic Channel of DXY (Simplified Chinese pinyin as DingXiangYuan), the biggest professional network in China, we have been working on the academic transmission of updated information from bedside to the public. In China, Internet and WeChat have replaced the traditional mass media as newspapers, TV and radio. Usually, we distill the essence of the updated scientific information into essays and circulate them via the new mass media. At this time, we will bring the essence of the Review to the public in China as usual, sharing the advanced concepts with Chinese elder people in the community, as well as the adults. After all, the young are aging year by year and will ultimately be the elder in the future.

References
1. Vieira ER, Palmer RC, Chaves PH. Prevention of falls in older people living in the community. Bmj 2016;353:i1419 doi: 10.1136/bmj.i1419[published Online First: Epub Date]|.
2. Perry DC, Metcalfe D, Griffin XL, et al. Inequalities in use of total hip arthroplasty for hip fracture: population based study. Bmj 2016;353:i2021 doi: 10.1136/bmj.i2021[published Online First: Epub Date]|.
3. Ruegg TB, Wicki AG, Aebli N, et al. The diagnostic value of magnetic resonance imaging measurements for assessing cervical spinal canal stenosis. Journal of neurosurgery Spine 2015;22(3):230-6 doi: 10.3171/2014.10.SPINE14346[published Online First: Epub Date]|.
4. Joestl J, Lang NW, Tiefenboeck TM, et al. Management and Outcome of Dens Fracture Nonunions in Geriatric Patients. The Journal of bone and joint surgery American volume 2016;98(3):193-8 doi: 10.2106/JBJS.O.00101[published Online First: Epub Date]|.
5. Steffens D, Maher CG, Pereira LS, et al. Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA internal medicine 2016;176(2):199-208 doi: 10.1001/jamainternmed.2015.7431[published Online First: Epub Date]|.
6. Cherkin DC, Sherman KJ, Balderson BH, et al. Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial. Jama 2016;315(12):1240-9 doi: 10.1001/jama.2016.2323[published Online First: Epub Date]|.
7. Morone NE, Greco CM, Moore CG, et al. A Mind-Body Program for Older Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA internal medicine 2016;176(3):329-37 doi: 10.1001/jamainternmed.2015.8033[published Online First: Epub Date]|.
8. Soukup MG, Glomsrod B, Lonn JH, et al. The effect of a Mensendieck exercise program as secondary prophylaxis for recurrent low back pain. A randomized, controlled trial with 12-month follow-up. Spine 1999;24(15):1585-91; discussion 92
9. Glomsrod B, Lonn JH, Soukup MG, et al. "Active back school", prophylactic management for low back pain: three-year follow-up of a randomized, controlled trial. Journal of rehabilitation medicine 2001;33(1):26-30
10. Newman AB, Bayles CM, Milas CN, et al. The 10 keys to healthy aging: findings from an innovative prevention program in the community. Journal of aging and health 2010;22(5):547-66 doi: 10.1177/0898264310363772[published Online First: Epub Date].

Competing interests: No competing interests

02 May 2016
Wang Hai-Qiang
Spinal surgeon; Editor-in-Chief of Orthopedic Channel of DXY
Jun Zhang
Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University
127 Changle Western Road, Xi'an