Preventing falls in older adults

Evidence shows that exercise and nutrition interventions can manage the risk of older adults suffering falls. IPAN experts explain how.

Falls are a major public health problem and a common cause of injury and death in adults aged 60 years and older, placing significant burden on health systems.

Globally, it is estimated that each year, 30 per cent of older adults experience at least one fall and around 684,000 deaths are caused by falls. Falls are also the leading cause of fractures and injury-related hospitalisation in Australia in people aged 65 years and over.

Health care costs from a single fall are substantial – averaging between $1600 and $5688 AUD. Given our ageing population, the financial cost of falls is expected to rise to around $1.4 billion per year by 2051[1].

Falls can have a significant impact on our older population, both physically and mentally. Once a person has suffered a fall, they can develop a fear of another fall. This fear can cause them to be less active, leading to more dependence and ultimately risking further disability and institutionalisation.

However, Dr Paul Jansons, Research Fellow at the Institute for Physical Activity and Nutrition (IPAN), Deakin University, says it is possible to reduce the risk of falls and fractures and improve the outlook for our older population.

“As we age, we typically lose muscle mass and strength, and this might be complicated by other conditions such as low blood pressure, arthritis, dementia and depression,” Dr Jansons said.

“Research has shown that exercise can reduce fall-related fractures by around 30-40 per cent.”

IPAN research is examining ways to improve people’s access to – and uptake of – appropriate evidence-based exercise programs to improve their overall health and physical activity, and to reduce the risk of falls and fractures.

One project, led by IPAN’s Professor Robin Daly and funded under the Australian Government’s Medical Research Future Fund, is trialling the use of telehealth to deliver a multi-faceted exercise and lifestyle self-management program for falls and fracture prevention. The trial involves using digital health as a new model of service delivery to improve bone and muscle health and mobility to reduce falls and fractures in older adults with osteoporosis and/or who are at risk for falls and fractures.

“Exercise is one part of the equation, but lifestyle risk management means taking a holistic approach,” Professor Daly said.

“Nutrition support, managing environmental factors like poorly-fitting clothes or footwear, loose rugs and mats, slippery surfaces and unsafe transfers from chairs and beds and even home modifications, such as installing shower rails and improving lighting, are also important.

“It’s also important to point out that not all forms of exercise are equal when it comes to managing falls and fracture risk. A GP can identify risk factors and develop a treatment plan alongside other health professionals such as exercise physiologists, physiotherapists, occupational therapists and dietitians to ensure that a comprehensive personalised care plan is delivered for best results.”

Using exercise and nutrition to manage the risk of falls

 Evidence-based tips for older adults from IPAN researchers:

  •  Resistance training performed at least twice weekly (for example, exercises such as sit-to-stands, lunges, calf raises and step ups performed for 2 sets of 8-12 reps at a moderate-high intensity) will help improve muscle strength, power, and muscle mass.
  • Exercise that challenges balance and mobility, such Tai Chi, the Otago exercise program (home based strength and balance training program) and stepping based programs, have been shown to reduce the risk and rate of falls in older people by between 19 to 52 per cent.
  • Balance training using safe, progressively difficult postures with a gradual reduction in the base of support (e.g. one-legged stand), and exercises involving dynamic movements that change the centre of gravity (e.g. leaning and reaching activities, stepping over obstacles) are effective for improving balance and/or reducing falls risk .
  • Many people fall as they are unable to multi-task. Combining two tasks simultaneously (also known as ‘dual-tasking’), such as performing a memory task while walking, or a hand-eye co-ordination activity with a balance task, can improve dual task performance.
  • Nutritional interventions such as vitamin D supplements may help to reduce the rate of falls in older people, particularly in those who are deficient in vitamin D prior to treatment. There is also some evidence suggesting higher protein intakes are associated with positive effects on muscle which may help to reduce falls and fracture risk, especially when combined with resistance-based exercise.

[1] Moller J. Projected costs of fall related injury to older persons due to demographic change in Australia: report to the Commonwealth Department of Health and Ageing. Canberra: New Directions in Health and Safety; 2003

This blog was prepared by IPAN members Dr Paul Jansons and Dr Jackson Fyfe, with input from Professor Robin Daly and Associate Professor David Scott.