Vitamin D and exercise may help prevent falls in elderly

Prescribing a vitamin D supplement and recommending exercise for patients 65 and older could reduce their risk of falling, according to a recent evidence review.

The review, published in the Dec. 21, 2010, issue of Annals of Internal Medicine, was commissioned by the U.S. Preventive Services Task Force to help the agency update its recommendation for preventing falls in the elderly. Before the guidelines are published, a draft will be posted for public comment online.

The task force does not have recommendations on primary care physicians counseling patients on fall prevention. But in 1996, the task force reviewed the effectiveness of counseling to prevent household and recreational injuries, including falls, by age group.

"There are interventions that are successful in preventing falls in older adults. ... That's important news, because falls are so common" in this age group, said lead review author Yvonne Michael, ScD, associate professor in the Dept. of Epidemiology and Biostatistics at Drexel University School of Public Health in Philadelphia.

"Based on the clinical trials that we examined, we found that those participants who got vitamin D, with or without calcium, had a reduced risk of falling compared to those who didn't get it," Michael said.

One in three adults 65 and older falls each year, according to the Centers for Disease Control and Prevention. Among this population, falls are the leading cause of injury-death and the most common cause of nonfatal injuries, such as hip fractures.

Researchers examined 54 randomized controlled trials published between 1991 and 2010 on interventions that could be used in primary care to prevent falls among older patients. The interventions included home-hazard modification, such as adding nonslip tape to stairs and vitamin D supplements, exercise and physical therapy.

Researchers found that participants who received vitamin D supplements were 17% less likely to fall than those who did not get the supplement. The findings were based on nine studies that involved nearly 6,000 participants who received daily oral doses of vitamin D. Daily doses ranged from 10 to 1,000 IUs. The review also said there is a potential increased risk of kidney stones with high levels of the nutrient (link).

Exercise and physical therapy reduced participants' risk of falling by about 13%, according to the review authors. The results were pooled from 18 studies, which involved nearly 4,000 adults 65 and older. Most of the exercises were aimed at improving individuals' gait, balance, strength and flexibility.

Home-hazard modification, vision correction, medication assessment and withdrawal, clinical education and behavioral counseling were not effective in reducing falls on their own.