Strategies for fall-prevention in older people

Fall prevention in the elderly is one of the most important public health issues worldwide. Strategies for fall-prevention consist of fall-risk assessment, multifactorial interventions, exercise training, reduction in medications use, environmental modifications, vision improvement, vitamin D and calcium supplementation, cardiac pacing, and education. Before an intervention can be prescribed, a fall-risk assessment, including functional balance and mobility tests for the community-dwelling elderly and a more comprehensive battery of tests for the institutionalized and hospitalized elderly, needs to be conducted. Labor intensive and costly multifactorial interventions are the most effective and most consistent in reducing falls. Balance exercise programs, particularly tai chi, efficiently and effectively reduce falls and have other health-related benefits. Psychotropic medications can be reduced to prevent many falls, but it is difficult to change medication-taking behavior in the elderly. Changing the environment is an appropriate response in cases with a history of falls, and cataract surgery can reduce falls in those who are visually impaired. Vitamin D, calcium supplementation, and hip protectors are also effective for institutionalized elderly. Cardiac pacing can help only a few elderly people while educational programs are ineffective. Finally, fall-related issues (including selection of an appropriate strategy for prevention), role playing of clinicians, study of falls prevention in institutionalized and hospitalized elderly, fall-related education, and coordination of health care practices, are discussed in detail.