Exercise for falls prevention in aged care: systematic review and trial endpoint meta-analyses.

Suzanne M Dyer, Jenni Suen, Wing S Kwok, Rik Dawson, Charlotte McLennan, Ian D Cameron, Keith D Hill, Catherine Sherrington

Journal: Age and ageing 2023;52(12):afad217

PMID: 38109410

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Plain Language Summary

World Health Organisation guidelines recommend all older adults undertake physical activity for falls prevention and a range of other health benefits. This study's aim was to examine the effectiveness of exercise for falls prevention in residential aged care. This study was a systematic review and meta-analysis of randomised controlled trials. The participants ranged from 73 to 86 years of age. Results showed that exercise interventions can effectively prevent falls in older people living in residential aged care facilities based on moderate certainty evidence. Authors concluded that exercise is recommended as a fall prevention strategy for older people living in aged care facilities who have sufficient physical and mental capacity and agree to participate (moderate certainty evidence). Furthermore, continuation of exercise is required for effective fall prevention, as exercise has little or no lasting effect on falls after the end of a programme (high certainty evidence).

Abstract

BACKGROUND

There is strong evidence that exercise reduces falls in older people living in the community, but its effectiveness in residential aged care is less clear. This systematic review examines the effectiveness of exercise for falls prevention in residential aged care, meta-analysing outcomes measured immediately after exercise or after post-intervention follow-up.

METHODS

Systematic review and meta-analysis, including randomised controlled trials from a Cochrane review and additional trials, published to December 2022. Trials of exercise as a single intervention compared to usual care, reporting data suitable for meta-analysis of rate or risk of falls, were included. Meta-analyses were conducted according to Cochrane Collaboration methods and quality of evidence rated using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

12 trials from the Cochrane review plus 7 new trials were included. At the end of the intervention period, exercise probably reduces the number of falls (13 trials, rate ratio [RaR] = 0.68, 95% confidence interval [CI] = 0.49-0.95), but after post-intervention follow-up exercise had little or no effect (8 trials, RaR = 1.01, 95% CI = 0.80-1.28). The effect on the risk of falling was similar (end of intervention risk ratio (RR) = 0.84, 95% CI = 0.72-0.98, 12 trials; post-intervention follow-up RR = 1.05, 95% CI = 0.92-1.20, 8 trials). There were no significant subgroup differences according to cognitive impairment.

CONCLUSIONS

Exercise is recommended as a fall prevention strategy for older people living in aged care who are willing and able to participate (moderate certainty evidence), but exercise has little or no lasting effect on falls after the end of a programme (high certainty evidence).

Address: Rehabilitation, Aged and Extended Care, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.; Institute for Musculoskeletal Health, Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia.; John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, New South Wales, Australia.; Kolling Institute, The University of Sydney, St Leonards, New South Wales, Australia.; Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Peninsula Campus, Monash University, Frankston, Australia.

DOI: 10.1093/ageing/afad217