Interventions to decrease falls in this population include fall-prevention training for staff, living space adjustments, exercise programmes, hip protectors, patient education and medications.
Studies evaluating the effects of balance training and muscle training on fall prevention have produced some positive results, but a 2012 Cochrane Review found exercise interventions to have no effect on falls in elderly residents of care facilities.
Studies evaluating vitamin D supplementation have produced more consistent results, with a 2004 meta-analysis in the Journal of the American Medical Association reporting that vitamin D supplementation reduces the risk of falls by more than 20% in institutionalised elderly.
The aim of the current study, published in the International Journal of Gerontology by Imaoka, et al., was to evaluate the synergistic effect of low-frequency exercise and vitamin D supplementation on fall risk in institutionalised elderly.
In this randomised, non-blind, controlled clinical trial, 91 participants were randomised to one of four intervention groups for 3 months: control (usual care, which included 3 exercise sessions per week); low-frequency exercise (2 exercise sessions per week); vitamin D supplementation (900IU/day); or combination of low-frequency exercise and vitamin D.
The primary outcome measure was the number of falls during 6 months.
A total of 75 subjects completed the trial. Serum 25(OH)-vitamin D improved in the vitamin D group from mean levels of 13.2ng/mL to 37.8ng/mL and in the combined group from 12.5ng/mL to 36.3ng/mL.
Falls occurred in 9 participants in the control group, 7 in the low-frequency exercise group, 6 in the vitamin D group, and 4 in the combined group.
The Cox proportional hazard ratios (HRs) for falls were not significantly different for any of the groups except the combined group. The combination of low-frequency exercise and vitamin D supplementation significantly reduced fall risk by 72.4% (HR=0.276; 95% CI, 0.083-0.924; p=.037) when compared with usual care.
The authors of this study conclude that low-frequency exercise of no more than 2 days per week, in combination with vitamin D supplementation of 900IU per day, may contribute to prevention of falls in the institutionalised elderly population.
