Physical inactivity, depression and falls all increase risk of developing a disability in later life. But targeting falls may be a particularly effective way to reduce the nation's disability levels, according to a new study.
Fall-prevention efforts that combine education about risks with exercise, home safety and health assessments offer the most promise, at least in the short run, found researchers led by Vicki Freedman, Ph.D., a professor at the University of Medicine and Dentistry of New Jersey.
Freedman and her colleagues compared three strategies to reduce late-life disability: increasing physical activity, identifying and treating depression and avoiding falls. Their findings, published in the current issue of The Milbank Quarterly, arise from a review of more than 100 intervention studies.
The review found that fall prevention efforts targeted at frail adults can reduce the risk of falling and related injuries by about 25 percent. Community-wide efforts that have been tested abroad were shown to reduce fall-related fractures by 6 percent to 33 percent.
'Both medical and environmental aspects of disability need to be addressed in a disability prevention program,' Freedman said. 'Approaches that recognize the complexities of disability appear to be more successful than those that address only a single factor.'
About one-third of people aged 65 or older — or nearly 12 million people — experience falls, said Freedman. Of these, about 20 percent to 25 percent experience severe injuries or limitations.
Traditional health insurance programs may address medical aspects of a disability, but they rarely fund home safety changes or assistive technologies that may help an older adult live independently. The researchers call for additional research that considers how best to finance and deliver a multicomponent disability prevention program.
'Ideally, such an effort should consider not only which components to target, but also which audiences to target — older adults, their families, providers or perhaps entire communities.'
Freedman said she was surprised how little evidence she and her colleagues could find about the likely long-term effects of different intervention strategies. Most studies lasted less than a year. This scarcity of evidence is significant, she said, because conclusions about the long run could be very different.
Jon Pynoos, Ph.D., co-director of the Fall Prevention Center of Excellence, said that the review correctly identified medical risk assessment/management, physical activity and environmental modifications as the 'big three' interventions capable of significantly reducing falls.
'Now we need to create 'real-world' programs that combine these elements and make them available to persons at moderate to high risk of falls who need them,' he said.
Pynoos said that one challenge is coordinating components from various fields — such as medicine, exercise and home modifications — with different eligibility requirements, reimbursement systems and approaches. It is also important to understand what 'dose' effect or level of each intervention is needed to have an impact, he said.
'At the Fall Prevention Center of Excellence, we are working to create sustainable community-based programs that will serve as models that can be replicated in various settings,'Pynoos said.