Coaching Doesn’t Always Prevent Falls in the Elderly

Falls in the elderly are serious affairs; they result in injuries – chiefly fractures – that cause disability and sometimes death. Several studies have shown that intensive ‘training’ can reduce the likelihood of falls by older people. But a new study has thrown cold water on the ability to prevent falls by moderately intense efforts at prevention. The findings were published in the Journal of the American Geriatrics Society.

The 344 participants were all over 65 and had had two falls in the previous year, or one in the last 2 years plus a balance problem. All of them had an in-home assessment at 2 visits by a trained nurse or physical therapist. They were then randomly allocated to an ‘intervention’ or a ‘control’ group. The intervention consisted of appropriate recommendations to the patient and their physician, referrals to a physical therapist, 11 monthly phone calls, and a balance exercise plan. The controls had a home safety assessment.

There was no difference in the rate of falls over the year between the intervention and the control group. But nursing home days were less in the intervention group. Interestingly, the subjects with a Mini-Mental State Exam score below 28– i.e. those with an questionable degree of cognitive impairment – and/or had someone caring for them had a 45% lower risk of falling during the year than the other intervention group subjects.

This study doesn’t tell us too much – except that, to avoid older folk having falls, strenuous efforts at prevention must be made, and that having a caregiver close at hand will probably help.