Tom Morrione, MD examines the poll results for the topic, “Fall Prevention in the Elderly.”

Table 1. Poll Results

Correction of Visual Deficiency 

4 %

Exercise or Physical Therapy 

45 %

Home Hazard Management 

10 %

Medication Adjustment or Withdrawal 

22 %

Vitamin or Nutritional Supplementation 

18 %

For the elderly, a fall is perhaps the most common threat to independence.  Each year, over 30% of community-dwelling elderly experience a fall.  The risk rockets up to 60% for those who have a history of a single fall within the previous year.  Fall related complications are the leading cause of death from injury for those older than 65.  10-15% of the falls result in a traumatic injury such as a fracture.  Even without a fracture, 50% of those fallen are unable to get up often forced to crawl to a phone or yell for help sustaining injury from being on the ground for a prolonged time.

The causes are often multiple, a combination of age-related decline, chronic illnesses and medications.  Several studies over the past two decades have identified some of the more prominent potential risk factors and most confirmed that the cumulative affect of multiple risk factors was greater than the sum.

As more of the risk factors were identified, several studies over the past decade tackled the impact of interventions.  Most appeared to be common sense, however, clearly some interventions have a greater impact in risk reduction than others.  A systematic review of interventions for preventing falls in elderly people was published by the Cochrane Collaboration in 2003 and revised in 2005.  The review included 62 randomized studies with either community-dwelling or institutionalized elderly.  Populations were placed in either a control versus intervention or groups comparing interventions.  Some of the results are summarized as follows:

Table 2. Cochrane Data


Relative Risk

Confidence Interval

Tai Chi – 15 week course 


0.36 – 0.74

Personal Training – Muscle and Balance Training 


0.66 – 0.98

Home Hazard Management 


0.54 – 0.81

Medication Adjustment or Withdrawal 


0.16 – 0.74

Vitamin or Nutritional Supplementation 



The largest affect was found to be within medication withdrawal.  One study within the analysis showed that stopping psychotropic medications resulted in a relative risk reduction of 66%.  The second largest benefit was achieved by improved strength and balance through Tai Chi resulting in a reduction of 49%.

Though not well reflected above in the Cochrane analysis, several studies have been published touting the benefits with Vitamin D supplementation in preventing falls.  Bischoff-Ferrari published a meta-analysis in 2004 calculating a pooled risk reduction of more than 20% and a number needed to treat of 15 to prevent one fall.

In summary, simple modifications by practitioners can drastically reduce the risk of falls with elderly and thereby reduce the risk of fracture or injury resulting in loss of independence or death.  Adding vitamin D, encouraging Tai Chi and medication review are some of the few interventions shown to be the most effective in achieving this goal and have now become regular recommendations to my patient population.

Tom Morrione, MD
Family and Geriatric Medicine

Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, et al. Effect of Vitamin D on falls: a meta-analysis. JAMA. 2004;291(16):1999–2006.

Gillespie L, Gillespie W, Robertson M, et al. Interventions for preventing falls in elderly people. Cochrane Database Syst Rev. 2003;4:CD00340; 2005 update. Cochrane

October 20, 2008