Eight trials of exercise interventions, 5 trials of multifaceted interventions, 6 trials of assessment in the community and 4 trials in residential settings, were included. The number of participants in the trials was not stated.
Exercise interventions alone (8 trials).
One trial of a series of exercises and training in gait and transfers in semi-independent residents of long-stay nursing homes showed no reduction in the rate of falls. One trial of individually tailored programmes of physical therapy for women over 80 found a significant reduction in the rate of falls. In one trial, the combined results from three different types of supervised exercise showed a reduced risk of falls.
Only one out of 5 trials in unselected older people (a trial of t'ai chi) found a reduction in the number of falls. A Cochrane review of four of the above studies concluded that exercise alone does not reduce the rate of falls. A pre-planned meta-analysis of three published trials on exercise and unpublished data from four other trials showed a decreased rate of falls among patients who received training in exercise and balance when compared with controls. A trial on the effect of brisk walking on osteoporosis in women with a history of fracture found that the cumulative risk of falls was higher in the intervention than the control group.
Multifaceted interventions (5 trials).
One trial combined exercise sessions, daily walks, a home assessment with safety improvements, and group teaching sessions on the prevention of falls. A decrease in falls occurred within the intervention group, but there were no differences in the number of falls requiring medical care. One trial targeted high-risk patients, and combined an assessment by nurse practitioners and physiotherapists with interventions directed at several risk factors. The rate of falls was substantially reduced. One trial that tested an assessment visit by a nurse, which aimed to increase physical and social activity, found a significant reduction in the rate of falls after one year. A Cochrane review of drugs and assessment and advice about environmental hazards (2 trials) found a significant reduction in the number of people who fell. A later trial (in older people referred to an accident and emergency department after a fall) of medical assessment at the local day hospital and an occupational therapy assessment at home, with advice and education and direct intervention where appropriate, reported a decrease in falls in the intervention group. The successful intervention programmes included medical assessment and home safety assessment and advice, changes in prescribed drugs, environmental changes, tailored exercise, training in transfer skills and gait, and referral of clients to relevant health care professionals according to need.
Assessment in the community (6 trials).
One trial showed a beneficial effect of the intervention when people aged 75 years or older were assessed at home by trained lay volunteers, but the study was of poor methodological quality. Four trials studied home safety assessment without referrals or active intervention; none detected a reduction in the number of falls or incidence of fractures. One study included a medical assessment at the day hospital after discharge, followed by an occupational therapy visit at home with direct intervention advice, education and referral. This study showed a reduction in the number of falls over one year.
Residential settings (4 trials).
There were two studies concerning individual assessment of people at high risk. One showed a reduction in admissions to hospital when ambulatory residents were assessed within 7 days of a fall, and also a non significant reduction in the rate of falls. The second found a reduction in the rates of falls after assessment and development of individual treatment plans along with education of staff caring for residents who had fallen in the past year and who had a deficit in one of four 'safety domains'. In another study, semi-independent residents of long-stay nursing homes were given training in resistance, flexibility, balance, gait and transfers; no reduction in the incidence of falls was found. Another study found the use of external hip protectors was beneficial in the prevention of hip fractures in residents of nursing homes, but that compliance was a problem.