Information about fall in the elderly and vitamin d





 
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Vitamin D May Reduce Falls in Elderly Nursing Home Residents
============================================================
by jonathansoroko on February 13, 2010

From Medscape
Vitamin D May Reduce Falls in Elderly Nursing Home Residents. (login
required)

January 29, 2010 — Vitamin D supplementation and pharmacist review of
medications may help reduce falls in elderly nursing home residents,
according to the results of a systematic review reported online
January 20 in the Cochrane Database of Systematic Reviews.
"Falls in nursing care facilities and hospitals are common events that
cause considerable morbidity and mortality for older people," write
Ian D. Cameron, MBBS, PhD, from Sydney Medical School, the University
of Sydney in Ryde, Australia, and colleagues.

The goal of this review was to determine the efficacy of interventions
aiming to reduce falls by older people in nursing care facilities and
hospitals. The reviewers searched the Cochrane Bone, Joint and Muscle
Trauma Group Specialised Register (January 2009); the Cochrane Central
Register of Controlled Trials (The Cochrane Library 2008, Issue 2);
MEDLINE, EMBASE, and CINAHL (all to November 2008); trial registers;
and bibliographies of retrieved articles.
Criteria for inclusion in the review were randomized controlled trials
of interventions designed to reduce falls in older people in nursing
care facilities or hospitals, with main study endpoints of fall rate
and the risk of falling. Methodologic quality of the trials was
independently evaluated by 2 reviewers, who also extracted and pooled
data where appropriate.

There were 41 trials, enrolling a total of 25,422 participants,
meeting selection criteria. Findings from 7 trials testing supervised
exercise interventions in nursing care facilities were inconsistent.
Overall, multifactorial interventions were not associated with a
significantly lower rate of falls in 7 trials enrolling a total of
2997 participants or with a lower risk of falling in 8 trials
enrolling a total of 3271 participants.
However, multifactorial interventions provided by a multidisciplinary
team were associated with lower rate of falls in nursing home
residents (rate ratio RaR, 0.60; 95% confidence interval CI, 0.51
- 0.72; 4 trials, n = 1651) and risk of falling (risk ratio RR,
0.85; 95% CI, 0.77 - 0.95; 5 trials, n = 1925), based on a post hoc
subgroup analysis.

Vitamin D supplementation in nursing home residents was associated
with a lower rate of falls (RaR, 0.72; 95% CI, 0.55 - 0.95; 4 trials,
n = 4512) but not with the risk of falling (RR, 0.98; 95% CI, 0.89 -
1.09; 5 trials, n = 5095).
Multifactorial interventions in hospitals for patients with a length
of stay of 3 weeks or more were associated with a lower rate of falls
(RaR, 0.69; 95% CI, 0.49 - 0.96; 4 trials, n = 6478) and the risk of
falling (RR, 0.73; 95% CI, 0.56 - 0.96; 3 trials, n = 4824). In
addition, supervised exercise interventions were associated with a
significant decrease in the risk of falling (RR, 0.44; 95% CI, 0.20 -
0.97; 3 trials, n = 131).

"There is evidence that multifactorial interventions reduce falls and
risk of falling in hospitals and may do so in nursing care
facilities," the review authors write. "Vitamin D supplementation is
effective in reducing the rate of falls in nursing care facilities.
Exercise in subacute hospital settings appears effective but its
effectiveness in nursing care facilities remains uncertain."
Limitations of this review include those inherent in the selected
studies, such as lack of blinding, confounding because of differences
in treatment and control groups at entry, differences in underlying
care programs, poorly defined inclusion and exclusion criteria and
falling events, and differences in ascertainment of falls.

"Falls prevention programmes that include exercises for frail nursing
care facility residents should carefully assess each individual's
suitability, as there is the possibility that exercise programmes may
increase their risk of falls," the review authors conclude. "The
choice of type of exercises may be important in avoiding an increase
in falls. The rate of falls and number of fallers should be monitored
before and after adopting an intervention because it might increase
falls."
South Eastern Sydney and Illawarra Area Health Service, Australia;
Rehabilitation Studies Unit, Faculty of Medicine, University of
Sydney, Australia; University of Otago, New Zealand; National Ageing
Research Institute, Australia; and Accident Compensation Corporation,
New Zealand, supported this review. The review authors have disclosed
no relevant financial relationships.

Cochrane Database Syst Rev. Published online January 20, 2010.
Abstract
For more information on falls in the elderly is available from the
Centers for Disease Control.

Tagged as: fall prevention, geriatrics
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Vitamin D May Reduce Falls in Elderly Nursing Home Residents -
 From Medscape Vitamin D May Reduce Falls in Elderly Nursing
 Home Residents. (login required) January 29, 2010 — Vitamin D
 supplementation and pharmacist review of medications may help
 reduce falls in elderly nursing home residents, according to
 the results of a systematic review reported online January 20
 in the Cochrane Database of ... - Vitamin D May Reduce Falls
 in Elderly Nursing Home Residents

 
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