Updated evidence shows that tailored exercise programs, vitamin D supplements and dairy-rich diets can help reduce falls in care homes.
Falls remain one of the most serious health risks facing older people living in residential aged care around the world. The latest update to Cochrane’s landmark Interventions for preventing falls in older people in care facilities review finds that tailored exercise programs, vitamin D supplements and dairy-rich diets can help prevent them.
“We know that falls are one of the most serious and common health risks facing older people, particularly in residential care settings,” explains lead author and Flinders University Senior Research Fellow Dr Suzanne Dyer. “Falls lead to broken bones, a loss of independence, hospitalization and, sadly, death – making this research critical for better understanding prevention and support for older people in aged care facilities.”
Already used in the development of new Australian National Falls Prevention Guidelines, this latest review update analyzes evidence from over 100 clinical trials involving nearly 69,000 residents in 25 countries.
“We looked at a wide range of interventions and strategies ranging from staff training and medication reviews to assistive technology and changes in care delivery. However, the strongest evidence centres on tailored exercise programs, vitamin D supplements, better nutrition, and personalised falls prevention based on individual falls risks as among the most effective measures to reduce falls in care homes.” says Dr Dyer.
Here’s what the review found.
Ongoing exercise in aged care
Among the most consistent findings was the value of ongoing, tailored exercise. Programs that were moderate or low intensity and delivered in a group, by physios or trained staff, can reduce the number of falls residents experience. And for residents who can walk, they should have the opportunity to exercise for at least an hour a week. Importantly, residents with dementia who are able to participate can also benefit from these programs.
The authors stress that short bursts of activity – such as a 6-week program - are not enough. Yet in practice, many homes still provide only brief, seated group sessions usually lasting 20 or 30 minutes, once or twice a week that are not intense or regular enough to make a difference.
“About one in three adults worldwide currently don’t get the recommended amount of weekly exercise — at least 150 minutes of moderate activity or 75 minutes of vigorous activity,” explains Dr Rik Dawson, review co-author and President of the Australian Physiotherapy Association, highlighting the scale of inactivity.
“The figures are even worse when it comes to aged care, where residents spend up to 85% of their waking time sedentary and have been shown to engage in less than 5 minutes of moderate to vigorous physical activity a day. However, the latest global evidence clearly shows exercise is an effective and essential component of falls prevention.”
Improving diet, dairy intake and nutrition
The review also highlights the role of diet. Malnutrition in aged care is a global issue, undermining health and quality of life. Menus that provide sufficient protein and calcium are critical, and dairy foods stand out as a simple, effective intervention.
“The evidence tells us that menus should have at least 3.5 servings of dairy foods – milk, yoghurt, cheese – daily,” says Dr Dyer. “Involving a dietician in designing menus to make sure this happens can reduce the number of falls and hip fractures.”
Vitamin D supplementation
As in previous versions of this review, vitamin D supplementation was found to be a simple but effective measure. Because residents in aged care spend little time outdoors, deficiency is widespread, leaving muscles and bones weaker and more prone to injury.
“Many older people in aged care facilities have low vitamin D levels, which can affect muscle strength,” explains Dr Dyer. “Daily or weekly dosing improves muscle function, helping prevent both falls and fractures.”
While vitamin D has long been on clinicians’ radar, the updated review reinforces that supplementation should be considered routine in care settings.
Individual and tailored assessments
The review also took a closer look at multifactorial programs, which combine several strategies based on a resident’s risk profile. In the previous update, it was unclear whether these approaches worked to reduce falls. But by incorporating new methods and detailed analysis, it is now clear that when these programs are provided by tailoring carefully to individual needs and actively involving care staff, they are more effective, reducing both fall rates and the number of residents who fall.
“Personalised falls prevention approaches should consider the individual needs of the residents,” says Dr Dawson. “So, for example, if they have dementia, consider if they need additional support to use mobility aids, or keep track of their glasses.”
Looking ahead: translating evidence into action
“Tailored exercise programs, vitamin D supplements, better nutrition and involving care staff in providing falls prevention approaches can make a real difference,” concludes Dr Dyer. “With the right mix of strategies, it’s possible to reduce risks and help older people in care stay safer and more independent. We look forward to sharing our next review to help prevent falls in hospital settings in the months ahead.”
With the global population ageing rapidly – and the number of people over 80 expected to triple by 2050 – the findings of this international review highlight practical, evidence-based measures that can improve health and independence for older people now and into the future.