Every year, one in three community-dwelling adults aged 65 and older falls. Many of these falls lead to moderate to severe injuries, resulting in emergency department visits and hospital admissions, and the death rate from falls has risen sharply over the past decade. Falls present a considerable financial challenge to the nation's healthcare services. In 2013, the direct medical costs for fall-related incidents, adjusted for inflation, was $34 billion, mostly covered by Medicare.[1, 2] These medical costs will rise as baby boomers age and fall-related injuries increase.
Falls are preventable with risk assessment and exercise. Exercise has been shown to reduce the incidence of falls by 13% to 40%,[4, 5] which has led to a broad consensus among experts that community-dwelling older adults, especially those at risk of falling, should be offered exercises that incorporate elements of balance, gait, and strength training.[6, 7] Organizations including the American Geriatrics Society and British Geriatrics Society, Academy of Geriatric Physical Therapy of the American Physical Therapy Assocation, National Institute for Health and Care Excellence, U.S. Preventive Services Task Force, and National Council on Aging have issued guidelines, recommendations, and action plans to assist practitioners working with those at risk for falls.
The Centers for Disease Control and Prevention (CDC) Injury Center has created the CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults, which identifies 14 exercise-based interventions supported by randomized controlled trials (RCTs). Table 1 provides summary information of these interventions, their outcomes in reducing falls, and on-line resources.
|Program||Reduction in Fall Rates or Risk||Setting and Delivery Method||Time Required for Implementation||Online Program Resources||Current Implementation Status||Training Opportunities|
|Stay Safe, Stay Active||40%||Community setting, delivered by accredited exercise instructors||1-hour class session (37 sessions total) once per week over 1-year period||www.cdc.gov/HomeandRecreationalSafety/Falls/compendium.html||Unavailable||Unavailable|
|The Otago Exercise Programme||35%||Home setting, delivered by physical therapists or nurses||30-minute individual session 3 times per week plus outdoor walk ≥2 times per week||www.med.unc.edu/aging/cgec/exercise-program|
|Erlangen Fitness Program||23%||Home setting, delivered by physical therapists or nurses||1-hour class session (32 sessions total) twice weekly for 16 weeks plus selected daily home exercises||www.cdc.gov/HomeandRecreationalSafety/Falls/compendium.html||Unavailable||Unavailable|
|Tai Chi: Moving for Better Balancea||55% risk of multiple falls||Local senior centers and adult activity centers, delivered by a tai chi grand master||1-hour class session (48 sessions total) twice weekly for 24 weeks||tjqmbb.org/program.html|| |
|Australian Group Exercise Program||22% for the whole study sample; 31% for a subsample who had fallen in previous year||Residential care community centers and senior centers, delivered by trained exercise instructors||1-hour class session (96 sessions total) twice weekly for 12 months||www.cdc.gov/HomeandRecreationalSafety/Falls/compendium.html||Unavailable||Unavailable|
|Veterans Affairs Group Exercise Program||6 falls per 1,000 hours of activity||Clinical settings, delivered by trained exercise physiology graduate students||90-minute class session (36 sessions total) 3 times weekly for 12 weeks||www.cdc.gov/HomeandRecreationalSafety/Falls/compendium.html||Unavailable||Unavailable|
|Falls Management Exercise Intervention||31%||Community leisure centers and homes, delivered by trained exercise instructors, physical therapists, and occupational therapists||1-hour class session (36 sessions total) weekly plus 30-minute, twice-weekly home exercise session for 36 weeks||www.laterlifetraining.co.uk/||www.cdc.gov/HomeandRecreationalSafety/Falls/compendium.html||Unavailable|
|Central Sydney Tai Chi Trial||35%||General community settings (e.g., town halls, senior centers), delivered by experienced tai chi instructors or instructors experienced in teaching physical activity to older people||1-hour class session (16 sessions total) weekly for 16 weeks||www.cdc.gov/HomeandRecreationalSafety/Falls/compendium.html||Unavailable||Unavailable|
|Simplified Tai Chi||47% risk of multiple falls||Facilities in a residential retirement community, delivered by tai chi grand master||25-minute class session (30 sessions total) twice weekly, with an encouragement of 15 minute practice daily, for 15 weeks||www.cdc.gov/HomeandRecreationalSafety/Falls/compendium.html||Unavailable||Unavailable|
|Lifestyle Approach to Reducing Falls Through Exercise||31%||Home settings, delivered by a physical therapist, occupational therapist, or exercise physiologist||Weekly 40–90 minute sessions for 5 weeks with 2 booster visits|| |
|Senior Fitness and Prevention||46%||Community gymnasiums, delivered by certified exercise instructors||Twice-weekly 60-minute classes plus two 20-minute home exercise sessions for 18 months||www.cdc.gov/HomeandRecreationalSafety/Falls/compendium.html||Unavailable||Unavailable|
|Adapted Physical Activity Program||60%||A local community sport center, delivered by a physical therapist and a physical therapy student assistant||1-hour class session (48 sessions total) twice weekly for 25 weeks||www.cdc.gov/HomeandRecreationalSafety/Falls/compendium.html||Unavailable||Unavailable|
|Music-Based Multitask Exercise Program||54%|| |
Common areas of residential retirement
Communities, delivered by certified Jaques-Dalcroze instructors
|1-hour weekly classes (25 sessions total) for 25 weeks||www.cdc.gov/HomeandRecreationalSafety/Falls/compendium.html||Unavailable||Unavailable|
|Multitarget Stepping Program||65%||A community health center, delivered by a physical therapist or an exercise trainer||Twice weekly 5- to 7-minute multitask stepping exercises plus 30-minute physical exercise (including mild strength training, aerobic, balance, flexibility exercises) sessions (48 sessions total) for 24 weeks||www.cdc.gov/HomeandRecreationalSafety/Falls/compendium.html||Unavailable||Unavailable|
However, few of these evidence-based interventions have been adopted in clinical or community practice[25, 26] because of a lack of research-to-practice data and gaps in the current guidelines regarding how to prescribe appropriate interventions or implement and integrate them into routine clinical and community practice. In this article we highlight current challenges to delivering these CDC-compiled interventions and offer solutions to enhance their potential to serve clients through community programs and medical practice.