HLTH 380 Week 2 Article Analysis Example

One Fall in Four Prevented: An Analysis of the Cochrane Evidence on Exercise for Older Adults Living at Home

Introduction

Falls are one of the greatest threats to older adults' independence. A single fall can lead to a hip fracture, a move to a nursing home or a fear of falling that keeps a person from leaving home. Sherrington et al. (2019) reviewed the evidence on whether exercise can keep older adults who live at home from falling.

Summary of the Article

The authors combined 108 randomized trials with 23,407 participants from 25 countries. Participants averaged 76 years of age, and 77% were women. Set against control activities not expected to prevent falls, exercise lowered how often participants fell by 23%, which the authors illustrate as about 195 fewer falls per 1,000 people over a year. Exercise also cut the share of participants who had any fall during follow-up by 15%. The evidence for these findings was rated high certainty. Exercise programs focused on balance and functional movements, such as standing up from a chair and stepping, showed clear benefits, and programs combining several types of exercise also appeared effective. The effect was similar whether or not participants were selected because they were at higher risk of falling. A limitation is that many trials had unclear or high risk of bias in at least one area. The review also tested exercise alone, so it does not show how much more could be gained by combining exercise with other steps, such as home safety changes or medication review, which many fall prevention programs use together.

Analysis

The size of the problem makes these findings important. Florence et al. (2018) calculated that falls among Americans 65 and older cost the health system roughly $50 billion in 2015, counting both fatal and nonfatal injuries, with Medicare paying about $28.9 billion. Robnett and Chop (2015) explain that normal aging brings gradual changes in muscle strength, balance and reaction time, and that many of these changes can be slowed through activity. That explains why balance and functional exercises work: they target the specific abilities that decline with age and that people need to catch themselves when they trip. Falls are not an unavoidable part of growing old; they are, in large part, a preventable result of lost strength and balance that exercise can rebuild.

Implications for Health Promotion

Communities could offer balance and strength classes in senior centers, churches and parks, and health providers could screen older patients for fall risk and refer them to such programs. Because the benefit appeared even among people not at high risk, programs should be open to all older adults rather than only those who have already fallen. Programs must also be designed so people keep coming, since exercise helps only while it continues; classes that are close to home, inexpensive and social, such as group tai chi or walking clubs, are more likely to hold participants than programs that require driving across town. Health promotion in this sense addresses the social dimension of health as well as the physical one.

Conclusion

This review provides strong evidence that exercise prevents falls. Given the human and financial cost of falls, making balance and strength training widely available is one of the most practical ways to help older adults stay independent.

References

Florence, C. S., Bergen, G., Atherly, A., Burns, E., Stevens, J., & Drake, C. (2018). Medical costs of fatal and nonfatal falls in older adults. Journal of the American Geriatrics Society, 66(4), 693-698. https://doi.org/10.1111/jgs.15304

Robnett, R. H., & Chop, W. C. (2015). Gerontology for the health care professional (3rd ed.). Jones & Bartlett Learning.

Sherrington, C., Fairhall, N. J., Wallbank, G. K., Tiedemann, A., Michaleff, Z. A., Howard, K., Clemson, L., Hopewell, S., & Lamb, S. E. (2019). Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 2019(1), CD012424. https://doi.org/10.1002/14651858.CD012424.pub2