CDC COMPENDIUM OF EFFECTIVE FALL INTERVENTIONS: What Works for Community-Dwelling Older Adults

Feb 18, 2023

4th Edition Update Excerpts and Commentary

Written by: Bethany Russell

The CDC (Centers for Disease Control) recently updated their report of research studies on interventions to reduce risk for falls. As a physical therapist I found this compendium to be a valuable way to expand my perspective on effective balance treatments. They looked at studies of the general population of community dwelling adults ages 65 and older – and here are some of the treatments related to a significant reduction in fall risk (and how much of a reduction in fall risk):

Group exercise classes focusing on strength, balance, endurance, and coordination (22-66%)

Home exercise programs focusing on the above skills (such as the Otago program) (35%)

Incorporating strength and balance training into everyday life (for example standing heel to toe while brushing teeth) (30%)

Tai Chi classes designed to improve balance (46-55%)

Slip recovery training with a physical therapist (50%)

Vitamin D + calcium supplementation under the guidance of a physician (38-52%)

Surgery to remove cataracts if present (34%)

A physician and a pharmacist reducing psychotropic medication or reviewing medication lists (39-64%)

Occupational therapists performing home safety visits (33-61%)

As you can see, similar interventions were related to a range of apparent effectiveness in terms of reducing fall risk. I looked more closely, trying to determine what factors may have contributed to those higher or lower numbers, and here is my interpretation:

Regarding home safety:

Individualized recommendations perform better than general recommendations

Occupational therapist recommendations perform better than handouts, mailed recommendations, or powerpoint presentations

Vitamin D supplementation was even more effective for women than men

Regarding exercise:

Higher intensity performs better than lower intensity/higher reps

Clear progression of exercises performs better than programs that don’t prioritize progression

Otago home exercise program: even higher efficacy for those over the age of 80

Group exercise classes led/designed by a physical therapist or exercise physiologist perform better than classes led by those with less applicable training

More intention (dedicate time to formal exercise every week) performs better than less intention (do a few extra squats as you unload the dishwasher), which still performs better than nothing!

All successful exercise interventions addressed multiple factors – balance practice, strength, endurance, and flexibility

Working with (such as creating a plan together to address individual fall risk factors, or supervised exercise) performs better than talking at (presentations or handouts with generalized education on how to prevent falls)

I believe these data hold some helpful reminders for physical therapists in terms of accessible and evidence backed steps we can take when addressing balance with adults ages 65+:

Ask about any untreated visual deficits

Some may want to refer to MD to discuss if vitamin D/calcium supplementation is appropriate

Consider referring back to MD for review in cases of polypharmacy or psychotropic medication use

Refer to occupational therapy for home safety if indicated

Share decision making with goal setting and plan of care design

Keep the intensity high (of course this looks different for everyone) and push for continuous progressions as strength and balance improve

Incorporate progressive resistance training, not just bodyweight and light band exercises, when feasible

Start where you need to start and it can still be effective: if someone is only willing to do little bits throughout their day, or health conditions allow only light intensity exercise, these were also related to some improvement!

Finally, for those who have time to go through all 255 pages of the original document – it’s a good read. The authors included links to all of the successful protocols, and if you’re new to treating balance or just want more ideas, these protocols contain a wealth of intervention ideas!

Citation: Burns ER, Kakara R, Moreland B. A CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults. 4th ed. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2022.