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Physical therapy approaches to reduce fall and fracture risk among older adults

Abstract

Falls and fall-related injuries, such as fractures, are a growing problem among older adults, often causing longstanding pain, functional impairments, reduced quality of life and excess health-care costs and mortality. These problems have led to a variety of single component or multicomponent intervention strategies to prevent falls and subsequent injuries. The most effective physical therapy approach for the prevention of falls and fractures in community-dwelling older adults is regular multicomponent exercise; a combination of balance and strength training has shown the most success. Home-hazard assessment and modification, as well as assistive devices, such as canes and walkers, might be useful for older people at a high risk of falls. Hip protectors are effective in nursing home residents and potentially among other high-risk individuals. In addition, use of anti-slip shoe devices in icy conditions seems beneficial for older people walking outdoors. To be effective, multifactorial preventive programs should include an exercise component accompanied by individually tailored measures focused on high-risk populations. In this Review, we focus on evidence-based physical therapy approaches, including exercise, vibration training and improvements of safety at home and during periods of mobility. Additionally, the benefits of multifaceted interventions, which include risk factor assessment, dietary supplements, elements of physical therapy and exercise, are addressed.

Key Points

  • Regular multicomponent exercise is the most effective single physical therapy approach to reduce falls and fractures in older adults

  • Exercise is also an important component of multifaceted intervention measures aimed at the prevention of falls

  • Vibration training is a potential modality to improve muscle performance, balance and bone strength among older adults and might also reduce falls

  • Home-hazard assessment and modification, including use of assistive devices, could potentially be helpful for people at a high risk of falling

  • Hip protectors in nursing home residents and anti-slip shoe devices in older people walking outdoors in icy conditions are useful tools to prevent falls and fractures

  • Multifactorial fall prevention programs have to be individually tailored to, and focused on, high-risk populations

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Figure 1: Risk factors of falls and reduced bone strength that result in fractures.

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Acknowledgements

We thank Seppo Niemi (UKK Institute, Tampere, Finland) for his technical assistance in preparing Figure 1. S. Karinkanta, M. Piirtola, H. Sievänen, K. Uusi-Rasi and P. Kannus are supported by grants from the Medical Research Fund of Tampere University Hospital, Tampere, Finland. M. Piirtola is supported by research grants from the Hospital District of Southwest Finland, Turku and Lieto Health Centre, Lieto, Finland. S. Karinkanta and M. Piirtola contributed equally to this work.

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Karinkanta, S., Piirtola, M., Sievänen, H. et al. Physical therapy approaches to reduce fall and fracture risk among older adults. Nat Rev Endocrinol 6, 396–407 (2010). https://doi.org/10.1038/nrendo.2010.70

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