Falls in Older People

"The aim of this third edition of our book is to review and incorporate this new material to provide researchers, students, and health care workers with a means for gaining access to current thinking and best clinical practice. Listed below are some highlights of progress and encouraging findings. Studies aimed at understanding balance have used paradigms such as tripping, slipping, and stepping to more accurately reflect situations in which people fall. A large body of neuropsychological research has shown that balance activities that were generally considered to be reflex or automatic require attention, and that impaired executive functioning is an important risk factor for falls. New wearable sensor technologies have allowed mobility and fall risk to be remotely assessed, paving the way for unobtrusive at-home monitoring. Several cognitive-motor interventions comprising exergames have been evaluated in randomized controlled trials, where they have been shown to improve balance. These may be an enjoyable way to facilitate adherence. Cognitive behavior therapy in association with exercise can substantially reduce fear of falling. Systematic reviews have synthesized the findings of randomized controlled trials have examined the effects of a range of exercise interventions in preventing falls in community dwellers. From this large body of evidence, it is now possible to conclude that effective exercise programs must comprise challenging, weight-bearing balance exercises. It is less clear how to prevent falls in residential care, but a recent well-designed randomized controlled trial has shown that an exercise intervention can prevent falls in nursing home residents. Several fall prevention interventions have now also been demonstrated to be cost-effective, again particularly exercise interventions in community dwellers"--