Reducing Falls In The Elderly

Poor vitamin D status is independently associated with an increased risk of falling in the elderly, particularly in those aged 65-75 years (Snijder et al 2006). A 2004 review of double-blind RCTs of vitamin D in elderly populations conducted between 1960 and 2004 found that supplementation with vitamin D reduced the risk of a fall by more than 20% and that approximately 1 5 people needed to take vitamin D for up to 3 years to protect one person from a fall. The results were significant in women only and appeared to be independent of calcium administration, type of vitamin D and duration of therapy (Bischoff-Ferrari et al 2006). More recent research has suggested an even greater reduction in the incidence of falls. According to a double-blind randomised study involving 64 institutionalised elderly women (age range: 65-97 years; mean 25-hydroxyvitamin D levels: 16.4 ng/ml), treatment with 1200 mg/day calcium plus 800 lU/day cholecalciferol over a 3-month treatment period reduced the rate of falls by 60% compared with calcium supplementation alone (Bischoff-Ferrari et al 2006). After conducting a balance assessment, it was estimated that of the observed 60% reduction in the rate of falls, up to 22% of the treatment effect was explained by a change in postural balance and up to 14% by dynamic balance. A 60% reduction in the incidence of peripheral fractures was also identified by Cosman in 2005 for vitamin D supplementation (700-800 IU/day) with adequate or supplemented calcium. With regard to hip fracture specifically, a 40% reduction in incidence was observed. As a result of these impressive results, routine administration is recommended for those institutionalised or housebound elderly who are already at risk of deficiency (Sambrook & Eisman 2002).

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