Newswise — Exercise programs that lend strength, flexibility and balance might be one of the best ways to prevent falls among people age 65 and older, according to a Cochrane review of more than 100 studies.

A variety of other measures — from pacemakers to vitamin D supplements — might be useful in preventing certain individuals from falling, but exercise appears to be the most widely effective strategy for reducing both the risk of falling and the overall number of falls among older people.

"It may not be possible to prevent falls completely, but people who tend to fall frequently may be enabled to fall less often," said Lesley Gillespie, an orthopedic trauma specialist at the University of Otago in New Zealand and lead author of the review.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Each year, about 30 percent of people over age 65 who live outside of assisted care facilities experience a fall. Poor balance, diminished eyesight, the side effects of medications and dementia are among the reasons older people sometimes fall.

One in five of these falls could require medical attention, but even without causing serious injury, falling can make individuals fearful of leaving their homes or participating in activities, the Cochrane researchers noted.

"Falling puts a strain on the family and is an independent predictor of admission to a nursing home," Gillespie said.

Gillespie and colleagues examined 111 studies of falling prevention measures, which included more than 55,000 people from 15 countries. The studies suggest that group exercise programs, Tai Chi and home exercise programs all reduce the risk of falls and the rate of falling.

"Effective exercise programs for reducing falls focus on balance, strength and flexibility, and challenge the older adults to improve in all of these components," said Bonita Lynn Beattie, a physical therapist and vice president for injury prevention at the Center for Healthy Aging. She suggested that older adults should check in with their primary doctor before beginning an exercise program, especially if they "have significant weakness, balance issues or dizziness."

Other preventive measures might only be effective for small, targeted groups. For instance, "taking vitamin D supplements probably does not reduce falls, except in people who have a low level of vitamin D in the blood," Gillespie said. Similarly, cataract surgery and insertion of a pacemaker can help specific groups of people with poor eyesight or certain blood pressure conditions fall less often.

Anti-slip devices worn on shoes during icy conditions and reviewing medications regularly are also effective in reducing falls. In some cases, gradually reducing the dosage of sleep aids and depression medicines can reduce the number of falls experienced by an individual, the researchers found.

Behavioral changes can also make a difference, Beattie said. "An older adult should probably reconsider climbing on a ladder to clean gutters or using a chair to change a light bulb or reach high shelves," she said.

Gillespie said that the findings "may not be applicable to older people with dementia," since most of the studies in the review "specifically excluded them from participation."

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit for more information.

Gillespie LD, et al. Interventions for preventing falls in older people living in thecommunity. Cochrane Database of Systematic Reviews 2009, Issue 2.

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