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As people get older, they may fall more often for a variety of reasons including problems with balance, poor vision, and dementia. Up to 30% may fall in a year. Although one in five falls may require medical attention, less than one in 10 results in a fracture.
This review looked at the healthcare literature to establish which fall prevention interventions are effective for older people living in the community, and included 159 randomised controlled trials with 79,193 participants.  
Group and home-based exercise programmes, usually containing some balance and strength training exercises, effectively reduced falls, as did Tai Chi. Overall, exercise programmes aimed at reducing falls appear to reduce fractures.
Multifactorial interventions assess an individual's risk of falling, and then carry out treatment or arrange referrals to reduce the identified risks. Overall, current evidence shows that this type of intervention reduces the number of falls in older people living in the community but not the number of people falling during follow-up. These are complex interventions, and their effectiveness may be dependent on factors yet to be determined.  
Interventions to improve home safety appear to be effective, especially in people at higher risk of falling and when carried out by occupational therapists. An anti-slip shoe device worn in icy conditions can also reduce falls.
Taking vitamin D supplements does not appear to reduce falls in most community-dwelling older people, but may do so in those who have lower vitamin D levels in the blood before treatment.  
Some medications increase the risk of falling. Three trials in this review failed to reduce the number of falls by reviewing and adjusting medications. A fourth trial involving family physicians and their patients in medication review was effective in reducing falls. Gradual withdrawal of a particular type of drug for improving sleep, reducing anxiety, and treating depression (psychotropic medication) has been shown to reduce falls.
Cataract surgery reduces falls in women having the operation on the first affected eye. Insertion of a pacemaker can reduce falls in people with frequent falls associated with carotid sinus hypersensitivity, a condition which causes sudden changes in heart rate and blood pressure.
In people with disabling foot pain, the addition of footwear assessment, customised insoles, and foot and ankle exercises to regular podiatry reduced the number of falls but not the number of people falling.
The evidence relating to the provision of educational materials alone for preventing falls is inconclusive.

Interventions for preventing falls in older people living in the community

Until recently, gait was generally viewed as a largely automated motor task, requiring minimal higher-level cognitive input. Increasing evidence, however, links alterations in executive function and attention to gait disturbances. This review discusses the role of executive function and of attention in healthy walking and gait disorders while summarizing the relevant, recent literature. We describe the variety of gait disorders that may be associated with different aspects of executive function, and discuss the changes occurring in executive function as a result of aging and disease as well the potential impact of these changes on gait. The attentional demands of gait are often tested using dual tasking methodologies. Relevant studies in healthy adults and patients are presented, as are the possible mechanisms responsible for the deterioration of gait during dual tasking. Lastly, we suggest how assessments of executive function and attention could be applied in the clinical setting as part of the process of identifying and understanding gait disorders and fall risk.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/mds.21720

The role of executive function and attention in gait

Falls and freezing of gait are two "episodic" phenomena that are common in Parkinson's disease. Both symptoms are often incapacitating for affected patients, as the associated physical and psychosocial consequences have a great impact on the patients' quality of life, and survival is diminished. Furthermore, the resultant loss of independence and the treatment costs of injuries add substantially to the health care expenditures associated with Parkinson's disease. In this clinically oriented review, we summarise recent insights into falls and freezing of gait and highlight their similarities, differences, and links. Topics covered include the clinical presentation, recent ideas about the underlying pathophysiology, and the possibilities for treatment. A review of the literature and the current state-of-the-art suggests that clinicians should not feel deterred by the complex nature of falls and freezing of gait; a careful clinical approach may lead to an individually tailored treatment, which can offer at least partial relief for many affected patients.

https://reylab.bidmc.harvard.edu/pubs/2004/md-2004-19-871.pdf

Falls and freezing of gait in Parkinson's disease : a review of two interconnected, episodic phenomena

The purpose of this perspective article is to describe the use of a physiological profile approach to falls risk assessment and prevention that has been developed by the Falls and Balance Research Group of the Prince of Wales Medical Research Institute, Sydney, Australia. The profile's use for people with a variety of factors that put them at risk for falls is discussed. The Physiological Profile Assessment (PPA) involves a series of simple tests of vision, peripheral sensation, muscle force, reaction time, and postural sway. The tests can be administered quickly, and all equipment needed is portable. The results can be used to differentiate people who are at risk for falls ("fallers") from people who are not at risk for falls ("nonfallers"). A computer program using data from the PPA can be used to assess an individual's performance in relation to a normative database so that deficits can be targeted for intervention. The PPA provides valid and reliable measurements that can be used for assessing falls risk and evaluating the effectiveness of interventions and is suitable for use in a range of physical therapy and health care settings.

/pdf/a-physiological-profile-approach-to-falls-risk-assessment-o0zjoaylyk.pdf

A Physiological Profile Approach to Falls Risk Assessment and Prevention

Fall events among people with stroke living in the community: circumstances of falls and characteristics of fallers

Background: The risk of people with Parkinson’s disease (PD) falling is greater than that of the general population but to date, disease-specific predictors of falling have not been

Predicting Fallers in a Community-Based Sample of People with Parkinson’s Disease

Objectives: To (1) identify and monitor changes in deficits of attention and balance in the subacute stage following stroke, (2) investigate fall events, (3) explore relationships between deficits of attention, balance and falling post stroke.Design: A prospective observational study.Setting: Hospitalized patients with stroke were recruited from a rehabilitation ward.Subjects: Fourteen subjects were recruited, 13 subjects (age 21–80 years) completed all assessments. Ten had right and three had left hemispheric lesions. Eight subjects were male.Main outcome measures: Subjects were assessed on two occasions during a six-week period. Standardized tests were used to measure unilateral visual neglect, sustained and selective attention and balance. Fall histories were collected by chart review and semi-structured interview.Results: At the initial assessment six subjects had sustained auditory attention deficit, eight had deficits of auditory selective attention, 12 had visual selective attention deficits and se...

A pilot study of attention deficits, balance control and falls in the subacute stage following stroke

Purpose: To develop a test that identified fallers from their turning strategies, as people with Parkinson's Disease (PD) commonly fall turning.Method: We compared (1) Turn Types demonstrated when turning 180° during the Timed Up and Go Test (TUG Test) by 19 non-fallers and 29 fallers (median age 71) and (2) Turn Types, Turning Steps, Heelstrike, Stability and the Use of Space and Support demonstrated when turning 180° during an everyday activity by 15 non-fallers and 26 fallers (median age 75). Turns were rated from video by observers blinded to group. Inter-observer agreement was tested.Results: Similar proportions of fallers and non-fallers demonstrated multiple-step Turn Types during the TUG Test (69% v 58%; p = 0.433) and the everyday activity (66% vs. 46%; p = 0.241). When turning, similar proportions of each group lacked Heelstrike, lost Stability and used the available Space and Support (p > 0.7); Turning Step counts were also similar (p = 0.891). Inter-observer agreement proved acceptable except ...

Developing methods to evaluate how people with Parkinson's Disease turn 180°: an activity frequently associated with falls

The contribution of impaired mobility to disordered sleep in Parkinson's disease (PD) remains uncertain. We evaluated the sleep of 38 people with PD and observed their turning strategies. Most reported difficulty maintaining sleep and difficulty turning. Those who hip-hitched rated themselves more disabled and those who sat up had more severe PD than those who used support. Using multiple strategies was associated with sleep disturbance. As the ability to turn deteriorates, we recommend patients identify the single strategy least disruptive to sleep. Research must address whether improving mobility improves sleep quality.

Impaired bed mobility and disordered sleep in Parkinson's disease.

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