Fall related injuries are common,1 2 3 result in considerable healthcare utilisation, and are a major cause of long term pain and functional impairment among older adults.4 They also increase considerably the risk of discharge to a nursing home5 and have a high economic cost.6
It has been established that well designed exercise programmes can prevent falls in older adults living at home.7 8 However, evidence that these programmes can also prevent injuries caused by falls is poor. This void is partly because most previous trials were underpowered to examine the effect of exercise on injurious falls, in particular the most severe falls. In a supplementary analysis, the recently updated Cochrane review of interventions for preventing falls in older adults living at home examined the effect of exercise on fractures specifically.7 This analysis, which was based on six trials, showed that fall prevention exercise programmes are associated with a significantly lower risk of fractures.
To our knowledge, no review or meta-analysis has examined the effect of fall prevention exercise programmes on other injurious falls outcomes that are common and that can also have important medical, psychological, and economic consequences. Besides causing fractures or other serious injuries, falls leading to medical care ought to be considered since their cost to society is high and their burden on the healthcare system heavy.6 9 Even falls causing relatively minor injuries are important to consider, as they too may have serious consequences, such as diminished self confidence, social isolation, and restriction on activity, which in turn will accelerate functional decline and increase the risk of placement in a nursing home.4
Using a meta-analytical approach, we reviewed the current evidence about the effect of exercise interventions designed for community dwelling older adults on different outcomes of injurious falls, based on severity or medical care. There is no consensus about the outcomes of fall related injuries that should be evaluated in controlled trials, and published trials reporting injurious falls use quite different definitions.10