With advancing age, every individual can be affected by sensory, motor, and cognitive defects, as well as by chronic illnesses. Past the age of 85 years, over three out of four French people state that their activities are limited. Falls, which are frequent events for older people, are part of the risk of losing autonomy and being admitted to an institution, and prove very costly in terms of quality of life and care. In an ageing population, prevention of falls and maintaining independence in daily activities are therefore major challenges for public health.
The authors of the collective expert report thus emphasise the beneficial effect of regular physical activity, centred on balance training, for all older subjects at varying risk of falling. To be tailored to the state of health and lifestyle of older people, physical exercise programmes should be better supervised and involve closer cooperation between players from the medical, non-profit and sports sectors.
Accidental falls in older people: current situation and consequences
The elderly population is a very heterogeneous group from a medical and functional point of view. From the age of 65 years, 15-20% of people living at home would be fragile. Moreover, fragility is associated with an increased risk of mortality and insults such as falls.
In France, according to the permanent survey on everyday accidents, falls represented 90% of everyday accidents recorded among the over 75s by the emergency services in 2009. 20-33% of people aged 65 years or older report having fallen in the previous year. Of those who had fallen, half would have fallen at least twice that year. Moreover, falls are the main cause of physical trauma among the over 70s.
Physical exercise contributes to reducing the frequency and risk of falling
The most effective exercise programmes are those centred on balance training. Generally, those that include balance exercises lead to a significant reduction in risk of falling in the order of 25%. Nonetheless, muscle strength training and endurance improvement contribute to the maintenance of functional abilities, and have effects that complement balance training in preventing falls. For older people living at home, programmes based on several types of physical activity exercises are effective in both reducing the rate of falls, the risk of falling, and the risk of fractures.
Physical activity: a solution for maintaining autonomy in older people
Older people who devote time to a physical activity have a better perception of their general health, vitality, and mental and physical condition.
Recommended actions by the authors of this collective expert report include three main objectives:
– Develop physical exercise programmes suited to the state of health of the older subject; – Encourage the implementation of physical activity programmes; – Educate people about falls, and identify and care for older people at risk.
The authors of the present expert report have also formulated several recommendations for research:
– Carry out studies making it possible to specify optimum programmes in terms of efficacy and acceptability, especially for the oldest, least mobile and most fragile people; – Perform cost-effectiveness analyses of prevention programmes; analyse the incidence and consequences of falls in France; – Elucidate the basic mechanisms underlying risk factors for falls; – Assess the psychological and behavioural aspects of risk of falling associated with the fear of falling; – Better define the facilitators and impediments to participation in physical activity by older people.
Hubert BLAIN, Département de gériatrie, Centre de prévention et de traitement des maladies du vieillissement Antonin Balmes, CHU Montpellier, Unité Movement to health – Euromov, MacVia-LR, Université Montpellier 1, Montpellier
Frédéric BLOCH, Pôle gériatrique, Site Broca, Hôpitaux Universitaires Paris Centre (AP-HP), Paris
Liliane BOREL, Aix Marseille Université, CNRS, Neurosciences intégratives et adaptatives, UMR 7260, FR3C, Marseille
Patricia DARGENT-MOLINA, Inserm UMR 1018, Centre de recherche en épidémiologie et santé des populations, Villejuif
Jean-Bernard GAUVAIN, Court-séjour Gériatrie, Centre hospitalier régional d’Orléans, Nouvel Hôpital, Orléans
David HEWSON, Institut Charles Delaunay, LM2S UMR CNRS 6279, Sciences et technologies pour la maîtrise des risques, Université de technologie de Troyes, Troyes
Marie-Ève JOEL, Laboratoire d’économie (Équipe santé), LEDA-LEGOS, Université Paris Dauphine, Paris
Gilles KEMOUN, Médecine physique et de réadaptation, UFR Médecine et pharmacie, Poitiers
France MOUREY, Inserm U 1093, Cognition, action et plasticité sensorimotrice, UFR Médecine, Université de Bourgogne, Dijon
François PUISIEUX, Pôle de gérontologie, CHRU de Lille, Université Lille 2, Lille
Yves ROLLAND, Gérontologie clinique et médecine interne, Gérontopôle de Toulouse, Pôle gériatrie Casselardit, Inserm U 1027, Toulouse
Yannick STEPHAN, EA 4556, Dynamique des capacités humaines et des conduites de santé, Universités Montpellier 1, 3, Montpellier
La coordination de cette expertise a été assurée par le Pôle d’expertise collective de l’Inserm rattaché à l’Institut multi-organismes Santé publique.