Exercise for Preventing Falls in People with Dementia: Time to Work Together

For people with dementia (PWD), a crucial aspect of their daily lives is maintaining optimal levels of functional ability [1]. As such, the prevention of falls remains, to this day, a major challenge in this population and for health care [2]. Indeed, falls are at least twice as more common in PWD compared to cognitively normal older adults [3] and are associated with more frequent adverse events [4]. However, even if dementia cannot be reversed, there is evidence that proper interventions can improve quality of life and delay the onset of disability in activities of daily living [5]. Many systematic reviews and meta-analyses have focused on fall reduction but have provided mixed results. For example, two previous systematic reviews and meta-analyses from Sherrington [6] and Barreto [7] found a significant benefit for exercise in reducing falls in cognitively healthy people, but not in PWD.

In Jehu et al.’s systematic review published in the Journal of Alzheimer’s Disease [8], it was investigated if exercise could reduce falls in PWD. The study included only PWD aged 55 years and older either living in nursing homes (NH) or in the community and included many types of fall outcomes (fallers, injurious fallers, recurrent falls, etc.). The search strategy included 12 studies in which the influence of exercise on the incidence rate ratio of falls was significantly decreased in only two studies. Furthermore, these two studies were so different regarding the length of interventions (9 hours of total exercise over 3 months versus 100 hours of exercise over 12 months) and setting (long-term care versus community dwelling PWD) that is very difficult to compare and share recommendations. The authors mention that again, insufficient data remains in reducing the number of falls by exercise interventions.

However, because exercise has already been found effective in reducing falls in cognitively normal older adults [6, 7], indicating that maybe other risk factors may contribute to the non-significant effect of exercise in PWD. As a matter of fact, a previous study found that medication consumption and chronic conditions were the two most frequent risk factors for falls in PWD [9], indicating that there may be more effective interventions in reducing falls in PWD. Intriguingly, the lack of competence and teamwork failure of the NH staff were contributing factors for serious adverse events [10] in PWD living in NH. Furthermore, a previous systematic review and meta-analysis found that pharmacist-led medication review significantly reduced fall rates in PWD living in NH. Finally, a recent meta-analysis from Gulka et al. [11] have found similar results, showing a reduction of the risk of falls in people with cognitive impairment. However, these interventions did not actively engage PWD with exercise, they were aimed at educating nursing home staff and reviewing medication, raising the question if exercise alone can be effective in reducing falls for PWD. More interestingly, the authors found no multidisciplinary interventions where many health professionals were implicated (i.e., pharmacists or physicians and exercise specialists) to reduce falls in PWD. Even though these previous interventions were focused on NH residents, PWD living in the community have still high medication consumption that increases the risk of falls [12].

To conclude, even though results from Jehu et al.’s systematic review do not provide promising results on the role of exercise in fall reduction in PWD, it helps support the point that exercise alone is not effective and that multidisciplinary interventions need to be developed and tested to address this hypothesis. In line with this, there seems to be a gap in the literature in multidisciplinary interventions, such as exercise interventions combined with pharmacist-led medication review in reducing falls in PWD.