Effects of Resveratrol on Cerebral Blood Flow Variables and Cognitive Performance in Humans

A double-blind, placebo-controlled, crossover investigation 1, 2, 3.

David O Kennedy, Emma L Wightman, Jonathon L Reay, Georg Lietz, Edward J Okello, Anthea Wilde and Crystal F Haskell

1 From the Brain PerformanceNutrition Research Centre Northumbria University Newcastle upon Tyne United Kingdom (DOK ELW JLR AWCFH)the School of Agriculture FoodRural Development Newcastle University Newcastle upon Tyne United Kingdom (GLEJO).

2. The research described herein was internally funded, and all materials were purchased on the open market.

3.Address reprint requests and correspondence to DO Kennedy, Brain, Performance and Nutrition Research Centre, Northumbria University, Newcastle, United Kingdom NE1 8ST. E-mail: david.kennedy@unn.ac.uk.

ABSTRACT

Background: The many putative beneficial effects of the polyphenol resveratrol include an ability to bolster endogenous antioxidant defenses, modulate nitric oxide synthesis, and promote vasodilation, which thereby improves blood flow. Resveratrol may therefore modulate aspects of brain function in humans.

Objective: The current study assessed the effects of oral resveratrol on cognitive performance and localized cerebral blood flow variables in healthy human adults.

Design: In this randomized, double-blind, placebo-controlled, crossover study, 22 healthy adults received placebo and 2 doses (250 and 500 mg) of trans-resveratrol in counterbalanced order on separate days. After a 45-min resting absorption period, the participants performed a selection of cognitive tasks that activate the frontal cortex for an additional 36 min. Cerebral blood flow and hemodynamics, as indexed by concentration changes in oxygenated and deoxygenated hemoglobin, were assessed in the frontal cortex throughout the posttreatment period with the use of near-infrared spectroscopy. The presence of resveratrol and its conjugates in plasma was confirmed by HPLC after the same doses in a separate cohort (n = 9).

Results: Resveratrol administration resulted in dose-dependent increases in cerebral blood flow during task performance, as indexed by total concentrations of hemoglobin. There was also an increase in deoxyhemoglobin after both doses of resveratrol, which suggested enhanced oxygen extraction, that became apparent toward the end of the 45-min absorption phase and was sustained throughout task performance. Cognitive function was not affected. Resveratrol metabolites were present in plasma throughout the cognitive task period.

Conclusion: These results showed that single doses of orally administered resveratrol can modulate cerebral blood flow variables.

Received for publication September 9, 2009. Accepted for publication March 3, 2010.

B Vitamins Reduce Stroke, Heart Disease Deaths

Benefits of Folate and B6 Apply to Men and Women, Researchers Say

By Bill Hendrick
WebMD Health News

Reviewed by Laura J. Martin, MD

April 15, 2010 — Foods rich in B vitamins such as folate and B-6 may reduce the risk of death from stroke and heart problems, Japanese researchers say.

Their study looked at the effects of B vitamins on men and women separately, but findings suggest that foods containing the B vitamins might benefit people of both sexes.

Their primary findings:

* Folate and B-6 may reduce the risk of heart failure in men.
* The same vitamins seem to reduce the risk of death from stroke and heart disease in women.

Sources of folate include vegetables, fruits, whole or enriched grains, fortified cereals, beans, and legumes. B-6 sources include fish, vegetables, liver, meats, whole grains, and fortified cereals.
Vitamin B6, Folate Fight Heart Disease

The researchers examined data from 23,119 men and 35,611 women between ages 40 and 79 who completed questionnaires about dietary habits as part of the Japan Collaborative Cohort Study.

They found that at a median of 14 years follow-up, 986 people had died from stroke, 424 from heart disease, and 2,087 from all diseases related to the cardiovascular system.

Patients were divided into five groups based on their intake of folate, vitamin B6, and vitamin B12. Researchers compared people with the diets lowest and highest for each nutrient and found that higher consumption of folate and B6 was associated with significantly fewer deaths from heart failure in men. In women, they detected significantly fewer deaths from stroke, heart disease, and total cardiovascular deaths.

Vitamin B12 was not found to be associated with a reduced risk of mortality.

The protective effects of folate and vitamin B6 did not change even when researchers made adjustments for the presence of cardiovascular factors or when people taking supplements were eliminated from the analysis.

The researchers say B6 and folate may fight cardiovascular disease by lowering levels of homocysteine, an amino acid in the blood that is affected by diet, but also heredity.

The researchers say the findings on the value of B vitamins were consistent with studies in North America and Europe. Homocysteine is believed to cause damage to the inner linings of arteries, promoting blood clots.
B Vitamins: More Research Needed

Hiroyasu Iso, MD, professor of public health at Osaka University and one of the study authors, says in a news release that people in Japan need to increase consumption of foods containing folate and vitamin B6.

The researchers say the correlation between intake of folate and B vitamins with cardiovascular disease is controversial and that evidence of benefits has been limited to Asian populations. Given their findings, the researchers say there is an urgent need for more research aimed at replicating the results of their study in different populations.

The study is published in the April issue of Stroke: Journal of the American Heart Association.

The Institute of Medicine (IOM), the health arm in the U.S. of the National Academy of Sciences, recommends 1.3 to 1.7 milligrams of vitamin B6 per day, depending on age and sex. The IOM says extremely high-dose folate supplements should be avoided and recommends adult intake of 400 micrograms daily.

D is for deficiency

Less exposure to sunlight leaves many Americans lacking key vitamin
By Gee Loeb Sharp McClatchy News Service
Posted: 03/28/2010 11:51:12 PM MDT

We have evolved into a society sorely lacking in vitamin D.

Countless research hours have been conducted to help spread the word on its benefits, debunk the myths associated with it and lay out a simple set of guidelines to follow for optimum usage.

According to Dr. Jay Mattingly, a full-time anesthesiologist working for University of Tennessee Medical Group who recently became certified by the American Board of Anti-Aging, more than 1 billion people worldwide are deficient in vitamin D.

Actually, vitamin D isn`t a vitamin at all, but a hormone with receptors in all organs of the body, including the brain, heart, breast, colon, prostate and pancreas.

According to the Vitamin D Council, vitamin D deficiency has been implicated as a major factor in the pathology of at least 17 varieties of cancer, as well as heart disease, stroke, hypertension, autoimmune diseases, diabetes, depression, chronic pain, osteoarthritis, osteoporosis and more.

A major reason for our evolutionary decrease in vitamin D is our avoidance of the sun`s rays. Ask any vitamin D enthusiast about the sun`s ultraviolet rays and you`ll hear about its benefits, and how the skin produces about 10,000 units of vitamin D in response to 20 to 30 minutes of summer sun exposure.

Agnes Green, owner of The Healer Within wellness center in Portland, Ore., and a functional nutritionist, says we lack enough exposure to the sun to allow our bodies to produce sufficient amounts of vitamin D.

“We`re involved in more indoor activities,” Green says. “We are on our computers or watching TV, especially children and young adults who play video games. Our sun supply is cut down by diminished exposure, and what little time we do spend outdoors is rendered useless by the UV protection we lather over ourselves. … UV sunglasses also rob us of vitamin D production. … Unless you live directly under a hole in the ozone layer, you have no need for this militant sun protection. On the contrary, you`re doing yourself and your kids a disservice.”

How much vitamin D should you take? Though the U.S. government recently increased its daily recommendation to 400 IU daily, other doctors and health care professionals recommend a much higher dosage.

“The dose I recommend is 800 to 1,000 IU daily, though many of my patients with osteoporosis are still deficient at that dosage,” says Dr. Catherine Robilio Womack, internist and associate professor of medicine at the University of Tennessee Health Science Center. “Many osteoporosis patients need 1,000 to 2,000 IU daily or a bigger weekly dosage. It doesn`t matter so much what you take daily; it is the cumulative dose that is important.”

Vitamin D in pill form can be toxic when taken in excess, so it is always important to have your levels checked after increasing your intake.

According to Mattingly, everyone needs differing amounts of vitamin D, just like anything else, but the average person needs 5,000 IU daily.

“There are no adequate dietary sources of vitamin D,” Mattingly says. “The average multi-vitamin has only 400 IU and an 8 oz. glass of milk supplies only 100 IU. Even supplements like Caltrate have only 600 to 800 IU.”

Vitamin and calcium supplements may reduce breast cancer risk

Public release date: 18-Apr-2010
http://www.eurekalert.org/pub_releases/2010-04/aafc-vac041210.php

Contact: Jeremy Moore
jeremy.moore@aacr.org
267-646-0557
American Association for Cancer Research

Vitamin and calcium supplements may reduce breast cancer risk

WASHINGTON, D.C. — Vitamins and calcium supplements appear to reduce the risk of breast cancer, according to findings presented at the American Association for Cancer Research 101st Annual Meeting 2010.

“It is not an immediate effect. You don’t take a vitamin today and your breast cancer risk is reduced tomorrow,” said Jaime Matta, Ph.D., professor in the Ponce School of Medicine in Puerto Rico. “However, we did see a long-term effect in terms of breast cancer reduction.”

Matta said the findings suggest that the calcium supplements are acting to enhance DNA repair capacity, a complex biological process involving more than 200 proteins that, if disrupted, can lead to cancer.

“This process involves at least five separate pathways and is critical for maintaining genomic stability,” said Matta. “When the DNA is not repaired, it leads to mutation that leads to cancer.”

The study included 268 women with breast cancer and 457 healthy controls. Women were more likely to have breast cancer if they were older, had a family history of breast cancer, had no history of breastfeeding and had lower DNA repair capacity.

Vitamin supplements appeared to reduce the risk of breast cancer by about 30 percent. Calcium supplements reduced the risk of breast cancer by 40 percent. After controlling for the level of DNA repair capacity, calcium supplements were no longer as protective, but the link between vitamin supplements and breast cancer reduction remained.

“We’re not talking about mega doses of these vitamins and calcium supplements, so this is definitely one way to reduce risk,” said Matta.

Women who eat foods with high glycemic index may be at greater risk for heart disease

Public release date: 12-Apr-2010
http://www.eurekalert.org/pub_releases/2010-04/jaaj-wwe040810.php

Contact: Vittorio Krogh, M.D., M.S.
vittorio.krogh@istitutotumori.mi.it
JAMA and Archives Journals

Women who eat foods with high glycemic index may be at greater risk for heart disease

Consuming carbohydrates with high glycemic index—an indicator of how quickly a food affects blood glucose levels—appears to be associated with the risk of coronary heart disease in women but not men, according to a report in the April 12 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

High-carbohydrate diets increase the levels of blood glucose and of harmful blood fats known as triglycerides while reducing levels of protective HDL or “good” cholesterol, thereby increasing heart disease risk, according to background information in the article. However, not all carbohydrates have the same effect on blood glucose levels. The glycemic index is a measure of how much a food raises blood glucose levels compared with the same amount of glucose or white bread. A related measure, the glycemic load, is calculated based on the glycemic index of a given food and also on the total amount of carbohydrates it contains.

Sabina Sieri, Ph.D., of Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, and colleagues studied 47,749 Italian adults—15,171 men and 32,578 women—who completed dietary questionnaires. Based on their responses, the researchers calculated their overall carbohydrate intakes as well as the average glycemic index of the foods they consumed and the glycemic loads of their diets. During a median (midpoint) of 7.9 years of follow-up, 463 participants (158 women and 305 men) developed coronary heart disease.

The one-fourth of women who consumed the most carbohydrates overall had approximately twice the risk of heart disease as the one-fourth who consumed the least. When these carbohydrates were separated into high– and low–glycemic index categories, increased intake from high–glycemic index foods was significantly associated with greater risk of coronary heart disease, whereas low–glycemic index carbohydrates were not. “Thus, a high consumption of carbohydrates from high–glycemic index foods, rather than the overall quantity of carbohydrates consumed, appears to influence the risk of developing coronary heart disease,” the authors write.

The one-fourth of women whose diet had the highest glycemic load had 2.24 times the risk of heart disease compared with the one-fourth of women with the lowest glycemic load.

Overall carbohydrate intake, glycemic index and glycemic load were not associated with heart disease risk in men. This could be because the adverse changes associated with carbohydrate intake, including triglyceride levels, are stronger risk factors for heart disease in women than in men, the authors note.

“We tentatively suggest that the adverse effects of a high glycemic diet in women are mediated by sex-related differences in lipoprotein and glucose metabolism, but further prospective studies are required to verify a lack of association of a high dietary glycemic load with cardiovascular disease in men,” they conclude.

How Many Calories Per Day for the Elderly?

All foods contain calories that provide the body with energy necessary for human function. Reading, sitting quietly, the pumping action of the heart and normal breathing all require calories. Caloric needs are greatest for young adults. As we age and our activity levels and muscle mass decrease, so does the amount of calories we need to consume.

Elderly Energy Needs

1. After we reach 50, recommended nutrient intake drops by 5 percent for each decade we age due to a decrease in the body’s active cells and loss of muscle tissue.

But determining ideal caloric intake for the elderly is not much different than calculating it for younger adults. It does, however, require some basic arithmetic.

The Harris-Benedict equation is a formula that determines basal metabolic rate then factors in physical activity to derive at the recommended daily caloric intake. The basal metabolic rate is the amount of calories burned at rest.

The formula to determine metabolic rate varies for elderly men and women.

This is the formula for women: BMR = 655 + (4.35 x weight in pounds) + (4.7 x height in inches) — (4.7 x age in years).
And here’s the formula for men: BMR = 66 + (6.23 x weight in pounds) + (12.7 x height in inches) — (6.8 x age in years)

Once the basal metabolic rate has been determined, you need to factor in activity levels. To account for activity, you multiply the BMR by a figure representing the appropriate activity level. For the elderly individual who participates in little or no activity, multiply the BMR by 1.2. For the person who is lightly active or participates in sports one to three times per week, multiply the BMR by 1.375. The moderately active elderly individual who exercises or participates in sports three to five days per week should multiply his or her BMR by 1.55. The exerciser who works out hard six to seven days per week should multiply the BMR by 1.725.

An example might be useful. Here are the step-by-step calculations you would use to determine the ideal caloric intake for a 79-year-old female who is 66 inches tall, weighs 130 pounds and who exercises one to three times per week.

First, you would determine basal metabolic rate:

BMR = 655 + (4.35 x 130) + (4.7 x 66) — (4.7 x 79)
BMR = 655 + (565.5) + (310.2) — (371.3)
BMR = 655 + 504.4
BMR = 1,159.4 Calories
Then, you would you would account for her activity level. This elderly woman participates in activity one to three times per week; therefore, her BMR is multiplied by 1.375.
Activity level = 1,159.4 x 1.375
Activity level = 1,594.175 calories

Therefore, the women should ideally consume about 1,595 calories per day.

Food Pyramids as a Guide

2. The U.S. Department of Agriculture created an interactive tool, mypyramid.gov, to address individual dietary needs for the American population. At the mypyramid.gov site, individuals can enter personal information such as age, weight, height and activity level to determine caloric needs.

How the elderly get their calories also is important.

Researchers at Tufts University have revised the food guide pyramid for the elderly to focus on specific nutrient needs.
A healthy diet for the elderly consists of three or more daily servings of brightly colored vegetables, two or more servings of deeply colored fruits, six or more servings of whole and fortified grains, three or more servings of low-fat dairy and two or more servings of protein-rich foods such as lean meats, eggs and legumes.

Hydration

3. Hydration is also a concern for the elderly due to their decreased sense of thirst. An adequate consumption of water is eight 8-ounce glasses of water, fruit juice, tea or coffee per day.

Source: www.ehow.com/ livestrong.com

The Benefits of Exercise in Postmenopausal Women At a Glance

A new study out of Australia shows significant benefits to bone mineral density among postmenopausal women who participate in a twice-weekly exercise program.

Read more about this research below.

A February 2010 research study from the University of New South Wales examined the effect of an aerobic weight-bearing exercise program on bone mineral density (BMD) in postmenopausal women. The purpose of the study was to examine what specific role – if any – regular exercise had on BMD.

30 postmenopausal women were divided into two groups for the study. The first group (19 women, mean age 66.4 years) was assigned a two-year exercise program consisting of twice-weekly aerobic weight-bearing exercises. The second group (11 women, mean age 65.4 years) did not participate in an exercise program. Before and after the two-year study period, bone density measurements were taken at the spine and hip of each study participant.

At the end of the study, women in the exercise group experienced less than one-fourth the spinal BMD loss compared to the control group (-0.8 compared to -3.8, 95% CI 0.3-5.7% difference.) Results were even more impressive for the hip measurement, where the exercise group saw a 9.6% improvement compared to a 4.4% loss in the controls (14.0% difference, 95% CI 4.6-23.5.)

The authors of the study concluded: “this study adds strong evidence that twice-weekly weight-bearing aerobic exercise has a protective effect on bone density in postmenopausal women as well as being associated with other measurable benefits.”

Caplan GA, Ward JA, Lord SR. The benefits of exercise in postmenopausal women. 2010. Australian Journal of Public Health 17(1):23-6.

How Red Wine May Shield Brain from Stroke Damage

Newswise — Researchers at Johns Hopkins say they have discovered the way in which red wine consumption may protect the brain from damage following a stroke.

Two hours after feeding mice a single modest dose of resveratrol, a compound found in the skins and seeds of red grapes, the scientists induced an ischemic stroke by essentially cutting off blood supply to the animals’ brains. They found that the animals that had preventively ingested the resveratrol suffered significantly less brain damage than the ones that had not been given the compound.

Sylvain Doré, Ph.D., an associate professor of anesthesiology and critical care medicine and pharmacology and molecular sciences at the Johns Hopkins University School of Medicine, says his study suggests that resveratrol increases levels of an enzyme (heme oxygenase) already known to shield nerve cells in the brain from damage. When the stroke hits, the brain is ready to protect itself because of elevated enzyme levels. In mice that lacked the enzyme, the study found, resveratrol had no significant protective effect and their brain cells died after a stroke.

“Our study adds to evidence that resveratrol can potentially build brain resistance to ischemic stroke,” says Doré, the leader of the study, which appears online in the journal Experimental Neurology.

www.functionalfoods.com

Whole Foods Market “Organic” food made in China

Vitamin D May Reduce Falls in Elderly Nursing Home Residents

January 29, 2010 — Vitamin D supplementation and pharmacist review of medications may help reduce falls in elderly nursing home residents, according to the results of a systematic review reported online January 20 in the Cochrane Database of Systematic Reviews.

“Falls in nursing care facilities and hospitals are common events that cause considerable morbidity and mortality for older people,” write Ian D. Cameron, MBBS, PhD, from Sydney Medical School, the University of Sydney in Ryde, Australia, and colleagues.

The goal of this review was to determine the efficacy of interventions aiming to reduce falls by older people in nursing care facilities and hospitals. The reviewers searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (January 2009); the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 2); MEDLINE, EMBASE, and CINAHL (all to November 2008); trial registers; and bibliographies of retrieved articles.

Criteria for inclusion in the review were randomized controlled trials of interventions designed to reduce falls in older people in nursing care facilities or hospitals, with main study endpoints of fall rate and the risk of falling. Methodologic quality of the trials was independently evaluated by 2 reviewers, who also extracted and pooled data where appropriate.

There were 41 trials, enrolling a total of 25,422 participants, meeting selection criteria. Findings from 7 trials testing supervised exercise interventions in nursing care facilities were inconsistent. Overall, multifactorial interventions were not associated with a significantly lower rate of falls in 7 trials enrolling a total of 2997 participants or with a lower risk of falling in 8 trials enrolling a total of 3271 participants.

However, multifactorial interventions provided by a multidisciplinary team were associated with lower rate of falls in nursing home residents (rate ratio [RaR], 0.60; 95% confidence interval [CI], 0.51 – 0.72; 4 trials, n = 1651) and risk of falling (risk ratio [RR], 0.85; 95% CI, 0.77 – 0.95; 5 trials, n = 1925), based on a post hoc subgroup analysis.

Vitamin D supplementation in nursing home residents was associated with a lower rate of falls (RaR, 0.72; 95% CI, 0.55 – 0.95; 4 trials, n = 4512) but not with the risk of falling (RR, 0.98; 95% CI, 0.89 – 1.09; 5 trials, n = 5095).

Multifactorial interventions in hospitals for patients with a length of stay of 3 weeks or more were associated with a lower rate of falls (RaR, 0.69; 95% CI, 0.49 – 0.96; 4 trials, n = 6478) and the risk of falling (RR, 0.73; 95% CI, 0.56 – 0.96; 3 trials, n = 4824). In addition, supervised exercise interventions were associated with a significant decrease in the risk of falling (RR, 0.44; 95% CI, 0.20 – 0.97; 3 trials, n = 131).

“There is evidence that multifactorial interventions reduce falls and risk of falling in hospitals and may do so in nursing care facilities,” the review authors write. “Vitamin D supplementation is effective in reducing the rate of falls in nursing care facilities. Exercise in subacute hospital settings appears effective but its effectiveness in nursing care facilities remains uncertain.”

Limitations of this review include those inherent in the selected studies, such as lack of blinding, confounding because of differences in treatment and control groups at entry, differences in underlying care programs, poorly defined inclusion and exclusion criteria and falling events, and differences in ascertainment of falls.

“Falls prevention programmes that include exercises for frail nursing care facility residents should carefully assess each individual’s suitability, as there is the possibility that exercise programmes may increase their risk of falls,” the review authors conclude. “The choice of type of exercises may be important in avoiding an increase in falls. The rate of falls and number of fallers should be monitored before and after adopting an intervention because it might increase falls.”

South Eastern Sydney and Illawarra Area Health Service, Australia; Rehabilitation Studies Unit, Faculty of Medicine, University of Sydney, Australia; University of Otago, New Zealand; National Ageing Research Institute, Australia; and Accident Compensation Corporation, New Zealand, supported this review. The review authors have disclosed no relevant financial relationships.

Cochrane Database Syst Rev. Published online January 20, 2010. Abstract

For more information on falls in the elderly is available from the Centers for Disease Control.
Clinical Context

Older persons in nursing care facilities and hospitals often fall, with possible complications including loss of independence, injury, and even mortality. Effective interventions to prevent falls are important for the health of these individuals as well as for public health and reduction of healthcare costs.

Interventions to lower fall risk should be evidence-based so that staff time and resources are allocated appropriately and so that older persons and their families are not subjected to the stress of ineffective interventions. This review aimed to inform best practice and to identify issues of importance for future research regarding strategies of fall prevention.

Study Highlights

• The objective of this Cochrane review was to examine the efficacy of interventions designed to reduce falls among older people in nursing care facilities and hospitals.
• Literature searched included the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (January 2009); the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 2); and MEDLINE, EMBASE, and CINAHL, all to November 2008.
• The reviewers also searched trial registers and references cited in identified articles.
• Selection criteria were randomized controlled trials of interventions designed to lower fall risk in elderly nursing home residents or hospital inpatients, with primary outcomes of fall rate and the risk of falling.
• 2 reviewers independently examined trial quality and extracted data, which were pooled when feasible.
• Inclusion criteria were met by 41 trials with a total of 25,422 participants.
• For supervised exercise interventions in nursing care facilities, 7 trials yielded inconsistent results.
• Overall, multifactorial interventions in nursing care facilities did not reduce fall rate in 7 trials (total n = 2997) or risk of falling in 8 trials (total n = 3271).
• A post hoc subgroup analysis showed that multifactorial interventions provided by a multidisciplinary team were associated with lower fall rate (RaR, 0.60; 95% CI, 0.51 – 0.72; 4 trials, n = 1651) and risk of falling (RR, 0.85; 95% CI, 0.77 – 0.95; 5 trials, n = 1925) in residents of nursing care facilities.
• In residents of nursing care facilities, vitamin D supplementation was associated with decreased fall rate (RaR, 0.72; 95% CI, 0.55 – 0.95; 4 trials, n = 4512).
• However, vitamin D supplementation did not reduce the risk of falling in residents of nursing care facilities (RR, 0.98; 95% CI, 0.89 – 1.09; 5 trials, n = 5095).
• In nursing care facilities, a clinical medication review by a pharmacist appeared to be effective in reducing the rate of falls.
• In hospitals, multifactorial interventions for patients with length of stay of 3 weeks or more were associated with a lower rate of falls (RaR, 0.69; 95% CI, 0.49 – 0.96; 4 trials, n = 6478) and risk of falling (RR, 0.73; 95% CI, 0.56 – 0.96; 3 trials, n = 4824).
• However, the reviewers could not make recommendations regarding any particular component of these multifactorial intervention programs.
• Supervised exercise interventions in hospitals were associated with a significant reduction in the risk of falling (RR, 0.44; 95% CI, 0.20 – 0.97; 3 trials, n = 131).
• The reviewers concluded that multifactorial interventions reduce falls and the risk of falling in hospitals and may do so in nursing care facilities.
• They also concluded that vitamin D supplementation effectively reduces the rate of falls in nursing care facilities.
• Although exercise in subacute hospital settings appears to be effective, it remains uncertain whether it is effective in nursing care facilities.
• Review limitations are those of the included studies, such as lack of blinding, confounding, and poorly defined inclusion and exclusion criteria and falling events.

Clinical Implications

• A Cochrane systematic review shows that for elderly persons in nursing care facilities, vitamin D supplementation effectively reduces the rate of falls. A clinical medication review by a pharmacist may also be effective in reducing the rate of falls. However, the value of exercise in reducing fall risk remains uncertain in this setting.
• In hospitals, multifactorial interventions reduce falls and the risk of falling in elderly persons. Exercise in subacute hospital settings also appears to be effective in reducing the risk of falling, based on this Cochrane systematic review.

Source: Medscape CME

Authors:

Laurie Barclay, MD
Freelance writer and reviewer, Medscape, LLC
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Brande Nicole Martin
CME Clinical Editor, Medscape, LLC
Disclosure: Brande Nicole Martin has disclosed no relevant financial information.

Laurie Barclay, MD
Freelance writer and reviewer, Medscape, LLC
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Laurie E. Scudder, MS, NP
Accreditation Coordinator, Continuing Professional Education Department, Medscape, LLC; Clinical Assistant Professor, School of Nursing and Allied Health, George Washington University, Washington, DC; Nurse Practitioner, School-Based Health Centers, Baltimore City Public Schools, Baltimore, Maryland
Disclosure: Laurie E. Scudder, MS, NP, has disclosed no relevant financial relationships.

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