Answer:  Exercise!  All exercise that improves your balance, flexibility, strength and endurance will help. Tai Chi looks good.

Interventions for preventing falls in older people living in the community.

Plain language summary

Interventions for preventing falls in older people living in the community
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 per year. Although one in five falls may require medical attention, less than one in 10 results in a fracture. Fear of falling can result in self-restricted activity levels. It may not be possible to prevent falls completely, but people who tend to fall frequently may be enabled to fall less often.

This review looked at which methods are effective for older people living in the community, and includes 111 randomised controlled trials, with a total of 55,303 participants.

Exercise programmes may target strength, balance, flexibility, or endurance. Programmes that contain two or more of these components reduce rate of falls and number of people falling. Exercising in supervised groups, participating in Tai Chi, and carrying out individually prescribed exercise programmes at home are all effective.

Multifactorial interventions assess an individual person’s risk of falling, and then carry out or arrange referral for treatment to reduce their risk. They have been shown in some studies to be effective, but have been ineffective in others. Overall current evidence shows that they do reduce rate of falls in older people living in the community. These are complex interventions, and their effectiveness may be dependent on factors yet to be determined.

Taking vitamin D supplements probably does not reduce falls, except in people who have a low level of vitamin D in the blood. These supplements may be associated with high levels of calcium in the blood, gastrointestinal discomfort, and kidney disorders.

Interventions to improve home safety do not seem to be effective, except in people at high risk, for example with severe visual impairment. An anti-slip shoe device worn in icy conditions can reduce falls.

Some medications increase the risk of falling. Ensuring that medications are reviewed and adjusted may be effective in reducing falls. Gradual withdrawal from some types of drugs for improving sleep, reducing anxiety and treating depression has been shown to reduce falls.

Cataract surgery reduces falls in people 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 may result in changes in heart rate and blood pressure.

Another review of the scientific literature concludes that multi-component exercise is the most effective answer:

The most effective physical therapy approach for the prevention of falls and fractures in community-dwelling older adults is regular multicomponent exercise; a combination of balance and strength training has shown the most success.

Nature Reviews Endocrinology 6, 396-407 (July 2010) | doi:10.1038/nrendo.2010.70

Physical therapy approaches to reduce fall and fracture risk among older adults

Saija Karinkanta, Maarit Piirtola, Harri Sievänen, Kirsti Uusi-Rasi & Pekka Kannus

Abstract

Falls and fall-related injuries, such as fractures, are a growing problem among older adults, often causing longstanding pain, functional impairments, reduced quality of life and excess health-care costs and mortality. These problems have led to a variety of single component or multicomponent intervention strategies to prevent falls and subsequent injuries. The most effective physical therapy approach for the prevention of falls and fractures in community-dwelling older adults is regular multicomponent exercise; a combination of balance and strength training has shown the most success. Home-hazard assessment and modification, as well as assistive devices, such as canes and walkers, might be useful for older people at a high risk of falls. Hip protectors are effective in nursing home residents and potentially among other high-risk individuals. In addition, use of anti-slip shoe devices in icy conditions seems beneficial for older people walking outdoors. To be effective, multifactorial preventive programs should include an exercise component accompanied by individually tailored measures focused on high-risk populations. In this Review, we focus on evidence-based physical therapy approaches, including exercise, vibration training and improvements of safety at home and during periods of mobility. Additionally, the benefits of multifaceted interventions, which include risk factor assessment, dietary supplements, elements of physical therapy and exercise, are addressed.