Q. I helped care for tutu who fell, fractured her hip, and died nine days later from a blood clot in her leg that went to her lungs. What can mom and dad do to prevent this? They take pills for stress.

A. You're right in worrying — 30 percent of people over 65 fall each year, and falls may lead to permanent weakness, increasing the risk of ending up in a nursing home three- to six-fold.

The highly regarded Cochrane group just published a review of randomized studies in April to see exactly what works to reduce falls in folks living in the community. It turns out that learning and practicing tai chi reduces falls. Fear of falling can cause our elderly to self-restrict activities like walking, leading to depression and osteoporosis, and tai chi can help them reverse course. Exercise programs may target strength, balance, flexibility or endurance. Programs other than tai chi that contain two or more of these components also reduce falls and should be continued at home.

Stopping drugs used for sleep, anxiety and depression also reduces falls, but if your parents are like my patients, it will be hard to get them to stop. A study by A. John Campbell and others from Dunedin and Seattle got about half of 93 folks age 65 and older and taking pills for anxiety, sleep, or depression, like Valium, Ativan (lorazepam) and alprazolam, to reduce their dose gradually — to 80 percent of the original dose after two weeks, 60 percent after five weeks, 40 percent after eight weeks, 20 percent after 11 weeks and zero by week 14. After 44 weeks, 17 folks in this group had fallen versus 40 in those who kept on taking their pills. So if you can get your folks to stop, then instead of a 70 percent chance of falling, their risk would be 30 percent, representing a 66 percent reduction in fall risk, greater than has been seen with any other falls prevention intervention.

Cataract surgery can reduce falls. Multifactorial interventions assess one's risk of falls, then arrange for treatment to reduce this risk. They were shown in some studies to be effective, but were ineffective in others. Overall, they do seem to reduce falls, but these are complex interventions, and their effectiveness may be dependent on factors yet to be determined.

I'd get a 25-hydroxyvitamin D level above age 50, even in sunny Hawai'i — anything less than 30 ng/ml is low and taking extra vitamin D actually reduces falls and maybe even cancers. I'd also get a bone density test in women age 60 to 64 who weigh less than 145 pounds and in all women above age 64. And start walking!

Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i John A. Burns School of Medicine. Send questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.