IMPORTANCEWith the global population aging, falls and fall-related injuries are ubiquitous, and several clinical practice guidelines for falls prevention and management for individuals 60 years or older have been developed. A systematic evaluation of the recommendations and agreement level is lacking.OBJECTIVES To perform a systematic review of clinical practice guidelines for falls prevention and management for adults 60 years or older in all settings (eg, community, acute care, and nursing homes), evaluate agreement in recommendations, and identify potential gaps. EVIDENCE REVIEW A systematic review following Preferred Reporting Items for SystematicReviews and Meta-analyses statement methods for clinical practice guidelines on fall prevention and management for older adults was conducted (updated July 1, 2021) using MEDLINE, PubMed, PsycINFO, Embase, CINAHL, the Cochrane Library, PEDro, and Epistemonikos databases. Medical Subject Headings search terms were related to falls, clinical practice guidelines, management and prevention, and older adults, with no restrictions on date, language, or setting for inclusion. Three independent reviewers selected records for full-text examination if they followed evidence-and consensus-based processes and assessed the quality of the guidelines using Appraisal of Guidelines for Research & Evaluation II (AGREE-II) criteria. The strength of the recommendations was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation scores, and agreement across topic areas was assessed using the Fleiss κ statistic. FINDINGSOf 11 414 records identified, 159 were fully reviewed and assessed for eligibility, and 15 were included. All 15 selected guidelines had high-quality AGREE-II total scores (mean [SD], 80.1% [5.6%]), although individual quality domain scores for clinical applicability (mean [SD], 63.4% [11.4%]) and stakeholder (clinicians, patients, or caregivers) involvement (mean [SD], 76.3% [9.0%]) were lower. A total of 198 recommendations covering 16 topic areas in 15 guidelines were identified after screening 4767 abstracts that proceeded to 159 full texts. Most (Ն11) guidelines strongly recommended performing risk stratification, assessment tests for gait and balance, fracture and osteoporosis management, multifactorial interventions, medication review, exercise promotion, environment modification, vision and footwear correction, referral to physiotherapy, and cardiovascular interventions. The strengths of the recommendations were inconsistent for vitamin D supplementation, addressing cognitive factors, and falls prevention education. Recommendations on use of hip protectors and digital technology or wearables were often missing. None of the examined guidelines included a patient or caregiver panel in their deliberations.

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Background our aim was to assess the effectiveness of medication review and deprescribing interventions as a single intervention in falls prevention. Methods   Design systematic review and meta-analysis. Data sources Medline, Embase, Cochrane CENTRAL, PsycINFO until 28 March 2022. Eligibility criteria randomised controlled trials of older participants comparing any medication review or deprescribing intervention with usual care and reporting falls as an outcome. Study records title/abstract and full-text screening by two reviewers. Risk of bias Cochrane Collaboration revised tool. Data synthesis results reported separately for different settings and sufficiently comparable studies meta-analysed. Results forty-nine heterogeneous studies were included. Community meta-analyses of medication reviews resulted in a risk ratio (RR) of 1.05 (95% confidence interval, 0.85–1.29, I2 = 0%, 3 studies(s)) for number of fallers, in an RR = 0.95 (0.70–1.27, I2 = 37%, 3 s) for number of injurious fallers and in a rate ratio (RaR) of 0.89 (0.69–1.14, I2 = 0%, 2 s) for injurious falls. Hospital meta-analyses assessing medication reviews resulted in an RR = 0.97 (0.74–1.28, I2 = 15%, 2 s) and in an RR = 0.50 (0.07–3.50, I2 = 72% %, 2 s) for number of fallers after and during admission, respectively. Long-term care meta-analyses investigating medication reviews or deprescribing plans resulted in an RR = 0.86 (0.72–1.02, I2 = 0%, 5 s) for number of fallers and in an RaR = 0.93 (0.64–1.35, I2 = 92%, 7 s) for number of falls. Conclusions the heterogeneity of the interventions precluded us to estimate the exact effect of medication review and deprescribing as a single intervention. For future studies, more comparability is warranted. These interventions should not be implemented as a stand-alone strategy in falls prevention but included in multimodal strategies due to the multifactorial nature of falls. PROSPERO registration number: CRD42020218231

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Los adultos mayores frágiles (AMF) tienen mayor riesgo de caídas, con morbi-mortalidad asociada. Nuestro objetivo fue disminuir el porcentaje de AMF con caídas luego de una intervención multifactorial y sistémica. Estudio cuasiexperimental antes-después, propio individuo control. Ámbito: domicilio de AMF, en área metropolitana de Buenos Aires. Periodo de reclutamiento: 01/10/17-31/04/18. Evaluación basal y seguimiento a 3 meses. Criterios de inclusión: ≥65 años con criterios de fragilidad según médico tratante. Criterios de exclusión: rechazo de intervención o paciente moribundo. Intervención: un orientador (agente) socio-sanitario evaluó sistemáticamente en domicilio distintas dimensiones para prevención de caídas e intervino según necesidad en cada caso en: seguridad ambiental, indicación y capacitación en uso de apoyos de marcha, ejercicios de fortalecimiento, mejora de la red de cuidado, y conciliación de medicación. Se analizó por intención de tratar el cambio en el porcentaje de personas con caídas en el último mes (McNemar). Incluimos 108 personas, edad promedio 85,2 años (DE 6,2), mujeres 79,6%. Barthel promedio 50,5 (DE 35,9). El 56,8% tenían dependencia severa o total; 29,6% demencia; 30,5% institucionalizados; 82,4% polimedicados. El 79,6% (IC95% 71,1-86,1) tenían alto riesgo de caídas. En evaluación inicial habían sufrido caídas en el último mes 33,3% (IC95% 25,2-42,7). Post intervención, 13,9% (IC95% 8,6-18,6), p<0,001. Tasa de caídas previa: 50/100 personas (DE 87); posterior: 11/100 personas (DE 34), p< 0,001. En conclusión, esta intervención multifactorial y sistémica en AMF mostró reducción de personas con caídas de 41,7%, y  tasa de caídas de 78%.

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Preventing falls in elderly people: USPSTF systematic review of evidence ObjetivosDescribir los beneficios y efectos adversos de las intervenciones usadas en prevención primaria de caídas en ancianos que viven en la comunidad.