Comparative Effectiveness of Published Interventions for Elderly Fall Prevention: A Systematic Review and Network Meta-Analysis

Abstract

Background: Falls are a major threat to older adults worldwide. Although various effective interventions have been developed, their comparative effectiveness remains unreported. Methods: A systematic review and network meta-analysis was conducted to determine the most effective interventions to prevent falls in community-dwelling adults aged 60 and over. Combined odds ratio (OR) and 95% credible interval (95% CrI) were calculated. Results: A total of 49 trials involving 27,740 participants and 9271 fallers were included. Compared to usual care, multifactorial interventions (MFI) demonstrated the greatest efficacy (OR: 0.64, 95% CrI: 0.53 to 0.77) followed by interventions combining education and exercise (EDU + EXC) (OR: 0.65, 95% CrI: 0.38 to 1.00) and interventions combining exercise and hazard assessment and modification (EXC + HAM) (OR: 0.66, 95% CrI: 0.40 to 1.04). The effect of medical care performed the worst (OR: 1.02, 95% CrI: 0.78 to 1.34). Model fit was good, inconsistency was low, and publication bias was considered absent. The overall quality of included trials was high. The pooled odds ratios and ranking probabilities remained relatively stable across all sensitivity analyses. Conclusions: MFI and exercise appear to be effective to reduce falls among older adults, and should be considered first as service delivery options. Further investigation is necessary to verify effectiveness and suitableness of the strategies to at-risk populations.

Epidemiology of facial fractures among older adults: A retrospective analysis of a nationwide emergency department database

“…A possible cause for that might be the successful implementation of some multifactorial interventions and a healthier lifestyle, including more exercising, among this population. 17 Nasal bones were the most common type of facial fracture among older adults in this ED visits study, accounting for 61% of the facial fractures. As the nose is the most prominent central part of the face, this result was largely expected.…”

“…Multifactorial interventions should include at least three of the following interventions: education, risk assessment and suggestion, exercise, medical care (including vitamin D 3 treatment, ophthalmologic treatment, etc. ), hazard assessment and modification, including personal or environmental safety recommendations …”

“…The mortality rates remained constant over the study period, which is a good result considering the continual increase in the older adult population in the same period. A possible cause for that might be the successful implementation of some multifactorial interventions and a healthier lifestyle, including more exercising, among this population …”

Frequent 911 Fall Calls in Older Adults: Opportunity for Injury Prevention Strategies

“…There is a large body of literature that demonstrates the effectiveness of fall prevention in older adults, with the Centers for Disease Control and Prevention (CDC) and the National Council on Aging supporting many community‐based strategies to reduce falls . Community fall prevention programs such as Stepping On, Community Aging in Place—Advancing Better Living for Elders, Enhance Fitness, FallScape, Silver Sneakers, Stay Active and Independent for Life, Otago, and Matter of Balance use workshops, exercise classes, and home‐based exercise programs to reduce falls of older adults in the community .…”

“…17,22,23 There is a large body of literature that demonstrates the effectiveness of fall prevention in older adults, with the Centers for Disease Control and Prevention (CDC) and the National Council on Aging supporting many community-based strategies to reduce falls. 14,[24][25][26] Community fall prevention programs such as Stepping On, Community Aging in Place-Advancing Better Living for Elders, Enhance Fitness, FallScape, Silver Sneakers, Stay Active and Independent for Life, Otago, and Matter of Balance use workshops, exercise classes, and home-based exercise programs to reduce falls of older adults in the community. 24,[27][28][29][30][31][32] In addition, the CDC has published robust resources describing evidence-based fall-prevention programs for communities and has created the Stopping Elderly Accidents, Deaths and Injuries toolkit to help guide and provide resources for healthcare providers to reduce fall risks of older adults.…”