Critical features of multifactorial interventions for effective falls reduction in residential aged care: a systematic review, intervention component analysis and qualitative comparative analysis

Abstract

Background Multifactorial fall prevention trials providing interventions based on individual risk factors have variable success in aged care facilities. To determine configurations of trial features that reduce falls, intervention component analysis (ICA) and qualitative comparative analysis (QCA) were undertaken. Methods Randomised controlled trials (RCTs) from a Cochrane Collaboration review (Cameron, 2018) with meta-analysis data, plus trials identified in a systematic search update to December 2021 were included. Meta-analyses were updated. A theory developed through ICA of English publications of trialist’s perspectives was assessed through QCA and a subgroup meta-analysis. Results Pooled effectiveness of multifactorial interventions indicated a falls rate ratio of 0.85 (95% confidence interval, CI, 0.65–1.10; I2 = 85%; 11 trials). All tested interventions targeted both environmental and personal risk factors by including assessment of environmental hazards, a medical or medication review and exercise intervention. ICA emphasised the importance of co-design involving facility staff and managers and tailored intervention delivery to resident’s intrinsic factors for successful outcomes. QCA of facility engagement plus tailored delivery was consistent with greater reduction in falls, supported by high consistency (0.91) and coverage (0.85). An associated subgroup meta-analysis demonstrated strong falls reduction without heterogeneity (rate ratio 0.61, 95%CI 0.54–0.69, I2 = 0%; 7 trials). Conclusion Multifactorial falls prevention interventions should engage aged care staff and managers to implement strategies which include tailored intervention delivery according to each resident’s intrinsic factors. Such approaches are consistently associated with a successful reduction in falls, as demonstrated by QCA and subgroup meta-analyses. Co-design approaches may also enhance intervention success.

Effective fall prevention exercise in residential aged care: an intervention component analysis from an updated systematic review

“…A recent study employing ICA and QCA methodologies on multifactorial fall prevention interventions highlighted the importance of incorporating exercise and engaging aged care staff and managers in implementing tailored strategies in RAC. 47 These findings emphasise the need for future research to explore multifactorial interventions in RAC settings, explore specific programme needs for recurrent fallers who may have different needs compared with single fallers and in other settings to enhance the generalisability of our ICA and bolster the quality of evidence.…”

“…A recent study employing ICA and QCA methodologies on multifactorial fall prevention interventions highlighted the importance of incorporating exercise and engaging aged care staff and managers in implementing tailored strategies in RAC. 47 These findings emphasise the need for future research to explore multifactorial interventions in RAC settings, explore specific programme needs for recurrent fallers who may have different needs compared with single To enhance reporting, future trials should adhere to recognised trial reporting guidelines such as the CONSORT statement, 45 Standard Protocol Items: Recommendations for Interventional Trials statement, 48 Template for Intervention Description and Replication checklist 49 and Consensus on Exercise Reporting guidelines 50 to enhance reporting.…”

Hospitalisations and emergency department presentations by older individuals accessing long-term aged care in Australia

“…34 International evidence of interventions to reduce falls in residential aged care suggests that achieving sustained improvements is difficult, but interventions that are multifactorial, tailored to individual residents and include co-design approaches may improve success rates. 35,36 For older people living in the community, studies examining hospital admission and ED avoidance programs including hospital-at-home services and urgent care centres for older people have shown many safe options that can reduce the need for hospitalisation and the length of time receiving care. 37,38 These approaches may be acceptable to older adults, but these studies have not specifically focused on older adults receiving home care services who may be at higher risk of admission.…”