Effectiveness of Non-Pharmacological Interventions to Prevent Falls in Older People: A Systematic Overview. The SENATOR Project ONTOP Series

Abstract

BackgroundFalls are common events in older people, which cause considerable morbidity and mortality. Non-pharmacological interventions are an important approach to prevent falls. There are a large number of systematic reviews of non-pharmacological interventions, whose evidence needs to be synthesized in order to facilitate evidence-based clinical decision making.ObjectivesTo systematically examine reviews and meta-analyses that evaluated non-pharmacological interventions to prevent falls in older adults in the community, care facilities and hospitals.MethodsWe searched the electronic databases Pubmed, the Cochrane Database of Systematic Reviews, EMBASE, CINAHL, PsycINFO, PEDRO and TRIP from January 2009 to March 2015, for systematic reviews that included at least one comparative study, evaluating any non-pharmacological intervention, to prevent falls amongst older adults. The quality of the reviews was assessed using AMSTAR and ProFaNE taxonomy was used to organize the interventions.ResultsFifty-nine systematic reviews were identified which consisted of single, multiple and multifactorial non-pharmacological interventions to prevent falls in older people. The most frequent ProFaNE defined interventions were exercises either alone or combined with other interventions, followed by environment/assistive technology interventions comprising environmental modifications, assistive and protective aids, staff education and vision assessment/correction. Knowledge was the third principle class of interventions as patient education. Exercise and multifactorial interventions were the most effective treatments to reduce falls in older adults, although not all types of exercise were equally effective in all subjects and in all settings. Effective exercise programs combined balance and strength training. Reviews with a higher AMSTAR score were more likely to contain more primary studies, to be updated and to perform meta-analysis.ConclusionsThe aim of this overview of reviews of non-pharmacological interventions to prevent falls in older people in different settings, is to support clinicians and other healthcare workers with clinical decision-making by providing a comprehensive perspective of findings.

Malnutrition risk and hospital‐acquired falls in older adults: A cross‐sectional, multicenter study

“…22 In clinical practice, multifaceted interventions for fall prevention in older persons should be individualized to address the individual patient's risks. 23 If a person is at risk of malnutrition, it may be beneficial to include nutritional interventions such as energy and protein supplementation or dietary counseling in the prevention program for the respective patient. If a vitamin D deficiency or osteoporosis is diagnosed, supplementation with vitamin D and calcium should be considered.…”

Malnutrition risk and hospital‐acquired falls in older adults: A cross‐sectional, multicenter study

“…22 In clinical practice, multifaceted interventions for fall prevention in older persons should be individualized to address the individual patient's risks. 23 If a person is at risk of malnutrition, it may be beneficial to include nutritional interventions such as energy and protein supplementation or dietary counseling in the prevention program for the respective patient. If a vitamin D deficiency or osteoporosis is diagnosed, supplementation with vitamin D and calcium should be considered.…”

Non-pharmacological, non-surgical interventions for urinary incontinence in older persons: A systematic review of systematic reviews. The SENATOR project ONTOP series

“…Therefore, other important outcomes may have been excluded. The standardised method employed in all the ONTOP reviews ensures consistency and has already resulted in published evidence-based recommendations for nondrug management in delirium [34], falls [35,36], stroke [37], pressure sores [38,39], behavioural disturbances in dementia [40], malnutrition [41] and sarcopenia [42]. This method also has the advantage of not pre-specifying interventions in the search terms, allowing evaluation of lesser-known interventions.…”

Emergency department falls: a longitudinal analysis of revisits and hospitalisations between patients who fall and patients who did not fall

“… 17 18 Qualitative data indicates that patients who present to the ED may have more willingness for falls prevention 10 and programmes should continue to capitalise on this motivation for secondary fall prevention strategies. 19 Further studies should also look at the cause of falls and patients’ associated comorbidities as indicators for outcomes. EDs should also consider urgently referring discharged fall patients to physical therapy or an evidence-based exercise and/or falls prevention programme.…”

“…While the most recent randomized trial of multifactorial strategies did not show a benefit for community-based falls prevention for at-risk individuals, it did not assess prevention activities for ED patients after a fall and it also acknowledges that behaviour modification through exercise, one of the most important interventions for future fall prevention, was not underscored 17 18. Qualitative data indicates that patients who present to the ED may have more willingness for falls prevention10 and programmes should continue to capitalise on this motivation for secondary fall prevention strategies 19. Further studies should also look at the cause of falls and patients’ associated comorbidities as indicators for outcomes.…”

Malnutrition risk and hospital‐acquired falls in older adults: A cross‐sectional, multicenter study

“…22 In clinical practice, multifaceted interventions for fall prevention in older persons should be individualized to address the individual patient's risks. 23 If a person is at risk of malnutrition, it may be beneficial to include nutritional interventions such as energy and protein supplementation or dietary counseling in the prevention program for the respective patient. If a vitamin D deficiency or osteoporosis is diagnosed, supplementation with vitamin D and calcium should be considered.…”

Non-pharmacological, non-surgical interventions for urinary incontinence in older persons: A systematic review of systematic reviews. The SENATOR project ONTOP series

“…Therefore, other important outcomes may have been excluded. The standardised method employed in all the ONTOP reviews ensures consistency and has already resulted in published evidence-based recommendations for nondrug management in delirium [34], falls [35,36], stroke [37], pressure sores [38,39], behavioural disturbances in dementia [40], malnutrition [41] and sarcopenia [42]. This method also has the advantage of not pre-specifying interventions in the search terms, allowing evaluation of lesser-known interventions.…”

Emergency department falls: a longitudinal analysis of revisits and hospitalisations between patients who fall and patients who did not fall

“… 17 18 Qualitative data indicates that patients who present to the ED may have more willingness for falls prevention 10 and programmes should continue to capitalise on this motivation for secondary fall prevention strategies. 19 Further studies should also look at the cause of falls and patients’ associated comorbidities as indicators for outcomes. EDs should also consider urgently referring discharged fall patients to physical therapy or an evidence-based exercise and/or falls prevention programme.…”

“…While the most recent randomized trial of multifactorial strategies did not show a benefit for community-based falls prevention for at-risk individuals, it did not assess prevention activities for ED patients after a fall and it also acknowledges that behaviour modification through exercise, one of the most important interventions for future fall prevention, was not underscored 17 18. Qualitative data indicates that patients who present to the ED may have more willingness for falls prevention10 and programmes should continue to capitalise on this motivation for secondary fall prevention strategies 19. Further studies should also look at the cause of falls and patients’ associated comorbidities as indicators for outcomes.…”

Malnutrition risk and hospital‐acquired falls in older adults: A cross‐sectional, multicenter study

“…22 In clinical practice, multifaceted interventions for fall prevention in older persons should be individualized to address the individual patient's risks. 23 If a person is at risk of malnutrition, it may be beneficial to include nutritional interventions such as energy and protein supplementation or dietary counseling in the prevention program for the respective patient. If a vitamin D deficiency or osteoporosis is diagnosed, supplementation with vitamin D and calcium should be considered.…”

Non-pharmacological, non-surgical interventions for urinary incontinence in older persons: A systematic review of systematic reviews. The SENATOR project ONTOP series

“…Therefore, other important outcomes may have been excluded. The standardised method employed in all the ONTOP reviews ensures consistency and has already resulted in published evidence-based recommendations for nondrug management in delirium [34], falls [35,36], stroke [37], pressure sores [38,39], behavioural disturbances in dementia [40], malnutrition [41] and sarcopenia [42]. This method also has the advantage of not pre-specifying interventions in the search terms, allowing evaluation of lesser-known interventions.…”

Emergency department falls: a longitudinal analysis of revisits and hospitalisations between patients who fall and patients who did not fall

“… 17 18 Qualitative data indicates that patients who present to the ED may have more willingness for falls prevention 10 and programmes should continue to capitalise on this motivation for secondary fall prevention strategies. 19 Further studies should also look at the cause of falls and patients’ associated comorbidities as indicators for outcomes. EDs should also consider urgently referring discharged fall patients to physical therapy or an evidence-based exercise and/or falls prevention programme.…”

“…While the most recent randomized trial of multifactorial strategies did not show a benefit for community-based falls prevention for at-risk individuals, it did not assess prevention activities for ED patients after a fall and it also acknowledges that behaviour modification through exercise, one of the most important interventions for future fall prevention, was not underscored 17 18. Qualitative data indicates that patients who present to the ED may have more willingness for falls prevention10 and programmes should continue to capitalise on this motivation for secondary fall prevention strategies 19. Further studies should also look at the cause of falls and patients’ associated comorbidities as indicators for outcomes.…”