Efficacy and Generalizability of Falls Prevention Interventions in Nursing Homes: A Systematic Review and Meta-analysis

Gulka, Heidi J.; Patel, Vaidehi; Arora, Twinkle; McArthur, Caitlin; Iaboni, Andrea

doi:10.1016/j.jamda.2019.11.012

Cited by 47 publications

(47 citation statements)

References 69 publications

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“…In conclusion, reducing the fall risk in older adults should be aimed at reducing and eliminating fall risk factors [ 49 ]. Since the causes of falls in older adults are usually the result of multiple factors, exercise as a single intervention has reduced the incidence of falls by more than 36% [ 25 ], some studies have pointed out that multifactorial interventions are more effective than single-factor interventions [ 50 ]. Interventions such as dual-task training [ 51 ], multiple standardized prevention programs (including exercise components and individualized design) [ 13 ], and multifactorial fall prevention programs with exercise interventions [ 52 ] are beneficial for older adults.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, for elderly people with dementia, there are safer ways to reduce their risk of falling. If they are not taken care of by the nursing staff, exercise activities can easily cause them to be injured [ 25 ]. Studies have explained which dimensions of abilities of the elderly are improved by exercise, such as dynamic balance, static balance, participants fear of falling, balance confidence, quality of life, and physical performance.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Exercise Intervention on Reducing the Fall Risk in Older Adults: A Meta-Analysis of Randomized Controlled Trials

Sun

Min

et al. 2021

IJERPH

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Exercise intervention has a positive effect on reducing the fall risk in older adults. To investigate the effect of different factors of exercise intervention (type, duration, and frequency) on reducing the fall risk in older adults, a meta-analysis was performed in this study. According to the PRISMA®, two researchers independently searched PubMed, Web of Science, and the China National Knowledge Infrastructure databases to assess the quality of the studies using the PEDro scale. A total of 648 subjects in 10 randomized controlled trials were included in this study, and the exercise interventions included integrated training (resistance training, core training, and balance training), balance training, core training, Pilates, Ba Duan Jin, and Tai Chi. These studies show that exercise intervention has a huge and significant impact on reducing the risk of falls of the elderly. In conclusion, an integrated intervention with a frequency of more than five times a week and a duration of more than 32 weeks are more effective in reducing the fall risk.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Effect of Exercise Intervention on Reducing the Fall Risk in Older Adults: A Meta-Analysis of Randomized Controlled Trials

Sun

Min

et al. 2021

IJERPH

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“…Scholars mainly studied MAs in the NH research in the following areas: medicine (17/41 of reviewed studies) [ 20 , 25 , 26 , 28 , 36 , 38 , 39 , 40 , 47 , 48 , 49 , 50 , 51 , 52 , 54 , 57 , 60 ], nursing (7/41) [ 24 , 31 , 32 , 33 , 34 , 35 , 56 ], psychiatry or psychology (6/41) [ 22 , 30 , 44 , 45 , 55 , 61 ], public health (4/41) [ 21 , 27 , 37 , 46 ], and pharmacology (3/41) [ 23 , 42 , 53 ], followed by the areas of rehabilitation (1) [ 41 ], nutrition (1) [ 29 ], dentistry (1) [ 43 ], and nursing and dentistry (1) [ 19 ]. In the reviewed articles, some studies (12/41) examined the physical issues NH residents face, including falls, exercise, or rehabilitation issues.…”

Section: Resultsmentioning

confidence: 99%

A Methodological Quality Evaluation of Meta-Analyses on Nursing Home Research: Overview and Suggestions for Future Directions

Shin

Jang

et al. 2022

IJERPH

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(1) Background: The nursing home (NH) research field lacks quality reporting about meta-analyses (MAs), and most gradings of MA evidence are biased on analyzing the effectiveness of independent variables in randomized control trials. (2) Objectives: This study aimed to perform a critical methodological review of MAs in the NH research field. (3) Methods: We searched the articles from four databases (PubMed, MEDLINE, CINAHL, and PsycINFO) until 15th January 2021. We reviewed a total of 41 published review articles in the NH research field. (4) Results: The studies primarily fell into the following categories: medicine (17/41), nursing (7/41), and psychiatry or psychology (6/41); 36.6% of the reviewed studies did not use any validated MA guidelines. The lowest correctly reported PRISMA 2000 guideline item was protocol and registration (14.6%), and more than 50% of articles did not report risk of bias. Moreover, 78.0% of studies did not describe missing reports of effect size formula. (5) Discussion: NH researchers must follow appropriate and updated guidelines for their MAs in order to provide validated reviews, as well as consider statistical issues such as the complexity of interventions, proper grouping, and scientific effect-size calculations to improve the quality of their study. Future quality review studies should investigate more diverse studies.

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“…Studies targeting specific tasks, such as oral hygiene and restraint reduction were more likely to have positive outcomes than those requiring global practice changes. A systematic review and meta‐analysis of 36 fall prevention studies in NHs found exercise as a single intervention reduced the number of fallers and recurrent fallers 15 . Staff education and multifactorial interventions also showed some positive effects.…”

Section: Discussionmentioning

confidence: 99%

Nursing home performance in a trial to reduce hospitalizations: Implications for future trials

Ouslander

Reyes

Yang

et al. 2021

J American Geriatrics Society

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Background Experience in trials of implementing quality improvement (QI) programs in nursing homes (NHs) has been variable. Understanding the characteristics of NHs that demonstrate improvements during these trials is critical to improving NH care. Design Secondary analysis of a randomized controlled trial of implementation of a QI program to reduce hospital transfers. Participants Seventy‐one NHs that completed the 12‐month trial Intervention Implementation included distance‐learning strategies, involvement of a champion, regular submission of data on hospitalizations and root cause analyses of transfers, and training, feedback and support. Measurements Primary outcomes included all‐cause and potentially avoidable hospitalizations and emergency department (ED) visits per 1000 NH resident days, and the percentage of residents readmitted in 30‐days. We compared multiple other variables that could influence effective program implementation in NHs in the highest versus lowest quartile of changes in the primary outcomes. Results The 18 high‐performing NHs had significant reductions in hospitalization and ED visits, whereas the 18 NHs in the low‐performing group had increases. The difference in changes in each outcome varied between a reduction of 0.75 and 2.30 events relative to a NH with a census of 100; the absolute difference in 30‐day readmissions was 19%. None of the variables we examined reached significance after adjustment for multiple comparisons between the groups. There was no consistent pattern of differences in nonprofit status, nursing staffing, and quality ratings. Conclusion Our experience and reviews of other NH trials suggest that key factors contributing to successful implementation QI programs in NHs remain unclear. To improve NH care, implementation trials should account for intervention fidelity and factors that have not been examined in detail, such as degree and nature of leadership support, financial and regulatory incentives, quality measures, resident and family perspectives, and the availability of onsite high‐quality medical care and support of the medical director.

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Efficacy and Generalizability of Falls Prevention Interventions in Nursing Homes: A Systematic Review and Meta-analysis

Cited by 47 publications

References 69 publications

The Effect of Exercise Intervention on Reducing the Fall Risk in Older Adults: A Meta-Analysis of Randomized Controlled Trials

The Effect of Exercise Intervention on Reducing the Fall Risk in Older Adults: A Meta-Analysis of Randomized Controlled Trials

A Methodological Quality Evaluation of Meta-Analyses on Nursing Home Research: Overview and Suggestions for Future Directions

Nursing home performance in a trial to reduce hospitalizations: Implications for future trials

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