Interventions to reduce the number of falls among older adults with/without cognitive impairment: an exploratory meta‐analysis

Guo, Jong Long; Tsai, Yi Ying; Liao, Jung‐Yu; Tu, Hsiu Mei; Huang, Chun‐Kai

doi:10.1002/gps.4056

Cited by 62 publications

(57 citation statements)

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“…To our knowledge, this is the first study to demonstrate this association over a long follow-up period. A strong body of evidence illustrates the value of exercise in fall prevention in elderly adults [6][7][8][9][10]. A recent review of meta-analyses of RCT of fall prevention interventions in community-dwelling older adults highlights the consistent evidence that exercise reduces falls [6].…”

Section: Discussionmentioning

confidence: 99%

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Lower likelihood of falling at age 90+ is associated with daily exercise a quarter of a century earlier: The 90+ Study

et al. 2017

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Objective: to explore the relationship between risk of falling at age 90+ and prior physical activity at age 60-70s. Design: population-based cohort study (The 90+ Study). Setting: California retirement community. Participants: of 1596 cohort members, 1536 had both falls and prior activity data. Mean age = 94 years; 78% female; 99% Caucasian. Methods: time spent in active physical activity was self-reported in 1980s; medical history, medication, assistive devices, residence type, and falls (outcome) was collected in 2000s. Activity/fall relationships were assessed using logistic regression. Results: falls were reported by 52% of participants, recurrent falls by 32%, and severe injury by 21% of fallers. In univariate analyses risk of falling at age 90+ was significantly related to medical history (heart disease, TIA/stroke, arthritis, vision disease, depression, dementia), medication use (hypnotics, anti-psychotics, anti-depressants), use of assistive devices (cane, walker, wheelchair), residence type (living with relatives, sheltered living), and source of information (self-report vs informant). Risks of falling and recurrent falls at age 90+ were 35-45% lower in those reporting 30+ minutes/day of active physical activity at age 60-70s compared with no activity. The odds ratio of falling was 0.65 (95% CI = 0.44-0.97) for 30-45 minutes/day and 0.64 (0.44-0.94) for 1+ hour/day adjusting for age, sex, medical history (stroke/TIA, vision disease, depression), use of assistive devices, and source of information. Conclusions and Relevance: falls are extremely common among the oldest-old and a significant proportion lead to severe injury. This work is the first to show an association between exercise at age 60-70s and lower risk of falling at age 90+.

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Section: Discussionmentioning

confidence: 99%

“…A strong body of evidence, including randomized controlled trials (RCT), has demonstrated the value of exercise in fall prevention in elderly adults [6][7][8][9][10]. However, the nature of these studies limit the follow-up period and longterm benefits, if any, are unknown.…”

Section: Introductionmentioning

confidence: 99%

Lower likelihood of falling at age 90+ is associated with daily exercise a quarter of a century earlier: The 90+ Study

et al. 2017

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“…The other six reviews included mixed populations of adults with and without cognitive impairment (Oliver, Connelly et al 2007, Jensen and Padilla 2011, Cameron, Gillespie et al 2012, Winter, Watt et al 2013, Guo, Tsai et al 2014. Persons with dementia.…”

Section: Figure 1: Flowchart Illustrating Reviews Identifiedmentioning

confidence: 99%

“…A number of reviews have investigated falls interventions in various cognitively impaired populations (Shaw 2007, Winter, Watt et al 2013, Guo, Tsai et al 2014. Meta-analysis of falls prevention programmes in adults with a cognitive impairment has previously been undertaken (Guo, Tsai et al 2014).…”

Section: Introductionmentioning

confidence: 99%

“…Meta-analysis of falls prevention programmes in adults with a cognitive impairment has previously been undertaken (Guo, Tsai et al 2014). This review included studies with mixed populations, including all degrees of severity, and institutionalised and non-institutionalised participants, making it difficult to infer which patient population benefits from the intervention and distorting clinical recommendations.…”

Section: Introductionmentioning

confidence: 99%

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Falls prevention interventions in older adults with cognitive impairment: A systematic review of reviews

Booth

Logan

Harwood

et al. 2015

International Journal of Therapy and Rehabilitation

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(2015) Falls prevention interventions in older adults with cognitive impairment: a systematic review of reviews. International Journal of Therapy and Rehabilitation, 22 (6 A note on versions:The version presented here may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the repository url above for details on accessing the published version and note that access may require a subscription. AbstractAim: This critical review explores the review material on falls prevention interventions in older adults with a cognitive impairment such as dementia.Method: A critical, systematic, review of review method was used. Five large electronic databases, MEDLINE, EMBASE, AMED, CINAHL, and the Cochrane electronic library, were searched. The search terms 'falls', 'rehabilitation', 'falls prevention', 'interventions', 'cognitive impairment', 'dementia', and 'Alzheimer's disease', were used. All available reviews were marked against predetermined inclusion and exclusion criteria.Results: There were seven reviews which met the inclusion criteria. Only one of the included reviews had a homogenous population of adults with a cognitive impairment. Exercise was the most commonly reported intervention, included in 91 studies and all seven reviews. Multifactorial and multicomponent falls prevention programmes were also frequently reported. Reports of efficacy were inconsistent for all interventions. Conclusion:Evidence for falls prevention interventions for adults with cognitive impairment is varied and inconclusive. When compared to literature for falls interventions in healthy older adults, both primary and synthesis studies in older adults with cognitive impairment are lacking in quality, number and homogeneity of sample population and interventions. Promising results are emerging but clinical recommendations cannot be made at this time.

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Interventions for preventing falls in older people in care facilities and hospitals

Cameron

Dyer²,

Panagoda

et al. 2018

Cochrane Database of Systematic Reviews

346

370

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Background Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of a review first published in 2010 and updated in 2012. Objectives To assess the effects of interventions designed to reduce the incidence of falls in older people in care facilities and hospitals. Search methods We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (August 2017); Cochrane Central Register of Controlled Trials (2017, Issue 8); and MEDLINE, Embase, CINAHL and trial registers to August 2017. Selection criteria Randomised controlled trials of interventions for preventing falls in older people in residential or nursing care facilities, or hospitals. Data collection and analysis One review author screened abstracts; two review authors screened full‐text articles for inclusion. Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction. We calculated rate ratios (RaR) with 95% confidence intervals (CIs) for rate of falls and risk ratios (RRs) and 95% CIs for outcomes such as risk of falling (number of people falling). We pooled results where appropriate. We used GRADE to assess the quality of evidence. Main results Thirty‐five new trials (77,869 participants) were included in this update. Overall, we included 95 trials (138,164 participants), 71 (40,374 participants; mean age 84 years; 75% women) in care facilities and 24 (97,790 participants; mean age 78 years; 52% women) in hospitals. The majority of trials were at high risk of bias in one or more domains, mostly relating to lack of blinding. With few exceptions, the quality of evidence for individual interventions in either setting was generally rated as low or very low. Risk of fracture and adverse events were generally poorly reported and, where reported, the evidence was very low‐quality, which means that we are uncertain of the estimates. Only the falls outcomes for the main comparisons are reported here. Care facilities Seventeen trials compared exercise with control (typically usual care alone). We are uncertain of the effect of exercise on rate of falls (RaR 0.93, 95% CI 0.72 to 1.20; 2002 participants, 10 studies; I² = 76%; very low‐quality evidence). Exercise may make little or no difference to the risk of falling (RR 1.02, 95% CI 0.88 to 1.18; 2090 participants, 10 studies; I² = 23%; low‐quality evidence). There is low‐quality evidence that general medication review (tested in 12 trials) may make little or no difference to the rate of falls (RaR 0.93, 95% CI 0.64 to 1.35; 2409 participants, 6 studies; I² = 93%) or the risk of falling (RR 0.93, 95% CI 0.80 to 1.09; 5139 participants, 6 studies; I² = 48%). There is moderate‐quality evidence that vitamin D supplementation (4512 particip...

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Interventions to reduce the number of falls among older adults with/without cognitive impairment: an exploratory meta‐analysis

Cited by 62 publications

References 30 publications

Lower likelihood of falling at age 90+ is associated with daily exercise a quarter of a century earlier: The 90+ Study

Lower likelihood of falling at age 90+ is associated with daily exercise a quarter of a century earlier: The 90+ Study

Falls prevention interventions in older adults with cognitive impairment: A systematic review of reviews

Interventions for preventing falls in older people in care facilities and hospitals

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