Multifactorial interventions for preventing falls in older people living in the community: a systematic review and meta-analysis of 41 trials and almost 20 000 participants

Abstract

ObjectiveTo assess the longer term effects of multifactorial interventions for preventing falls in older people living in the community, and to explore whether prespecific trial-level characteristics are associated with greater fall prevention effects.DesignSystematic review with meta-analysis and meta-regression.Data sourcesMEDLINE, EMBASE, CINHAL, CENTRAL and trial registries were searched up to 25 July 2018.Study selectionWe included randomised controlled trials (≥12 months’ follow-up) evaluating the effects of multifactorial interventions on falls in older people aged 65 years and over, living in the community, compared with either usual care or usual care plus advice.Review methodsTwo authors independently verified studies for inclusion, assessed risk of bias and extracted data. Rate ratios (RaR) with 95% CIs were calculated for rate of falls, risk ratios (RR) for dichotomous outcomes and standardised mean difference for continuous outcomes. Data were pooled using a random effects model. The Grading of Recommendations, Assessment, Development and Evaluation was used to assess the quality of the evidence.ResultsWe included 41 trials totalling 19 369 participants; mean age 72–85 years. Exercise was the most common prespecified component of the multifactorial interventions (85%; n=35/41). Most trials were judged at unclear or high risk of bias in ≥1 domain. Twenty trials provided data on rate of falls and showed multifactorial interventions may reduce the rate at which people fall compared with the comparator (RaR 0.79, 95% CI 0.70 to 0.88; 20 trials; 10 116 participants; I2=90%; low-quality evidence). Multifactorial interventions may also slightly lower the risk of people sustaining one or more falls (RR 0.95, 95% CI 0.90 to 1.00; 30 trials; 13 817 participants; I2=56%; moderate-quality evidence) and recurrent falls (RR 0.88, 95% CI 0.78 to 1.00; 15 trials; 7277 participants; I2=46%; moderate-quality evidence). However, there may be little or no difference in other fall-related outcomes, such as fall-related fractures, falls requiring hospital admission or medical attention and health-related quality of life. Very few trials (n=3) reported on adverse events related to the intervention. Prespecified subgroup analyses showed that the effect on rate of falls may be smaller when compared with usual care plus advice as opposed to usual care only. Overall, heterogeneity remained high and was not explained by the prespecified characteristics included in the meta-regression.ConclusionMultifactorial interventions (most of which include exercise prescription) may reduce the rate of falls and slightly reduce risk of older people sustaining one or more falls and recurrent falls (defined as two or more falls within a specified time period).Trial registration numberCRD42018102549.

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“…Of course, FOF can be a result of a fall. Simply managing the fear itself may not be effective in fall prevention; a recent systematic review and meta-analysis emphasized that multifactorial interventions (mostly exercise prescriptions) may reduce the rate of falls in older people [37]. Previous fall experiences make older arthritis patients feel more intimidated and restricted in their usual activities [36,38].…”

Fall-induced hospital-treated traumatic brain injuries among elderly Finns in 1970–2017

“…Multifactorial interventions aimed at reducing the number of falls of elderly persons by simultaneously modifying many of the predisposing and situational risk factors for falls have shown promising results (2,22,24,25). Also, single interventions, such as strength and balance training, reduction in psychotropic medication, correction of visual impairment, home-hazard assessment and modification, and gait-stabilizing anti-slip devices, can be effective (21,22,26,27).…”

Fall Prevention Knowledge, Attitudes, and Behaviors: A Survey of Emergency Providers

“…They concluded that multifactorial fall interventions did reduce falls in the intervention groups, but given the considerable heterogeneity their confidence in the results was low. 16 These mixed results of fall intervention programs are likely due to the complex physiology of falls, limitations in resources, and difficulty standardizing a process when every healthcare system functions differently. A root cause analysis of why certain programs do not succeed or what factors contributed to another program’s success is needed to provide more guidelines for implementing fall prevention programs in EDs.…”