Multiple component interventions for preventing falls and fall-related injuries among older people: systematic review and meta-analysis

Abstract

BackgroundLimited attention has been paid in the literature to multiple component fall prevention interventions that comprise two or more fixed combinations of fall prevention interventions that are not individually tailored following a risk assessment. The study objective was to determine the effect of multiple component interventions on fall rates, number of fallers and fall-related injuries among older people and to establish effect sizes of particular intervention combinations.MethodsMedline, EMBASE, CINAHL, PsychInfo, Cochrane, AMED, UK Clinical Research Network Study Portfolio, Current Controlled Trials register and Australian and New Zealand Clinical Trials register were systematically searched to August 2013 for randomised controlled trials targeting those aged 60 years and older with any medical condition or in any setting that compared multiple component interventions with no intervention, placebo or usual clinical care on the outcomes reported falls, number that fall or fall-related injuries. Included studies were appraised using the Cochrane risk of bias tool. Estimates of fall rate ratio and risk ratio were pooled across studies using random effects meta-analysis. Data synthesis took place in 2013.ResultsEighteen papers reporting 17 trials were included (5034 participants). There was a reduction in the number of people that fell (pooled risk ratio = 0.85, 95% confidence interval (95% CI) 0.80 to 0.91) and the fall rate (pooled rate ratio = 0.80, 95% CI 0.72 to 0.89) in favour of multiple component interventions when compared with controls. There was a small amount of statistical heterogeneity (I2 = 20%) across studies for fall rate and no heterogeneity across studies examining number of people that fell.ConclusionsThis systematic review and meta-analysis of randomised controlled trials found evidence that multiple component interventions that are not tailored to individually assessed risk factors are effective at reducing both the number of people that fall and the fall rate. This approach should be considered as a service delivery option.

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

“…79 Exercise does not appear to have an effect on depressive symptoms. 80 From 16 reviews including 11-159 trials and one overview regarding falls prevention, [73][74][75][76]78,[80][81][82][83][84][85][86][87][88][89][90] we found that exercise programmes assessing risk for falls and managing this, anti-slip devices in shoes, home safety assessment and modification and training in walking aid use, may help prevent falls. The strongest evidence related to exercise, which reduces the risk and rate of falls in community-dwelling older adults, 73,75,78,[81][82][83][84][85] though some authors advocate caution with using exercise interventions in frailer older adults.…”

“…78,81 Falls risk assessment and management appears to be effective. 81,83 Falls prevention programmes may reduce falls risk by up to 10% and may also reduce the fear of falling and falls-related injuries; 75,76,80,85,[88][89][90] however, results are inconclusive in cognitively impaired older adults. 74 Walking aids should be correctly sized and adapted, recommended by a health professional and only used when necessary with training.…”

Unintentional Home Injuries Across the Life Span: Problems and Solutions

“…A systematic review examined the effects of multiple interventions to prevent falls in older adults (60) and found that multicomponent interventions that were not tailored to individual risk factors were effective at reducing both the number of people who fell (pooled rate ratio = 0.85, 95% CI 0.80-0.91) as well as their rate of falls (pooled rate ratio = 0.80, 95% CI 0.72-0.89). This review presented the results of 17 trials with 5,034 participants.…”

Factors associated with fall prevention practices in older adults

“…2,3 Studies show that some practices have the potential to reduce the prevalence of falls in older adults, such as performing physical exercise, the use of vitamin D supplements and organization of the home. 4,5 Other studies highlight changes in behavior and ways of life of older adults, for example, avoiding going up and down stairs, walking slowly, using orthotic support when necessary, correctly using medications, not drinking alcohol, crossing the street at pedestrian crossing points and wearing corrective lenses. 2,6 Studies in developed countries have advanced in the production of knowledge on fall prevention practices among older adults and have investigated the adherence and engagement of these people in fall prevention programs.…”