New horizons in falls prevention and management for older adults: a global initiative

Abstract

Background falls and fall-related injuries are common in older adults, have negative effects both on quality of life and functional independence and are associated with increased morbidity, mortality and health care costs. Current clinical approaches and advice from falls guidelines vary substantially between countries and settings, warranting a standardised approach. At the first World Congress on Falls and Postural Instability in Kuala Lumpur, Malaysia, in December 2019, a worldwide task force of experts in falls in older adults, committed to achieving a global consensus on updating clinical practice guidelines for falls prevention and management by incorporating current and emerging evidence in falls research. Moreover, the importance of taking a person-centred approach and including perspectives from patients, caregivers and other stakeholders was recognised as important components of this endeavour. Finally, the need to specifically include recent developments in e-health was acknowledged, as well as the importance of addressing differences between settings and including developing countries. Methods a steering committee was assembled and 10 working Groups were created to provide preliminary evidence-based recommendations. A cross-cutting theme on patient’s perspective was also created. In addition, a worldwide multidisciplinary group of experts and stakeholders, to review the proposed recommendations and to participate in a Delphi process to achieve consensus for the final recommendations, was brought together. Conclusion in this New Horizons article, the global challenges in falls prevention are depicted, the goals of the worldwide task force are summarised and the conceptual framework for development of a global falls prevention and management guideline is presented.

Daily surveillance of falls is feasible and reveals a high incidence of falls among older adults

“…Participants recruited after the requirement to have had a fall in the last five years was dropped reported a fall rate in the preceding year of 38%. This is not dissimilar to the rates of around 35% that are typically quoted for adults older than 65 2 . By contrast, the group recruited earlier reported a fall rate in the previous year of 65%, which aligns with the observed rates for both groups during the first 12 months of the study period—65% for those recruited under the original conditions and 72% for those recruited later.…”

“…Falls are well known as a major cause of injury and disability among older adults 1 . As a consequence, considerable research efforts, including the global initiative on fall prevention and management, 2 are being made to identify risk factors and effective mitigation and treatment options. A critical element of such research is an accurate measure of fall occurrence.…”

Interventions to reduce falls in hospitals: a systematic review and meta-analysis

“…It was beyond the scope of this analysis to quantify the outcome of quality improvement (QI) initiatives, especially those pertaining to health professional education and training, despite growing traction of QI [ 76–78 ]. Preventing falls in real life clinical settings sometimes means iterative, locally driven QI with continuous monitoring of changes in local falls and injury data and health professional behaviours [ 79 ]. At an organisational level, hospital staff working on patient safety are interested in what works locally to produce sustained reductions in falls in addition to considering the gold-standard evidence afforded by global systematic reviews and meta-analyses [ 80 ].…”

How accurate are geriatricians’ fall predictions?

“…Additionally, comparisons between clinically administered fall risk assessments versus home or publicly administered assessments by trained fall risk screeners may help to elucidate the importance of extrinsic fall risk factor assessment. Finally, geriatricians (and other clinicians) are in a unique position to provide patient-centered, individualized assessments of fall risk, as called for by the global initiative currently developing new international guidelines to reduce falls in older adults [ 17 ]. More studies like ours will be needed to inform these and other fall reduction initiatives.…”