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Clinician Article

Comparisons of Interventions for Preventing Falls in Older Adults: A Systematic Review and Meta-analysis.



  • Tricco AC
  • Thomas SM
  • Veroniki AA
  • Hamid JS
  • Cogo E
  • Strifler L, et al.
JAMA. 2017 Nov 7;318(17):1687-1699. doi: 10.1001/jama.2017.15006. (Review)
PMID: 29114830
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Disciplines
  • Geriatrics
    Relevance - 7/7
    Newsworthiness - 5/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 5/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 5/7
  • Public Health
    Relevance - 6/7
    Newsworthiness - 5/7

Abstract

Importance: Falls result in substantial burden for patients and health care systems, and given the aging of the population worldwide, the incidence of falls continues to rise.

Objective: To assess the potential effectiveness of interventions for preventing falls.

Data Sources: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Ageline databases from inception until April 2017. Reference lists of included studies were scanned.

Study Selection: Randomized clinical trials (RCTs) of fall-prevention interventions for participants aged 65 years and older.

Data Extraction and Synthesis: Pairs of reviewers independently screened the studies, abstracted data, and appraised risk of bias. Pairwise meta-analysis and network meta-analysis were conducted.

Main Outcomes and Measures: Injurious falls and fall-related hospitalizations.

Results: A total of 283 RCTs (159?910 participants; mean age, 78.1 years; 74% women) were included after screening of 10?650 titles and abstracts and 1210 full-text articles. Network meta-analysis (including 54 RCTs, 41?596 participants, 39 interventions plus usual care) suggested that the following interventions, when compared with usual care, were associated with reductions in injurious falls: exercise (odds ratio [OR], 0.51 [95% CI, 0.33 to 0.79]; absolute risk difference [ARD], -0.67 [95% CI, -1.10 to -0.24]); combined exercise and vision assessment and treatment (OR, 0.17 [95% CI, 0.07 to 0.38]; ARD, -1.79 [95% CI, -2.63 to -0.96]); combined exercise, vision assessment and treatment, and environmental assessment and modification (OR, 0.30 [95% CI, 0.13 to 0.70]; ARD, -1.19 [95% CI, -2.04 to -0.35]); and combined clinic-level quality improvement strategies (eg, case management), multifactorial assessment and treatment (eg, comprehensive geriatric assessment), calcium supplementation, and vitamin D supplementation (OR, 0.12 [95% CI, 0.03 to 0.55]; ARD, -2.08 [95% CI, -3.56 to -0.60]). Pairwise meta-analyses for fall-related hospitalizations (2 RCTs; 516 participants) showed no significant association between combined clinic- and patient-level quality improvement strategies and multifactorial assessment and treatment relative to usual care (OR, 0.78 [95% CI, 0.33 to 1.81]).

Conclusions and Relevance: Exercise alone and various combinations of interventions were associated with lower risk of injurious falls compared with usual care. Choice of fall-prevention intervention may depend on patient and caregiver values and preferences.


Clinical Comments

Family Medicine (FM)/General Practice (GP)

Very important topic for anyone who takes care of older patients.

General Internal Medicine-Primary Care(US)

The actual definition of injurious falls is not explicitly stated.

Geriatrics

Nothing new.

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