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Cover of Interventions to Prevent Falls in Older Adults

Interventions to Prevent Falls in Older Adults

An Updated Systematic Review

Evidence Syntheses, No. 80

Investigators: , ScD, MS, , MD, MCR, , MD, MPH, , PhD, MPH, , PhD, , PhD, , MSW, , MS, and , MFA.

Oregon Evidence-based Practice Center
Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 11-05150-EF-1

Structured Abstract

Background:

Falls represent an important source of preventable morbidity and mortality in older adults, the fastest growing segment of the U.S. population. We undertook a systematic review of falls interventions applicable to primary care populations to inform the U.S. Preventive Services Task Force’s (USPSTF’s) updated recommendation on preventing falls in older adults.

Purpose:

To assess the benefits and harms of interventions for reducing falls and improving health outcomes in older adults in primary care settings, including multifactorial assessment and management, exercise/physical therapy, single clinical treatment of nutritional risks and visual deficits, hip protectors, home hazard modification, and clinical education/behavioral counseling.

Data Sources:

We searched the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, MEDLINE, Health Technology Assessments, and the National Institute of Health and Clinical Excellence for systematic reviews in 2007. We searched MEDLINE, Cochrane Central Registry of Trials, and the Cumulative Index to Nursing and Allied Health Literature (January 2002 to February 2009), limiting to English language only. We examined reference lists of relevant systematic reviews and other articles and considered references supplied by experts.

Study Selection:

Randomized clinical trials meeting inclusion/exclusion criteria, of at least fair quality according to USPSTF criteria, and reporting falls outcomes.

Data Extraction:

We abstracted data into standardized evidence tables, with data abstraction checked by another investigator. Two investigators evaluated all studies against pre-specified, design-specific USPSTF criteria for trials. Differences were resolved by consensus. Excluded studies are listed in the exclusion tables, with reasons for exclusion.

Data Synthesis:

We included 47 intervention trials with a total of 23,980 participants. Fourteen trials (16 intervention arms) addressed multifactorial assessment and management (n=5,570). Seven comprehensive multifactorial interventions reduced falls among primarily high-risk older adults, while nine noncomprehensive interventions did not. Seventeen trials (21 intervention arms) (n=3,985) of exercise/physical therapy interventions significantly reduced falls, with some suggestion that benefits were primarily among participants selected at higher-than-average risk for falling. Eight trials (n=5,216) of vitamin D supplementation among participants with mean ages of 71–77 years showed significantly reduced falls. Four trials (n=1,437) addressing visual acuity and cataract correction among adults with mean ages of 76–80 years found no reduction in falls. Two trials (n=4,769) with high-risk female participants with mean ages of 78–83 years found no benefit on falls or falls injuries with hip protector use. Small single trials of medication management, protein supplementation, and behavioral counseling showed no benefit. Limited data were available on intervention-associated harms or health outcomes in addition to falls.

Limitations:

The body of research is of fair quality and rarely reports important health outcomes, such as falls-related injuries. Available studies do not clarify the best way to identify higher risk community-dwelling older adults for evidence-based interventions due to heterogeneity in tested approaches.

Conclusions:

There is strong evidence that several types of primary care applicable falls interventions (i.e., comprehensive multifactorial assessment and management, exercise/physical therapy interventions, and vitamin D supplementation) reduce falls among those selected to be at higher risk for falling. Harms of these interventions appear to be minimal, but future research should confirm this assertion.

Contents

540 Gaither Road, Rockville, MD 20850; www​.ahrq.gov

3800 North Interstate Avenue, Portland, OR 97227

The final version of this updated systematic review was submitted to the Agency for Healthcare Research and Quality in July 2009. A manuscript derived from this report was published in Annals of Internal Medicine on December 21, 2010 (Michael YL, Whitlock EP, Lin JS, et al. Primary care relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2010;153:815–824). This manuscript contains additional data published through February 2010, which was not available at the time this evidence report was finalized. Please refer to the manuscript for updated information.

Consultant: Elizabeth Eckstrom, MD, MPH

Prepared for: Agency for Health Care Research and Quality, U.S. Department of Health and Human Services.1 Contract Number: HHSA-290-2007-10057-I, Task Order Number 3. Prepared by: Oregon Evidence-based Practice Center Center for Health Research, Kaiser Permanente Northwest.2

Suggested citation:

Michael YL, Lin JS, Whitlock EP, Gold R, Fu R, O’Connor EA, Zuber SP, Beil TL, Lutz KW. Interventions to Prevent Falls in Older Adults: An Updated Systematic Review. Evidence Synthesis No. 80. AHRQ Publication No. 11-05150-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; December 2010.

This report is based on research conducted by the Oregon Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA-290-2007-10057-I). The investigators involved have declared no conflicts of interest with objectively conducting this research. The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.

This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

1

540 Gaither Road, Rockville, MD 20850; www​.ahrq.gov

2

3800 North Interstate Avenue, Portland, OR 97227

Bookshelf ID: NBK51685PMID: 21595101
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