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J Med Libr Assoc. Apr 2008; 96(2): 88–100.
PMCID: PMC2268225

The impact of a literature consult service on geriatric clinical care and training in falls prevention

Molly Cahall, MA, MSLS, Rebecca N. Jerome, MLIS, MPH, and James Powers, MD


The importance of developing effective health care programs and services for elderly persons in the United States is increasing at warp speed due to significant projected growth in the size of this demographic in the near future. According to the US Census Bureau, the number of persons aged 65 years and older is expected to rise from an estimated 35 million people in 2000 to 55 million by the year 2020 [1]. The rapid growth in this age group can be explained in part by a considerable rise in the number of older people projected for 2011, when the Baby Boom generation (persons born between 1946 and 1964) begins to turn 65 years old. The number of oldest old (persons aged 85 years and older) is projected to double from 4.7 million in 2003 to 9.6 million by 2030 [2]. The growth is also partly explained by a steady increase in life expectancy from birth for both men and women, regardless of ethnicity, over the last century, currently at an all-time high of 77.9 years [3], compared to 49.2 years in 1900 [4].

Providing appropriate health care services for this age group is also gaining prominence in the United States [5, 6]. Geriatrics is the branch of medicine that focuses on prevention, diagnosis, and treatment of diseases in the aged and on the socioeconomic matters that affect health care services for elderly persons. Geriatrics research and clinical practice encompass both persons residing with or without caregivers at home and those receiving clinical care at hospitals and nursing facilities [7]. In addition to managing the care of aged patients, the key goals of geriatric medicine include training medical students, physicians, and other health care professionals in geriatric issues as well as researching the aging process and the accompanying conditions affecting the elderly [8].

One of the major issues targeted by geriatric medicine is the prevention of accidental falls [9]. Falls are a common health risk, can occur in virtually any setting, and can be fatal, particularly among individuals sixty-five years and older [10]. Complications due to falls are the leading cause of death due to injury in this age group in the United States. Falls are also one of the primary causes prompting emergency care and hospitalizations among the elderly [10]. These disturbing statistics have brought this issue under significant scrutiny by geriatric clinicians and researchers in medicine.


You frequently collaborate with a geriatrician in the adult primary care clinic of your large academic medical center. On a routine visit to his office to discuss his current needs for clinical evidence, he requests that you analyze the literature on effective interventions to reduce accidental falls in older persons. As he also provides geriatric care at the local Veterans Administration hospital and is the medical director at several local nursing homes and home health agencies, he notes that he is interested in literature describing interventions for use in private homes as well as those implemented in institutional settings. Figure 1 provides further clinical commentary on this question.

Figure 1
Clinician commentary


In patients over age sixty-five, what strategies have been shown to reduce the risk of accidental falls?


You decide that medical textbooks on geriatric care and basic journal articles providing an overview of accidental falls are appropriate background resources to gain a clear understanding of the issues surrounding the geriatrician's question. As you skim this material, you realize that the literature distinguishes between two main types of patient populations, persons living in the community and those temporarily or permanently residing in health care institutions. Frailty or “frail elderly” is another concept that you frequently see discussed in the literature in relation to falls. An internal medicine textbook [15] reveals that frailty is a high-risk clinical syndrome characterized by multiple signs and symptoms that increase with age, such as weakness, fatigue, decreased muscle mass, decreased food intake, balance and gait abnormalities, and weakened bones (osteopenia).

You also learn from reading a general review article [14] that the interaction of multiple intrinsic and extrinsic risk factors predisposes elderly patients to fall. Intrinsic factors involve characteristics of the individual, such as acute illness, lower extremity weakness, gait and balance deficits, or psychotropic medication use (e.g., benzodiazepines prescribed for anxiety or insomnia). Extrinsic factors include factors outside the individual, such as restraints, poor footwear, or environmental hazards (e.g., clutter, poor lighting) [14].

Understanding patient population characteristics, risk factors, and other core concepts related to falls gives you a clearer sense of some of the main issues surrounding the prevention of falls and increases your vocabulary for brainstorming keywords that are useful for a comprehensive literature search. Table 1 provides brief definitions for these and other important concepts related to falls in the elderly.

Table thumbnail
Table 1 Brief concept definitions with references to sources of information

Based on your background reading, you realize that some studies you find in your literature search focus primarily on specific patient populations who are at an increased risk for falls, such as the frail elderly or older persons with complex diseases and conditions who reside in a nursing home setting. Furthermore, in contrast to previous Journal of the Medical Library Association case studies that examined literature on specific therapeutic interventions such as antibiotics or surgical procedures, the wide variety of risk factors related to falls that you see in your initial reading leads you to expect that studies published on preventing falls will likely include behavioral and social components designed to target the characteristics and risk factors specific to elderly subjects and their environments. You also anticipate that your literature search will yield research on a variety of intervention strategies designed either to target fall risk factors and effectively reduce the rate of first-time events (primary intervention) or to reduce the likelihood of recurrent falls in patients who have already experienced a fall (secondary intervention). This foreknowledge will aid you in gauging whether your search strategies are retrieving appropriate and relevant information. Though both are key issues in geriatric medicine, this case will focus on search and synthesis of the literature on preventing first-time falls for the sake of brevity.


Armed with background knowledge, your next step is to begin constructing a literature search. You decide to focus first on clinical practice guidelines on the prevention of falls in the elderly to gain a sense of the current standard of care, to acquire additional core vocabulary or related key words for use in your search, and to review any relevant articles commonly cited among the guidelines.

Clinical practice guidelines

While guideline clearinghouses and biomedical literature databases are comprehensive one-stop resources that can be searched quickly, a brief time lag may exist between the guideline date of publication and its availability via these resources. Moreover, the National Guidelines Clearinghouse (NGC) periodically withdraws guidelines that have not been developed, reviewed, or revised in the last five years and places them in an electronic archive of citations only that must be searched separately [27]. In contrast, professional and government organizations (e.g., American College of Physicians, United States Preventive Services Task Force) often post their guidelines on their websites immediately after publication. A thorough search for current guidelines on this case's topic will therefore include clearinghouses like NGC, bibliographic databases that index medical literature, and individual websites from geriatrics-related professional organizations.

You recall from your background reading that the American Geriatrics Society (AGS) is the primary professional association for geriatrics in the United States. A quick browse of the AGS website reveals joint practice guidelines on the prevention of accidental falls in older persons, published in conjunction with the Academy of Orthopaedic Surgeons and the British Geriatrics Society [25].

You also consult the NGC database to locate any additional guidelines on accidental falls from other organizations. Using the term “falls” in the Disease/ Condition field of the NGC detailed search page, with limits set to persons sixty-five years and older in the Age of Target Population field, returns approximately thirty results sorted by relevance. Of these, you see seven guidelines on falls that were developed or adapted by nonprofit organizations, professional associations, and academic institutions from the United States and other countries [26, 2833].

Upon further review of the results, you immediately eliminate one guideline [31] that was adapted from guidelines already included in your search results and then consider the authority, purpose, and scope of the remaining six documents. Using the NGC guideline comparison tool, you see that four are from the United States [2830, 32], one is from the Canadian Task Force on Preventive Health Care [32], and another is from the Collaborating Centre for Nursing and Supportive Care in United Kingdom, developed for the National Institute for Health and Clinical Excellence (NICE) [26]. You realize that health disparities and life expectancy can vary significantly among countries [34] due to a wide range of reasons, such as differences in lifestyle choices (e.g., diet, exercise), genetic makeup, and available health care resources; therefore, determining the country of origin for each guideline is important and will be a significant piece of information to include in your overall written synthesis of guidelines recommendations. The guidelines authored in the United States are likely to be closest to practice at your institution, while the other guidelines may serve well as supplemental information.

Comparing the targeted settings among guidelines shows that three documents specifically address long-term care residents, two address both community-dwelling patients and institutionalized patients, and one addresses hospitalized patients only. As noted previously, your clinician is interested in all of these populations. You also note that different search methods (i.e., hand searching, electronic database searching, or both) were used to locate evidence to support guideline development, giving you a sense of the level of rigor and thoroughness with which the authors surveyed the published literature. Furthermore, three guidelines judged the quality and strength of the evidence and/or the recommendations via rating schemes, while two utilized expert consensus. Reviewing the method of evidence appraisal for guideline development gives you a sense of the level of authority and objectivity with which the recommendations were developed. All guidelines underwent an internal or external peer-review process before publication. Thus, you have a strong pool of guidelines to consider as you select items to provide to the geriatrician.


Next, you turn to PubMed to begin a search of the research studies literature and to locate any additional practice guidelines. Given the potential length of the guideline development and publication process, you may particularly wish to consider literature published since approximately 2000, around the time of the AGS 2001 guidelines mentioned previously. Selecting such a date range will help you avoid duplicating the effort already embodied in the guidelines.

Using the Medical Subject Heading (MeSH) database in PubMed, you see that “Accidental Falls” is the most relevant MeSH term that relates to the concept of falls. Next, you begin a search to locate the MeSH term for the concept of preventing falls. From your background reading, you know that these strategies may be described in the literature as “prevention,” “interventions,” or “programs.” You also know that effectiveness of the preventive strategies can be assessed by measuring a variety of outcomes, such as a reduction in the number of falls and falls risk (i.e., the likelihood that an individual will experience a fall). A search of the MeSH database using key words (e.g., “Prevention”) yields a number of related terms including “Accident Prevention” (which also includes “safety Management”), “Program Evaluation,” “Rehabilitation,” “Treatment Outcome,” and the subheading “Prevention and Control.” You also note that the MeSH term, “Aged”—including the narrower terms “Aged, 80 and Over” and “Frail Elderly”—may be very useful in restricting to articles on this specific age group.

Given the size of the literature on falls, you decide to limit the search using the “NOT” Boolean operator and append a string of publication types to the strategy that eliminates weaker literature, such as letters to the editor, case reports, news, editorials, comments, and records supplied by publishers. A basic search string with these additional terms looks like:

accidental falls/prevention and control[majr] AND aged[mh] AND (accident prevention[mh] OR program evaluation[mh] OR rehabilitation OR treatment outcome[mh]) NOT (case reports[pt] OR letter[pt] OR comment[pt] OR news[pt] OR editorial[pt] OR publisher[sb]).

Limiting the search to citations published in English since 2000 yields approximately 305 citations.

While this strategy serves as a strong starting point, as you browse the citation titles in the retrieval, you recall from your background reading that several individual interventions have been developed to help reduce the risk of falls, such as exercise, environment modification, dietary supplements, assistive devices, psychotropic medication withdrawal, and physical therapy for balance and gait training. You realize that a more thorough search will therefore include MeSH terms and keywords for interventions commonly examined either as a single strategy or as individual components of a multifaceted prevention program. A search of the MeSH database using keywords and related concepts for each of these strategies yields the terms “Exercise,” “Environment Design,” “Health Facility Environment,” “Dietary Supplements,” “Self-Help Devices,” “Protective Devices” (e.g., hip protectors), “Psychotropic Drugs/Administration and Dosage,” and “Physical Therapy Modalities,” which also includes the narrower term “Exercise Therapy.” A search string with these terms looks like:

accidental falls/prevention and control[majr] AND aged[mh] AND (“Exercise”[Mesh] OR “Environment Design”[Mesh] OR “Health Facility Environment”[Mesh] OR “Dietary Supplements”[Mesh] OR “Self-Help Devices”[Mesh] OR “Protective Devices”[Mesh] OR “Psychotropic Drugs/administration and dosage”[Mesh] OR “Physical Therapy Modalities”[Mesh]) NOT (case reports[pt] OR letter[pt] OR comment[pt] OR news[pt] OR editorial[pt] OR publisher[sb]).

Limiting the search to citations published in English since 2000 yields approximately 190 citations, all of which do not appear in the results of the first search, highlighting the utility of this separate search strategy.

To locate clinical practice guidelines and other evidence-based recommendations indexed in PubMed that may not be indexed in the NGC, you may try a strategy such as this, retrieving approximately 175 items in PubMed:

Accidental falls[majr] AND aged[mh] AND ((evidence based AND (guideline [tiab] OR guidelines [tiab] OR recommendations OR recommendation*)) OR practice guidelines[mh] OR practice guideline[pt] OR guidelines[mh] OR guideline[pt] OR consensus development conference OR consensus statement[tiab] OR consensus workshop[tiab] OR standards[sh] OR “standard of care”[tiab] OR “standards of care”[tiab] OR clinical advisory[tiab]).

This strategy includes terms related to evidence-based medicine, including those drawn from your own personal knowledgebase and training in evidence-based medicine concepts, from previous experience searching for clinical practice guidelines, and from reviewing the search methodologies published by expert appraisal groups such as the Cochrane Collaboration, the United States Preventive Services Task Force, and the National Institute for Clinical Excellence.

To ensure a thorough review of the literature for this clinical question, other bibliographic databases to consult may include CINAHL for nursing research and Web of Knowledge for professional meeting abstracts and other scientific studies. In addition, keyword searching in prominent search engines such as Google can yield the names of professional organizations or government agencies and relevant literature that may not be indexed by the above sources, such as evidence-based reports or white papers, clinical practice guidelines, and clinical advisories (e.g., professional committee opinions).


Clinical guidelines

As you skim the PubMed records, you see several reports that summarize or cite previous recommendations but few that are original practice statements. One guideline statement that looks useful is an evidence-based statement from Canada that uses a template from the Agency for Healthcare Research and Quality to develop guidance on risk factors that contribute to falls [35]. Viewing full-text of the Canadian guideline, you note that it may be useful only as supplementary information because its primary focus is on risk factors for preventing repeat falls (secondary prevention), rather than interventions for preventing an initial fall.

After surveying your entire list of guidelines for possible inclusion, you select the Canadian Task Force on Preventive Health Care guidelines [32], the NICE guidelines [26], and the AGS joint guidelines [25] that you located earlier via the NGC (Table 1) for their comprehensiveness, methodological rigor and assessment of the literature, and/or coverage of a unique aspect of falls, such as a specific patient population (e.g., frail elderly, persons 85, and older) or health care setting (e.g., hospital, nursing home, extended care).

Research studies

Given the immense amount of literature, you decide to focus primarily on the stronger levels of evidence, such as larger (e.g., ≥300 subjects) randomized clinical trials, systematic reviews, and meta-analyses.

As you scan through the records, you look for articles published in top geriatrics or peer-reviewed medicine journals as gauged by impact factor listed in the Journal Citation Reports database, as well as those published by reputable expert appraisal groups, such as the Cochrane Collaboration, and authors (e.g., Laurence Z. Rubenstein, A. John Campbell, M. Clare Robertson, and Mary E. Tinetti) who appear to be experts in the study of falls prevention, as gleaned from noting their affiliation with expert geriatric groups and/or authoring of multiple published studies, systematic reviews, or clinical practice guidelines.

You also see that the Cochrane Collaboration has published three systematic reviews of the literature in the Cochrane Database of Systematic Reviews regarding interventions for preventing falls. The first is a review on the effectiveness of any intervention type that reports outcomes according to community-dwelling versus nursing home setting [36]. The second Cochrane review focuses on the broader public health perspective by examining population-based interventions for preventing fall-related injuries in older people through public health programs administered in the community [37]. While somewhat relevant, this review focuses on city-wide or community-wide interventions, likely broader in scope than the need prompting the current question from the geriatrician. The third Cochrane review examines studies published between 1979 and 2004 that assess home environment modifications to prevent injuries [38]. From the abstract, you see that this article includes five studies involving children and fourteen studies on older people. All of the fourteen geriatric studies contain falls data; however, comparison with the studies examined in Gillespie et al. [36] reveals some overlap, and none of the fourteen were published more recently than those examined by Gillespie et al. You therefore select the Gillespie review for its focus solely on randomized clinical trials, coverage of both community-dwelling and institutionalized patients, comprehensive search methodology, and rigorous analysis of the evidence. You prefer this item over the review by Lyons et al. [38], because the latter focuses solely on home modification, contains some of the same research, and presents little new overall information on geriatric falls since the time of Gillespie's review.

In addition to the Cochrane reviews, you see several other systematic reviews but rule out many due to one or more characteristics that weakens the results, such as small sample size [39]; narrow scope, such as secondary prevention only [40]; focus on one intervention type [41, 42]; or lack of unique or significantly new data [42] compared to more comprehensive studies (e.g., Gillespie et al. [36], Chang et al. [44], Oliver et al. [44]).

After browsing the abstracts and full text of the retrieval of systematic reviews and meta-analyses, you select three systematic reviews [36, 43, 44] that share key characteristics of strength, such as a broad scope (e.g., multiple intervention types, multiple settings); comprehensive literature search; selection of strong study designs (e.g., randomized controlled trials, prospective cohort studies); large sample size (>40 studies); independent review of study methodological quality; and selection of meaningful outcomes, such as number, rate, or risk of falls, rather than intermediate outcomes such as muscle strength, balance, and gait. Two also included meta regression analyses of pooled studies to assess change in risk of falling [43] and the impact of dementia on effect size for rate of falls, fractures, and number of fallers [44].

You also note that these reviews possess other key characteristics individual to each. For example, one [44] was published recently and included studies on hospitalized patients, whereas the other two addressed only community-dwelling patients and/or those in nursing facilities. The review by Gillespie et al. [36] was conducted by the Cochrane Collaboration, an organization well known for its thorough, expert critical appraisals of research literature. The third [43] conducted sensitivity analyses to determine the robustness of its findings for possible publication bias. Additionally, using Web of Science, you note that one selected review has been cited more than ninety times [42], while another [36] was cited more than eighty-five times, adding objective data to your sense that the reviews are strong selections. After a quick scan of the citing authors, you realize that the some of the best-known researchers on falls (e.g., A. John Campbell, M. Clare Robertson, Laurence Z. Rubenstein, Mary E. Tinetti) cited these reviews in their subsequent research. These observations affirm your decision to include these reviews in your final pool of articles.

Turning next to the retrieval on individual clinical trials, you look for large, recent, well-designed studies with a patient population or setting that complements the selected systematic reviews. You note for your own background knowledge that most trials report the effectiveness of one or a combination of intervention strategies included in the reviews, such as group exercise, muscle strength and balance training, environmental modifications, psychotropic medication withdrawal or adjustment, nutritional supplementation, visual deficiency correction, home hazard modification, and tai chi. You also observe that a variety of trials assess the effectiveness of targeted and untargeted exercise programs ranging in duration from five to more than twenty weeks as an intervention to prevent or reduce the occurrence of falls in either community-dwelling or institutionalized patients [4553]. Realizing that various intervention strategies exist and are examined for effectiveness individually or in combination (e.g., multifaceted) alerts you that you will need to select studies that incorporate both approaches to adequately represent the preventive options described in the literature.

After browsing through the PubMed records for randomized trials, you select 2 recent studies [46, 48] that appear to possess several key characteristics of a strong publication and that complement your selection of systematic reviews, given their unique focus. Two are large, multicenter, randomized controlled trials that involve patients >75 years old. One assesses the effects of either a home modification program, an exercise program plus vitamin supplements, both interventions, or social visits on the rate of falls in 391 community-dwelling patients with severe visual impairment [46]. The other examines the effect of an exercise program consisting of either walking or balance training on falls rate, physical performance, and disability in 278 pre-frail (1–2 frailty indicators) or frail (3+ frailty indicators) older adults in long-term care centers [48]. Looking more closely at the full text of the two studies, you select them for their strong study design, their assessment of individual interventions, and the uniqueness of the subject populations involved compared to the research covered by the guidelines and systematic reviews that you have already selected.

In addition to systematic reviews and individual randomized trials, you also browse the PubMed retrieval for recent general reviews of the literature that appear comprehensive, authoritative, and well written, such as the review by experts Rubenstein and Josephson [14] on the evidence for preventing falls in the elderly. You also skim the references in these articles for commonly cited studies described as important research as a strategy to locate studies not returned in your search retrieval. In this instance, this process contributes no unique material and confirms the selection of guidelines, systematic reviews, and studies that you have already made.


The vast amount of research that has been conducted on accidental falls in the geriatric population, more specifically the myriad interventions examined, presents a challenge when considering the most effective way to summarize the evidence for this topic in a comprehensive yet concise manner. To organize your synthesis of the literature, the summary may contain an overall summary and table with three major sections: (1) systematic reviews, (2) practice guidelines, and (3) primary studies.

Key features to consider in summarizing individual research studies and systematic reviews include:

  • purpose of the study: the primary objectives of the study
  • study design and sample size (including number of studies in systematic review): the strength and power of the study to produce statistically significant results from which to make meaningful conclusions
  • subjects and setting (including inclusion/exclusion criteria): scope and volume of the patient population examined and the environment in which the intervention(s) were administered
  • core methods or procedures (including search methodology of systematic review): information on the conditions under which the subjects were assessed and the duration of the study
  • intervention(s) and control group: definition of the treatment group and whether or not a control was used as a comparison and the nature of the control (e.g., placebo, current standard of care)
  • salient results and outcomes: significant findings that can then be translated into effective intervention strategies to prevent falls
  • study weaknesses and limitations: supplementary data to readers to aid interpreting the study's results and conclusions
  • financial sponsor of the research: funding source and any financial stakeholders involved.

When summarizing the clinical practice guidelines, key features to consider may differ slightly from the features for research studies. They include:

  • authors and/or sponsoring organization(s): authority under which the guidelines were developed
  • publication date: currency of the guideline
  • purpose and objectives: scope of the guidelines regarding the patient population and setting as well as the intervention types and target outcomes
  • search methodology and publication date range: comprehensiveness and consistency of the evidence on which the guidelines were based
  • primary recommendations: suggested current standard of practice
  • evidence and recommendation grading use: quality and sufficiency of the available research and the strength of the subsequent recommendations
  • brief comments on limitations or contextual details: parameters under which the guideline recommendations do or do not apply.

In addition to including these key features, arranging the research and guidelines data into a tabular format provides concise presentation of each reference. Tables also allow busy clinicians to quickly scan for the information most interesting or relevant to them, such as study results and practice recommendations.

After summarizing the selected systematic reviews and practice guidelines, you also develop a brief overview paragraph to describe to the clinician the findings from your overall search and synthesis of the literature on falls prevention strategies. This summary also brings together your general impressions of the current consensus on falls prevention strategies based on your background reading and data from the studies and guidelines you reviewed. Key elements contained in the overview paragraph may include:

  • breadth and general consistency of the research literature (e.g., publication types and study designs): quantity and quality of evidence available
  • subject and settings: patient populations and settings to which the research applies
  • type and results of intervention strategies: most effective strategies available and strategies shown to be ineffective or for which the evidence is inconclusive
  • scope, currency, and country of origin of related clinical practice guidelines: the health care system under which the guidelines were developed and the authority and relevance of the practice recommendations to the clinical question at hand.

Figure 2 and Tables 2, ,3,3, and and44 give an example of what each of these components of the literature summary for this question might look like.

Table thumbnail
Table 2 Literature summary: prevention of accidental falls in the elderly population: systematic reviews
Table thumbnail
Table 3 Literature summary: prevention of accidental falls in the elderly population: clinical practice guidelines
Table thumbnail
Table 4 Literature summary: prevention of accidental falls in the elderly population: randomized controlled trials: special subject populations
Figure 2
Prevention of falls in patients sixty-five years and older, last updated November 2007


By identifying and synthesizing the literature on this topic, you are making an important contribution to clinical practice and medical staff training in the care of geriatric patients across multiple teaching settings and health care institutions. Your search and synthesis of the literature on accidental falls in the elderly provides your geriatrician colleague with a broad view of existing research and clinical recommendations that he can apply to all aspects of his practice as a geriatrician. Moving forward, he will use the evidence to inform clinical decision making and patient education in his primary care clinic at your medical center and at the other institutions for which he consults. For medical education, he will incorporate the findings into his teaching and training for medical students and medicine residents. He also comments that your summary will be useful during his assessment of the relevance and currency of the geriatrics-related curriculum for the medical school as it systematically increases geriatrics coverage in its courses and clerkships. Furthermore, he will use the evidence-based recommendations to augment professional or institutional committee meetings, as well as staff training related to patient safety and physical rehabilitation at affiliated nursing homes and home health agencies.

The impact of your work also will likely extend beyond solely the geriatrician's activities. By applying the research evidence and guideline recommendations you provided, your medical center and its patients will benefit tremendously from improved quality of care. For example, the medical center may benefit through increased patient safety, as the evidence and recommendations are used to develop more effective falls reduction programs, staff training, safety protocols, and patient education. Instituting proven intervention strategies during patient encounters at outpatient clinics, such as the medical center's adult primary care center and the nearby Veterans Administration hospital, will facilitate fewer accidental falls in the community, which has a growing population of elderly patients. Furthermore, applying the strategies outlined in your summary that have been shown to decrease the risk or rate of falls can translate into reduced costs to both the medical center and its patients by preventing the occurrence of severe health consequences commonly sustained during falls, such as death, fracture, lacerations, and head injury [54] and their subsequently high direct medical costs [55]. Finally, applying evidence-based falls prevention strategies to the clinical care of patients residing in the community as well as at the medical center and affiliated health care institutions can promote a reduction in the risk of mortality, pain, personal suffering, and loss of independence, thereby helping patients to maintain a better overall quality of life.

It is clear from these benefits that your expertise in searching the biomedical literature and synthesizing the available research evidence has made a valuable contribution that will substantially impact geriatric clinical care at your medical institution and the lives of the many patients it serves.

Table thumbnail
Table 3 Continued


The authors gratefully acknowledge the support of colleagues from the Eskind Biomedical Library. This case was supported in part by a training grant from the Donald W. Reynolds Foundation.


  • U.S. interim projections by age, sex, race, and Hispanic origin [web document]. Washington, DC: US Census Bureau, 2004. [rev. 18 Mar 2004; cited 1 Oct 2007]. <http://www.census.gov/ipc/www/usinterimproj/>.
  • He W, Sengupta M, Velkoff V, and DeBarros KA. 65+ in the United States [web document]. Washington, DC: US Government Printing Office, 2005. [rev. 5 Dec 2005; cited 1 Oct 2007]. <http://www.census.gov/prod/2006pubs/p23-209.pdf>.
  • Kung HC, Hoyert DL, Xu J, and Murphy SL. Deaths: preliminary data for 2005 [web document]. Atlanta, GA: Centers for Disease Control and Prevention, 2007. [rev. 12 Sept 2007; cited 11 Oct 2007]. <http://www.cdc.gov/nchs/products/pubs/pubd/hestats/prelimdeaths05/prelimdeaths05.htm>.
  • Glover J. United States life tables 1890, 1901, 1910, and 1901–1910: explanatory text, mathematical theory, computations, graphs, and original statistics tables of United States life annuities life tables of foreign countries mortality tables of life insurance companies [web document]. Washington, DC: Government Printing Office, 1921. [cited 01 Oct 2007]. <http://www.cdc.gov/nchs/products/pubs/pubd/lftbls/life/1890.htm>.
  • Institute of Medicine. The future health care workforce for older Americans [web document]. New York, NY: The National Academies, 2007. [rev. 1 May 2007; cited 19 Nov 2007]. <http://www.iom.edu/CMS/3809/40113.aspx>.
  • Wenger NS, Roth CP, and Shekelle P. Introduction to the assessing care of vulnerable elders—3 quality indicator measurement set. J Am Geriatr Soc. 2007.  Oct; 55(suppl 2):S247–S252. [PubMed]
  • American Geriatrics Society Foundation for Health in Aging. What is geriatrics?: an introduction to health care for older adults [web document]. New York, NY: American Geriatrics Society, 2007. [cited 11 Oct 2007]. <http://www.healthinaging.org/public_education/what_is_geriatrics.php>.
  • Duthie EH. Practice of geriatrics. St Louis, MO: WB Saunders, 1998.
  • Areas of basic competency for the care of older patients for medical and osteopathic schools [web document]. New York, NY: American Geriatrics Society, 1998. [rev. 1 Jan 1998; cited 08 Nov 2007]. <http://www.americangeriatrics.org/education/competencyPF.shtml>.
  • Fatalities and injuries from falls among older adults— United States, 1993–2003 and 2001–2005. MMWR Morb Mortal Wkly Rep. 2006.  Nov 17; 55(45):1221–4. [PubMed]
  • WISQARS injury mortality reports, 1999–2004 [web document]. Atlanta, GA: Centers for Disease Control and Prevention, 2007. [cited 11 Oct 2007]. <http://webappa.cdc.gov/sasweb/ncipc/mortrate10_sy.html>.
  • Walker JE, Howland J. Falls and fear of falling among elderly persons living in the community: occupational therapy interventions. Am J Occup Ther. 1991.  Feb; 45(2):119–22. [PubMed]
  • Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P, Gottschalk M, Koch ML, Trainor K, and Horwitz RI. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med. 1994.  Sep 29; 331(13):821–7. [PubMed]
  • Rubenstein LZ, Josephson KR. Falls and their prevention in elderly people: what does the evidence show? Med Clin North Am. 2006.  Sep; 90(5):807–24. [PubMed]
  • Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, and McBurnie MA. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001.  Mar; 56(3):M146–M156. [PubMed]
  • Rubenstein LZ, Robbins AS, Josephson KR, Schulman BL, and Osterweil D. The value of assessing falls in an elderly population. a randomized clinical trial. Ann Intern Med. 1990.  Aug 15; 113(4):308–16. [PubMed]
  • Nascher IL. Geriatrics. N Y Med J 1909;(90):358–9.
  • Koenigsberg R. ed. Churchill's illustrated medical dictionary. New York, NY: Churchill Livingstone, 1989.
  • The value of verifying board certification [web document]. Evanston, IL: American Board of Medical Specialties, 2007. [cited 08 Nov 2007] <http://www.abms.org/Who_We_Help/Professional_Organizations/value.aspx>.
  • Reichel W, Gallo J. Essential principles in the care of the elderly. In: Reichel's care of the elderly: clinical aspects of aging. Philadelphia, PA: Lippincott, Williams, and Wilkins, 1999.
  • PubMed MeSH database [web document]. Bethesda, MD: National Library of Medicine, 2007. [cited 13 Oct 2007]. <http://www.ncbi.nlm.nih.gov/sites/entrez?db=mesh>.
  • Fried L. Epidemiology in aging: implications of an aging society. In: Goldman L, Ausiello D, eds. Cecil textbook of medicine. 22nd ed. Philadelphia, PA: WB Saunders, 2004.
  • Fried LP, Walston J. Frailty and failure to thrive. In: Hazzard WR, Blass JP, Ettinger WH, Halter JB, Ouslander J, eds. Principles of geriatric medicine and gerontology. 4th ed. New York, NY: McGraw Hill, 1999:1387–402.
  • Kiely DK, Kiel DP, Burrows AB, and Lipsitz LA. Identifying nursing home residents at risk for falling. J Am Geriatr Soc. 1998.  May; 46(5):551–5. [PubMed]
  • American Geriatrics Society, British Geriatrics Society, American Academy of Orthopaedic Surgeons Panel on Falls Prevention. Guideline for the prevention of falls in older persons. J Am Geriatr Soc. 2001.  May; 49(5):664–72. [PubMed]
  • National Institute for Health and Clinical Excellence. Clinical practice guideline for the assessment and prevention of falls in older people [web document]. London, UK: Royal College of Nursing, 2005. [rev. 2004 Nov; cited 19 Oct 2007]. <http://guidance.nice.org.uk/CG21/>.
  • National Guideline Clearinghouse (NGC). [web document]. Rockville, MD: Agency for Healthcare Research and Quality, 2007. [rev. 26 Nov 2007; cited 29 Nov 2007]. <http://www.guideline.gov>.
  • Falls and fall risk [web document]. Columbia, MD: American Medical Directors Association, 1998. National Guideline Clearinghouse. [cited 19 Oct 2007]. <http://www.ngc.gov/summary/summary.aspx?doc_id=4953>.
  • Resnick B. Preventing falls in acute care. In: Mezey M, Fulmer T, Abraham I, Zwicker DA, eds. Geriatric nursing protocols for best practice. 2nd ed. New York, NY: Springer Publishing Company, 2003:141–64.
  • Lyons SS. Fall prevention for older adults [web document]. Iowa City, IA: University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core, 2004. National Guideline Clearinghouse. [rev. Feb 2004; cited 19 Oct 2007]. <http://www.ngc.gov/summary/summary.aspx?doc_id=4833>.
  • Prevention of falls and fall injuries in the older adult [web document]. Toronto, ON: Registered Nurses Association of Ontario, 2005. National Guideline Clearinghouse. [rev 2004 Mar; cited 29 Nov 2007]. <http://www.ngc.gov/summary/summary.aspx?doc_id=7091&nbr=004264>.
  • Norris MA, Walton RE, Patterson CJS, and Feightner JW. Prevention of falls in long-term care facilities [web document]. London, ON: Canadian Task Force on Preventive Health Care, 2005. [cited 19 Oct 2007]. <http://www.ctfphc.org/Sections/Falls.htm>.
  • Best Practice Committee, Health Care Association of New Jersey. Fall management guideline [web document]. Hamilton, NJ: The Association, 2007. [rev. Mar 2007; cited 19 Oct 2007]. <http://www.hcanj.org/docs/hcanjbp_fallmgmt6.pdf>.
  • Health statistics 2007. [web document]. Geneva, Switzerland: World Health Organization Press, 2007. [cited 26 Nov 2007]. <http://www.who.int/whosis/whostat2007.pdf>.
  • Moreland J, Richardson J, Chan DH, O'Neill J, Bellissimo A, Grum RM, and Shanks L. Evidence-based guidelines for the secondary prevention of falls in older adults. Gerontology. 2003.  Mar; 49(2):93–116. [PubMed]
  • Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, and Rowe BH. Interventions for preventing falls in elderly people. Cochrane Database Syst Rev 2003;(4): CD000340. [PubMed]
  • McClure R, Turner C, Peel N, Spinks A, Eakin E, and Hughes K. Population-based interventions for the prevention of fall-related injuries in older people. Cochrane Database Syst Rev 2005;(1):CD004441. [PubMed]
  • Lyons RA, John A, Brophy S, Jones SJ, Johansen A, Kemp A, Lannon S, Patterson J, Rolfe B, Sander LV, and Weightman A. Modification of the home environment for the reduction of injuries. Cochrane Database Syst Rev 2006;(4):CD003600. [PubMed]
  • Carter ND, Khan KM, Petit MA, Heinonen A, Waterman C, Donaldson MG, Janssen PA, Mallinson A, Riddell L, Kruse K, Prior JC, Flicker L, and McKay HA. Results of a 10-week community based strength and balance training programme to reduce fall risk factors: a randomised controlled trial in 65–75 year old women with osteoporosis. Br J Sports Med. 2001.  Oct; 35(5):348–51. [PMC free article] [PubMed]
  • Shaw FE, Bond J, Richardson DA, Dawson P, Steen IN, McKeith IG, and Kenny RA. Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: randomised controlled trial. BMJ. 2003.  Jan 11; 326(7380):73. [PMC free article] [PubMed]
  • Verhagen AP, Immink M, van der Meulen A, and Bierma-Zeinstra SM. The efficacy of tai chi chuan in older adults: a systematic review. Fam Pract. 2004.  Feb; 21(1):107–13. [PubMed]
  • Robertson MC, Campbell AJ, Gardner MM, and Devlin N. Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data. J Am Geriatr Soc. 2002.  May; 50(5):905–11. [PubMed]
  • Chang JT, Morton SC, Rubenstein LZ, Mojica WA, Maglione M, Suttorp MJ, Roth EA, and Shekelle PG. Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. BMJ. 2004.  Mar 20; 328(7441):680. [PMC free article] [PubMed]
  • Oliver D, Connelly JB, Victor CR, Shaw FE, Whitehead A, Genc Y, Vanoli A, Martin FC, and Gosney MA. Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses. BMJ. 2007.  Jan 13; 334(7584):82. [PMC free article] [PubMed]
  • Ballard JE, McFarland C, Wallace LS, Holiday DB, and Roberson G. The effect of 15 weeks of exercise on balance, leg strength, and reduction in falls in 40 women aged 65 to 89 years. J Am Med Womens Assoc. 2004.  Fall; 59(4):255–61. [PubMed]
  • Campbell AJ, Robertson MC, La Grow SJ, Kerse NM, Sanderson GF, Jacobs RJ, Sharp DM, and Hale LA. Randomised controlled trial of prevention of falls in people aged > or =75 with severe visual impairment: the VIP trial. BMJ. 2005.  Oct 8; 331(7520):817. [PMC free article] [PubMed]
  • Delbaere K, Bourgois J, Van Den Noortgate N, Vanderstraeten G, Willems T, and Cambier D. A home-based multidimensional exercise program reduced physical impairment and fear of falling. Acta Clin Belg. 2006.  Nov–Dec; 61(6):340–50. [PubMed]
  • Faber MJ, Bosscher RJ, Chin A, Paw MJ, and van Wieringen PC. Effects of exercise programs on falls and mobility in frail and pre-frail older adults: a multicenter randomized controlled trial. Arch Phys Med Rehabil. 2006.  Jul; 87(7):885–96. [PubMed]
  • Luukinen H, Lehtola S, Jokelainen J, Vaananen-Sainio R, Lotvonen S, and Koistinen P. Pragmatic exercise-oriented prevention of falls among the elderly: a population-based, randomized, controlled trial. Prev Med. 2007.  Mar; 44(3):265–71. [PubMed]
  • Means KM, Rodell DE, and O'Sullivan PS. Balance, mobility, and falls among community-dwelling elderly persons: effects of a rehabilitation exercise program. Am J Phys Med Rehabil. 2005.  Apr; 84(4):238–50. [PubMed]
  • Morgan RO, Virnig BA, Duque M, Abdel-Moty E, and Devito CA. Low-intensity exercise and reduction of the risk for falls among at-risk elders. J Gerontol A Biol Sci Med Sci. 2004.  Oct; 59(10):1062–7. [PubMed]
  • Skelton D, Dinan S, Campbell M, and Rutherford O. Tailored group exercise (falls management exercise—FaME) reduces falls in community-dwelling older frequent fallers (an RCT). Age Ageing. 2005.  Nov; 34(6):636–9. [PubMed]
  • Weerdesteyn V, Rijken H, Geurts AC, Smits-Engelsman BC, Mulder T, Duysens J.. A five-week exercise program can reduce falls and improve obstacle avoidance in the elderly. Gerontology. 2006;52(3):131–41. [PubMed]
  • Hitcho EB, Krauss MJ, Birge S, Claiborne Dunagan W, Fischer I, Johnson S, Nast PA, Costantinou E, and Fraser VJ. Characteristics and circumstances of falls in a hospital setting: a prospective analysis. J Gen Intern Med. 2004.  Jul; 19(7):732–9. [PMC free article] [PubMed]
  • Stevens JA, Corso PS, Finkelstein EA, and Miller TR. The costs of fatal and non-fatal falls among older adults. Inj Prev. 2006.  Oct; 12(5):290–5. [PMC free article] [PubMed]

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