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Emerg Med J. 2016 May;33(5):345-50. doi: 10.1136/emermed-2015-204815. Epub 2016 Jan 11.

Prehospital emergency services screening and referral to reduce falls in community-dwelling older adults: a systematic review.

Author information

1
Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA.
2
Division of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
3
Becker Medical Library, Washington University School of Medicine, St. Louis, Missouri, USA.
4
Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA.

Abstract

BACKGROUND:

Falls represent an increasing source of geriatric morbidity and mortality. Prehospital emergency services may be uniquely suited to screen and refer subsets of high-risk older adults to fall prevention programmes. This systematic review assesses the effectiveness of such screening and referral programmes.

METHODS:

We searched PubMed, Embase, CINAHL, Web of Science, Scopus, the Cochrane Library and OTseeker for English-language peer-reviewed randomised trials, non-randomised trials and cohort studies evaluating prehospital fall risk screening and referral programmes for community-dwelling adults ≥60 years of age. Risk of bias was assessed using the Cochrane Collaboration's tool. Primary outcomes included the risk and rate of falling. Secondary outcomes included successful follow-up to address fall risks and adverse events.

RESULTS:

From 6187 unique records, 6 studies were included. Screening varied from using semistructured risk assessments to recording chief complaints. All studies were at high risk of bias. One unblinded trial of a multifactorial fall prevention programme demonstrated a 14.3% (95% CI 6.1% to 22.5%) absolute reduction in annual fall risk and a relative fall incidence of 0.45 (95% CI 0.35 to 0.58). The probability of successful follow-up varied from 9.8% to 81.0%. No studies demonstrated any attributable adverse events.

CONCLUSIONS:

No high-quality evidence demonstrates that prehospital services reduce falls in community-dwelling older adults. Screening by prehospital personnel using semistructured risk assessments appears feasible, but it is unclear whether this is superior to referral based on fall-related chief complaints.

TRIAL REGISTRATION NUMBER:

PROSPERO 2012:CRD42012002782.

KEYWORDS:

accident prevention; accidental falls; geriatrics; paramedics, extended roles; prehospital care

PMID:
26755748
DOI:
10.1136/emermed-2015-204815
[Indexed for MEDLINE]

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