1. JAMA. 2017 Nov 7;318(17):1687-1699. doi: 10.1001/jama.2017.15006.

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

Tricco AC(1)(2), Thomas SM(1), Veroniki AA(1), Hamid JS(1), Cogo E(1), Strifler
L(1)(3), Khan PA(1), Robson R(1), Sibley KM(4)(5), MacDonald H(1), Riva JJ(6)(7),
Thavorn K(1)(8), Wilson C(1), Holroyd-Leduc J(9), Kerr GD(1), Feldman F(10),
Majumdar SR(11), Jaglal SB(12), Hui W(1), Straus SE(1)(13).

Author information: 
(1)Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's
Hospital, Toronto, Ontario, Canada.
(2)Epidemiology Division, Dalla Lana School of Public Health, University of
Toronto, Toronto, Ontario, Canada.
(3)Institute of Health Policy, Management and Evaluation, University of Toronto, 
Toronto, Ontario, Canada.
(4)Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario,
Canada.
(5)Department of Community Health Sciences, University of Manitoba, Winnipeg,
Manitoba, Canada.
(6)Department of Family Medicine, David Braley Health Sciences Centre, McMaster
University, Hamilton, Ontario, Canada.
(7)Department of Health Research Methods, Evidence, and Impact, McMaster
University, Hamilton, Ontario, Canada.
(8)Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa,
Ontario, Canada.
(9)Departments of Medicine and Community Health Sciences, University of Calgary, 
Calgary, Alberta, Canada.
(10)Older Adult Program, Fraser Health, Surrey, British Columbia, Canada.
(11)Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
(12)Department of Physical Therapy, University of Toronto, Toronto, Ontario,
Canada.
(13)Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

Comment in
    JAMA. 2017 Nov 7;318(17 ):1659-1660.
    JAMA. 2018 Apr 3;319(13):1382.

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.

DOI: 10.1001/jama.2017.15006 
PMCID: PMC5818787
PMID: 29114830  [Indexed for MEDLINE]