1. JAMA. 2018 Apr 24;319(16):1705-1716. doi: 10.1001/jama.2017.21962.

Interventions to Prevent Falls in Older Adults: Updated Evidence Report and
Systematic Review for the US Preventive Services Task Force.

Guirguis-Blake JM(1)(2), Michael YL(3), Perdue LA(1), Coppola EL(1), Beil TL(1).

Author information: 
(1)Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center
for Health Research, Kaiser Permanente, Portland, Oregon.
(2)Department of Family Medicine, University of Washington, Tacoma.
(3)Dornsife School of Public Health, Drexel University, Philadelphia,
Pennsylvania.

Importance: Falls are the most common cause of injury-related morbidity and
mortality among older adults.
Objective: To systematically review literature on the effectiveness and harms of 
fall prevention interventions in community-dwelling older adults to inform the US
Preventive Services Task Force.
Data Sources: MEDLINE, PubMed, Cumulative Index for Nursing and Allied Health
Literature, and Cochrane Central Register of Controlled Trials for relevant
English-language literature published through August 2016, with ongoing
surveillance through February 7, 2018.
Study Selection: Randomized clinical trials of interventions to prevent falls in 
community-dwelling adults 65 years and older.
Data Extraction and Synthesis: Independent critical appraisal and data
abstraction by 2 reviewers. Random-effects meta-analyses using the method of
DerSimonian and Laird.
Main Outcomes and Measures: Number of falls (number of unexpected events in which
a person comes to rest on the ground, floor, or lower level), people experiencing
1 or more falls, injurious falls, people experiencing injurious falls, fractures,
people experiencing fractures, mortality, hospitalizations,
institutionalizations, changes in disability, and treatment harms.
Results: Sixty-two randomized clinical trials (N = 35 058) examining 7 fall
prevention intervention types were identified. This article focused on the 3 most
commonly studied intervention types: multifactorial (customized interventions
based on initial comprehensive individualized falls risk assessment) (26 trials
[n = 15 506]), exercise (21 trials [n = 7297]), and vitamin D supplementation (7 
trials [n = 7531]). Multifactorial intervention trials were associated with a
reduction in falls (incidence rate ratio [IRR], 0.79 [95% CI, 0.68-0.91]) but
were not associated with a reduction in other fall-related morbidity and
mortality outcomes. Exercise trials were associated with statistically
significant reductions in people experiencing a fall (relative risk, 0.89 [95% 13
CI, 0.81-0.97]) and injurious falls (IRR, 0.81 [95% CI, 0.73-0.90]) and with a
statistically nonsignificant reduction in falls (IRR, 0.87 [95% CI, 0.75-1.00])
but showed no association with mortality. Few exercise trials reported
fall-related fractures. Seven heterogeneous trials of vitamin D formulations
(with or without calcium) showed mixed results. One trial of annual high-dose
cholecalciferol (500 000 IU), which has not been replicated, showed an increase
in falls, people experiencing a fall, and injuries, while 1 trial of calcitriol
showed a reduction in falls and people experiencing a fall; the remaining 5
trials showed no significant difference in falls, people experiencing a fall, or 
injuries. Harms of multifactorial and exercise trials were rarely reported but
generally included minor musculoskeletal injuries.
Conclusions and Relevance: Multifactorial and exercise interventions were
associated with fall-related benefit, but evidence was most consistent across
multiple fall-related outcomes for exercise. Vitamin D supplementation
interventions had mixed results, with a high dose being associated with higher
rates of fall-related outcomes.

DOI: 10.1001/jama.2017.21962 
PMID: 29710140  [Indexed for MEDLINE]