Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials

Abstract

AbstractObjective To assess the relative effectiveness of interventions to prevent falls in older adults to either a usual care group or control group.Table 2Components of multifactorial falls risk assessmentTrialOrthostatic blood pressureVisionBalance and gaitDrug reviewInstrumental activities of daily living or activities of daily livingCognitive evaluationEnvironmental hazardsOtherCarpenter 1990w4NoNoNoNoYesNoNoFabacher 1994w13YesYesYesYesYesYesYesAssessment of hearing and depressionRubenstein 1990w30YesYesYesYesYesYesYesNeurological and musculoskeletal examination, laboratory tests, 24 hour heart monitorTinetti 1994w37YesNoYesYesNoNoYesMuscle strength and range of motionWagner 1994w39NoYesNoYesNoNoYesHearing, assessment of alcohol misuse, assessment of physical activityGallagher 1996w15YesYesYesYesYesYesYesList of health problemsColeman 1999w7NoNoNoYesNoNoNoSelf management skills, health assessmentClose 1999w6YesYesYesYesYesYesYesAffect, carotid sinus studies (if clinical suspicion)McMurdo 2000w21YesYesNoYesNoNoNoReview of lighting in environmentVan Haastregt 2000w38NoNoNoYesYesYesYesPhysical health, psychosocial functioningMillar 1999w24YesYesNoYesNoNoNoReview of lighting in environmentCrome 2000w8*Jensen 2002w17NoYesYesYesYesYesYesHearing, review of lighting in environment, assistive device (for example, cane, walker), review of use of device, and repair of device if neededSee table A on bmj.com for details of references.* No specific components stated.Design Systematic review and meta-analyses.Data sources Medline, HealthSTAR, Embase, the Cochrane Library, other health related databases, and the reference lists from review articles and systematic reviews.Data extraction Components of falls intervention: multifactorial falls risk assessment with management programme, exercise, environmental modifications, or education.Results 40 trials were identified. A random effects analysis combining trials with risk ratio data showed a reduction in the risk of falling (risk ratio 0.88, 95% confidence interval 0.82 to 0.95), whereas combining trials with incidence rate data showed a reduction in the monthly rate of falling (incidence rate ratio 0.80, 0.72 to 0.88). The effect of individual components was assessed by meta-regression. A multifactorial falls risk assessment and management programme was the most effective component on risk of falling (0.82, 0.72 to 0.94, number needed to treat 11) and monthly fall rate (0.63, 0.49 to 0.83; 11.8 fewer falls in treatment group per 100 patients per month). Exercise interventions also had a beneficial effect on the risk of falling (0.86, 0.75 to 0.99, number needed to treat 16) and monthly fall rate (0.86, 0.73 to 1.01;2.7).Conclusions Interventions to prevent falls in older adults are effective in reducing both the risk of falling and the monthly rate of falling. The most effective intervention was a multifactorial falls risk assessment and management programme. Exercise programmes were also effective in reducing the risk of falling.