BMJ  2004;328:680 (20 March), doi:10.1136/bmj.328.7441.680

Primary care

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

¹ Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California at Los Angeles, CA 90095, USA, ² Southern California Evidence-Based Practice Center, RAND Health, Santa Monica, CA 90407, USA, ³ Greater Los Angeles VA Medical Center, Sepulveda, CA 91343, USA

Objective To assess the relative effectiveness of interventions to prevent falls in older adults to either a usual care group or control group.

View this table: [in this window] [in a new window]   Table 2 Components of multifactorial falls risk assessment

 
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.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Related Articles

Reasons or excuses for avoiding meta-analysis in forest plots

John P A Ioannidis, Nikolaos A Patsopoulos, and Hannah R Rothstein
BMJ 2008 336: 1413-1415. [Extract] [Full Text] [PDF]

Direct intervention is needed

Barney S Spivack
BMJ 2008 336: 343. [Extract] [Full Text] [PDF]

Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: systematic review and meta-analysis

S Gates, J D Fisher, M W Cooke, Y H Carter, and S E Lamb
BMJ 2008 336: 130-133. [Abstract] [Full Text] [PDF]

Preventing falls in elderly people living in hospitals and care homes

Ian D Cameron and Susan Kurrle
BMJ 2007 334: 53-54. [Extract] [Full Text] [PDF]

Preventing falls in elderly people

Lesley Gillespie
BMJ 2004 328: 653-654. [Extract] [Full Text] [PDF]

Effectiveness of targeted falls prevention programme in subacute hospital setting: randomised controlled trial

Terry P Haines, Kim L Bennell, Richard H Osborne, and Keith D Hill
BMJ 2004 328: 676. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

• Tinetti, M. E., Baker, D. I., King, M., Gottschalk, M., Murphy, T. E., Acampora, D., Carlin, B. P., Leo-Summers, L., Allore, H. G. (2008). Effect of Dissemination of Evidence in Reducing Injuries from Falls. NEJM 359: 252-261 [Abstract] [Full text]  
• Li, F., Harmer, P., Glasgow, R., Mack, K. A., Sleet, D., Fisher, K. J., Kohn, M. A., Millet, L. M., Mead, J., Xu, J., Lin, M.-L., Yang, T., Sutton, B., Tompkins, Y. (2008). Translation of an Effective Tai Chi Intervention Into a Community-Based Falls-Prevention Program. Am. J. Public Health 98: 1195-1198 [Abstract] [Full text]  
• Ioannidis, J. P A, Patsopoulos, N. A, Rothstein, H. R (2008). Reasons or excuses for avoiding meta-analysis in forest plots. BMJ 336: 1413-1415 [Full text]  
• Liu, H., Paige, N. M., Goldzweig, C. L., Wong, E., Zhou, A., Suttorp, M. J., Munjas, B., Orwoll, E., Shekelle, P. (2008). Screening for Osteoporosis in Men: A Systematic Review for an American College of Physicians Guideline. ANN INTERN MED 148: 685-701 [Abstract] [Full text]  
• Heesch, K C, Byles, J E, Brown, W J (2008). Prospective association between physical activity and falls in community-dwelling older women. J. Epidemiol. Community Health 62: 421-426 [Abstract] [Full text]  
• Ebeling, P. R. (2008). Osteoporosis in Men. NEJM 358: 1474-1482 [Full text]  
• Bartoletti, A., Fabiani, P., Bagnoli, L., Cappelletti, C., Cappellini, M., Nappini, G., Gianni, R., Lavacchi, A., Santoro, G. M. (2008). Physical injuries caused by a transient loss of consciousness: main clinical characteristics of patients and diagnostic contribution of carotid sinus massage. Eur Heart J 29: 618-624 [Abstract] [Full text]  
• Spivack, B. S (2008). Direct intervention is needed. BMJ 336: 343-343 [Full text]  
• Lamoreux, E. L., Chong, E., Wang, J. J., Saw, S. M., Aung, T., Mitchell, P., Wong, T. Y. (2008). Visual Impairment, Causes of Vision Loss, and Falls: The Singapore Malay Eye Study. IOVS 49: 528-533 [Abstract] [Full text]  
• van Helden, S., van Geel, A. C.M., Geusens, P. P., Kessels, A., Nieuwenhuijzen Kruseman, A. C., Brink, P. R.G. (2008). Bone and Fall-Related Fracture Risks in Women and Men with a Recent Clinical Fracture. JBJS 90: 241-248 [Abstract] [Full text]  
• Gates, S, Fisher, J D, Cooke, M W, Carter, Y H, Lamb, S E (2008). Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: systematic review and meta-analysis. BMJ 336: 130-133 [Abstract] [Full text]  
• Laybourne, A. H., Biggs, S., Martin, F. C. (2008). Falls exercise interventions and reduced falls rate: Always in the patient's interest?. Age Ageing 37: 10-13 [Abstract] [Full text]  
• Shumway-Cook, A., Silver, I. F., LeMier, M., York, S., Cummings, P., Koepsell, T. D. (2007). Effectiveness of a Community-Based Multifactorial Intervention on Falls and Fall Risk Factors in Community-Living Older Adults: A Randomized, Controlled Trial. J. Gerontol. A Biol. Sci. Med. Sci. 62: 1420-1427 [Abstract] [Full text]  
• Freeman, E. E., Munoz, B., Rubin, G., West, S. K. (2007). Visual Field Loss Increases the Risk of Falls in Older Adults: The Salisbury Eye Evaluation. IOVS 48: 4445-4450 [Abstract] [Full text]  
• Westlake, K. P, Culham, E. G (2007). Sensory-Specific Balance Training in Older Adults: Effect on Proprioceptive Reintegration and Cognitive Demands. ptjournal 87: 1274-1283 [Abstract] [Full text]  
• Baker, D. I., Gottschalk, M., Bianco, L. M. (2007). Step by Step: Integrating Evidence-Based Fall-Risk Management Into Senior Centers. Gerontologist 47: 548-554 [Abstract] [Full text]  
• Jamieson, L. M, Roberts-Thomson, K. F (2007). Hospitalized head injuries among older people in Australia, 1998/1999 to 2004/2005. Inj. Prev. 13: 243-247 [Abstract] [Full text]  
• Ashburn, A., Fazakarley, L., Ballinger, C., Pickering, R., McLellan, L. D, Fitton, C. (2007). A randomised controlled trial of a home based exercise programme to reduce the risk of falling among people with Parkinson's disease. J. Neurol. Neurosurg. Psychiatry 78: 678-684 [Abstract] [Full text]  
• Yardley, L, Beyer, N, Hauer, K, McKee, K, Ballinger, C, Todd, C (2007). Recommendations for promoting the engagement of older people in activities to prevent falls. Qual Saf Health Care 16: 230-234 [Abstract] [Full text]  
• Yardley, L., Nyman, S. R. (2007). Internet provision of tailored advice on falls prevention activities for older people: a randomized controlled evaluation. HEALTH PROMOT INT 22: 122-128 [Abstract] [Full text]  
• Donat, H., Ozcan, A. (2007). Comparison of the effectiveness of two programmes on older adults at risk of falling: unsupervised home exercise and supervised group exercise. Clin Rehabil 21: 273-283 [Abstract]  
• Yardley, L., Donovan-Hall, M., Francis, K., Todd, C. (2007). Attitudes and Beliefs That Predict Older People's Intention to Undertake Strength and Balance Training. J. Gerontol. B Psychol. Sci. Soc. Sci. 62: P119-P125 [Abstract] [Full text]  
• Kannus, P., Palvanen, M., Niemi, S., Parkkari, J. (2007). Alarming Rise in the Number and Incidence of Fall-Induced Cervical Spine Injuries Among Older Adults. J. Gerontol. A Biol. Sci. Med. Sci. 62: 180-183 [Abstract] [Full text]  
• Cameron, I. D, Kurrle, S. (2007). Preventing falls in elderly people living in hospitals and care homes. BMJ 334: 53-54 [Full text]  
• Ganz, D. A., Bao, Y., Shekelle, P. G., Rubenstein, L. Z. (2007). Will My Patient Fall?. JAMA 297: 77-86 [Abstract] [Full text]  
• Tinetti, M. E., Gordon, C., Sogolow, E., Lapin, P., Bradley, E. H. (2006). Fall-Risk Evaluation and Management: Challenges in Adopting Geriatric Care Practices. Gerontologist 46: 717-725 [Abstract] [Full text]  
• Yardley, L., Bishop, F. L., Beyer, N., Hauer, K., Kempen, G. I. J. M., Piot-Ziegler, C., Todd, C. J., Cuttelod, T., Horne, M., Lanta, K., Holt, A. R. (2006). Older People's Views of Falls-Prevention Interventions in Six European Countries.. Gerontologist 46: 650-660 [Abstract] [Full text]  
• Sayer, A. A., Syddall, H. E., Martin, H. J., Dennison, E. M., Anderson, F. H., Cooper, C. (2006). Falls, Sarcopenia, and Growth in Early Life: Findings from the Hertfordshire Cohort Study. Am J Epidemiol 164: 665-671 [Abstract] [Full text]  
• Belza, B., Shumway-Cook, A., Phelan, E. A., Williams, B., Snyder, S. J., LoGerfo, J. P. (2006). The Effects of a Community-Based Exercise Program on Function and Health in Older Adults: The EnhanceFitness Program. Journal of Applied Gerontology 25: 291-306 [Abstract]  
• Yardley, L, Donovan-Hall, M, Francis, K, Todd, C (2006). Older people's views of advice about falls prevention: a qualitative study. Health Educ Res 21: 508-517 [Abstract] [Full text]  
• Shojania, K. G., Ranji, S. R., McDonald, K. M., Grimshaw, J. M., Sundaram, V., Rushakoff, R. J., Owens, D. K. (2006). Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis.. JAMA 296: 427-440 [Abstract] [Full text]  
• Pearson, S., Inglis, S. C., McLennan, S. N., Brennan, L., Russell, M., Wilkinson, D., Thompson, D. R., Stewart, S. (2006). Prolonged effects of a home-based intervention in patients with chronic illness.. Arch Intern Med 166: 645-650 [Abstract] [Full text]  
• Wiles, C M, Busse, M E, Sampson, C M, Rogers, M T, Fenton-May, J, van Deursen, R (2006). Falls and stumbles in myotonic dystrophy. J. Neurol. Neurosurg. Psychiatry 77: 393-396 [Abstract] [Full text]  
• Forkan, R., Pumper, B., Smyth, N., Wirkkala, H., Ciol, M. A, Shumway-Cook, A. (2006). Exercise Adherence Following Physical Therapy Intervention in Older Adults With Impaired Balance. ptjournal 86: 401-410 [Abstract] [Full text]  
• Robitaille, Y., Laforest, S., Fournier, M., Gauvin, L., Parisien, M., Corriveau, H., Trickey, F., Damestoy, N. (2005). Moving Forward in Fall Prevention: An Intervention to Improve Balance Among Older Adults in Real-World Settings. Am. J. Public Health 95: 2049-2056 [Abstract] [Full text]  
• Kannus, P. (2005). KANNUS RESPONDS. Am. J. Public Health 95: 1306-1306 [Full text]  
• Reed, D., Price, E. G., Windish, D. M., Wright, S. M., Gozu, A., Hsu, E. B., Beach, M. C., Kern, D., Bass, E. B. (2005). Challenges in Systematic Reviews of Educational Intervention Studies. ANN INTERN MED 142: 1080-1089 [Abstract] [Full text]  
• Venning, G. (2005). Recent developments in vitamin D deficiency and muscle weakness among elderly people. BMJ 330: 524-526 [Full text]  
• Allore, H. G, Tinettia, M. E, Gill, T. M, Peduzzi, P. N (2005). Experimental designs for multicomponent interventions among persons with multifactorial geriatric syndromes. Clin Trials 2: 13-21 [Abstract]  
• Nair, A, Parr, H, Whitelock, H, Hanspal, R S (2005). Prevention of falls in hospital inpatients. JRSM 98: 45-45 [Full text]  
• (2004). Splinters & Fragments. Inj. Prev. 10: 384-384 [Full text]  
• (2004). 23 Apr 2004 to 23 Jul 2004. Evid. Based Nurs. 7: e4-e4 [Full text]  
• (2004). Other articles noted. Evid. Based Med. 9: e5-e5 [Full text]  
• (2004). Other articles noted. Evid. Based Med. 9: 159-160 [Full text]  
• (2004). Can We Prevent Falls in Older Adults?. JWatch General 2004: 4-4 [Full text]  
• Gillespie, L. (2004). Preventing falls in elderly people. BMJ 328: 653-654 [Full text]  

Rapid Responses:

Read all Rapid Responses

Vitamin D largely overlooked in review of interventions for the prevention of falls in older adults

William B. Grant
bmj.com, 20 Mar 2004 [Full text]