Education And Debate

Guidelines for the prevention of falls in people over 65

BMJ 2000; 321 doi: http://dx.doi.org/10.1136/bmj.321.7267.1007 (Published 21 October 2000) Cite this as: BMJ 2000;321:1007
  1. Gene Feder, professor (g.s.feder@mds.qmw.ac.uk)a,
  2. Colin Cryer, senior research fellowb,
  3. Sheila Donovan, facilitatora,
  4. Yvonne Carter, professor on behalf of the guidelines' development group.a
  1. a Department of General Practice and Primary Care, St Bartholomew's and Royal London Medical School, Queen Mary and Westfield College, London E1 4NS
  2. b Centre for Health Services Studies, University of Kent, Tunbridge Wells, Kent TN3 0TG
  1. Correspondence to: G Feder
  • Accepted 12 June 2000

General practice p 994

Older people frequently fall. This is a serious public health problem, with a substantial impact on health and healthcare costs.1 These guidelines translate trial evidence about prevention of falls into recommendations that can be implemented in different settings, with the aim of reducing the rate of falls and injurious falls in people over 65 (see boxes 2 3).

Summary points

Multifaceted interventions reduce falls in older people (those over 65)

Home assessment of older people at risk of falls without referral or direct intervention is not recommended

Assessment of high risk residents in nursing homes with relevant referral is effective

Evidence from well designed single trials shows that assessment and modification of risk factors of older people who have presented to an accident and emergency department after a fall and the provision of hip protectors in residents of nursing homes are effective

Methods

We updated two previous systematic reviews to include any new evidence up to March 1998. 4 5 We electronically searched Medline for all randomised controlled trials and systematic reviews by using the terms fall(s), accidental falls, fracture, elderly, aged, older, and senior. We followed up relevant references in papers, and we contacted researchers in prevention of falls for information about other trial evidence and about studies from journals not catalogued by the National Library of Medicine. For inclusion, studies had to be randomised controlled trials of interventions designed to minimise or prevent exposure to the risk factors for falling (or fracture) in people aged 65 years or over living in either community or residential care. Outcomes had to include the number of people who had fallen or the number of falls or fractures. We excluded drug or dietary treatments for the prevention of fractures. Trials that fulfilled the inclusion criteria were reviewed and summarised …

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