Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trialsBMJ 2004; 328 doi: http://dx.doi.org/10.1136/bmj.328.7441.680 (Published 18 March 2004) Cite this as: BMJ 2004;328:680
- John T Chang, clinical instructor ()1,
- Sally C Morton, codirector2,
- Laurence Z Rubenstein, professor3,
- Walter A Mojica, physician reviewer2,
- Margaret Maglione, policy analyst2,
- Marika J Suttorp, quantitative analyst2,
- Elizabeth A Roth, senior programmer analyst2,
- Paul G Shekelle, professor1
- 1Department 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
- 2Southern California Evidence-Based Practice Center, RAND Health, Santa Monica, CA 90407, USA
- 3Greater Los Angeles VA Medical Center, Sepulveda, CA 91343, USA
- Correspondence to: J T Chang, Division of General Internal Medicine and Health Services Research, 911 Broxton Avenue, Los Angeles, CA 90095-1736, USA
- Accepted 14 January 2004
Objective To assess the relative effectiveness of interventions to prevent falls in older adults to either a usual care group or control group.
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.
Relevant articles, details of studies, and references in table 2 are on bmj.com>
Contributors JTC, SCM, LZR, WAM, MM, EAR, PGS conceived and designed the study. JTC, SCM, LZR, MJS, EAR, PGS analysed and interpreted the data. JTC drafted the article. All authors helped revise the manuscript. JTC, SCM, and PGS will act as guarantors for the paper. The guarantors accept full responsibility for the conduct of the study, had access to the data, and controlled the decision to publish.
Funding This work was supported by a contract (No 500-98-0281) from the Centers for Medicare and Medicaid Services, United States Department of Health and Human Services to RAND Health. JTC was supported by a National Research Service Award training grant (PE-19001) and the UCLA Specialty Training and Advanced Research programme. PGS was a senior research associate of the Veterans Affairs Health Services Research and Development Service.
Competing interests None declared.
Ethical approval: Not required.
- Accepted 14 January 2004