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

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7441.680 (Published 18 March 2004) Cite this as: BMJ 2004;328:680

Data supplement

  • Appendix 1 Review and Background Articles

    Table A Randomised controlled trials included in meta-analysis

    Table B Studies with falls outcomes excluded from meta-analyses
     

    Appendix 1 [as supplied by author]. Review and Background Articles

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    Preventing falls and further injury in older people. Nursing Standard 1996 10:(47)32-33.

    Preventing falls in elderly. Physiother Frontline 1997 3:(23)18.

    Aguilar JJ, Santos FJ, Usabiaga T, Renau E, San Segundo R, Galvez S. Physical exercise and prevention of osteoporosis. Review [Spanish]. Rehabilitacion 1999 33:(3)195-9.

    American Medical Directors Association. Falls and Fall Risk. Clinical Practice Guideline 1998. AMA; 1998.

    Askham J, Glucksman E, Owens O, Swift C, Tinker A, Yu G. A Review of Research on Fall Among Elderly People. London: Age Concern Institute of Gerontology; 1990.

    Askham J, Glucksman E, Owens O, Swift C, Tinker A, Yu G. A review of research on falls among elderly people. London: Age Concern Institute of Gerontology; 1990.

    Baraff LJ, Della Penna R, Williams N, Sanders A. Practice guideline for the ED management of falls in community-dwelling elderly persons. Kaiser Permanente Medical Group. Ann Emerg Med 1997 30:(4)480-92.

    Brown AP. Reducing falls in elderly people: A review of exercise interventions. Physiother Theory Pract 1999 15:(2)59-68.

    Buchner D, Cress ME, Wagner EH, de Lateur BJ . The role of exercise in fall prevention: Developing targeting criteria for exercise programs. In: Vellas B, Toupet M, Rubenstein L, Albarede JL, Christen Y. (Eds.) Falls, balance, and gait disorders in the elderly. Amsterdam: Elsevier; 1992. p. 55-68.

    Campbell AJ. Role of rehabilitation in fall recovery and prevention. Rev Clinical Gerontol 1992 2:(1)53-65.

    Campbell AJ, Robertson MC, Gardner MM. Elderly people who fall: Identifying and managing the causes. Br J Hosp Med 1995 54:(10)520-3.

    Campbell JA. Drug treatment as a cause of falls in old age. A review of offending agents. Drugs Aging 1991 1:289-302.

    Chandler JM, Hadley EC. Exercise to improve physiologic and functional performance in old age. Clin Geriatr Med 1996 12:(4)761-84.

    Clemson L, Fitzgerald MH, Heard R. Content validity of an assessment tool to identify home fall hazards: the Westmead Home Safety Assessment. Br J Occup Ther 1999 62:(4)171-9.

    Commodore DI. Falls in the elderly population: a look at incidence, risks, healthcare costs, and preventive strategies. Rehabil Nurs 1995 20:(2)84-9.

    Coombs F. Engineering technology in rehabilitation of older adults. Exp Aging Res 1994 20:(3)201-9.

    Cumming RG. Epidemiology of medication-related falls and fractures in the elderly. Drugs Aging 1998 12:(1)43-53.

    Dishman RK. Compliance/adherence in health related exercise. Health Psychology 1988 1:237-267.

    Edwards N. A structured and individualised safety programme reduced falls in high risk nursing home patients. Evid Based Nurs 1998 1:(2)52.

    Evans D, Hodgkinson B, Lambert L, Wood J. Fall prevention: A systematic review. Clinical Effectiveness in Nursing 1999 3:106-111.

    Evans D, Hodgkinson B, Lambert L, Wood J. Falls risk factors in the hospital setting: a systematic review. Int J Nurs Pract 2001 7:(1)38-45.

    Feder G, Cryer C, Carter Y. Guidelines for the prevention of falls in people over 65. BMJ 2000 321:(7267)1007.

    Fitzsimmons A, Freundlich B, Bonner F. Osteoporosis and rehabilitation. Crit Rev Phys Rehabil Med 1997 9:(3/4)331-53.

    Fletcher A. Multidimensional assessment of elderly people in the community. Br Med Bull 1998 54:(4)945-60.

    Gardner MM, Buchner DM, Robertson C, Campbell AJ. Practical implementation of an exercise-based falls prevention programme. Age and Ageing 2001 30:77-83.

    Gardner MM, Robertson MC, Campbell AJ. Exercise in preventing falls and fall related injuries in older people: a review of randomised controlled trials. Br J Sports Med 2000 34:(1)7-17.

    Gillespie LD, Gillespie WJ, Cumming RG, Lamb SE, Rowe BH. Interventions for preventing falls in the elderly. In: The Cochrane Library, Issue 3. 2002.

    Gillies D. Elderly trauma: they are different. Aust Crit Care 1999 12:(1)24-30.

    Hayes N. A risk assessment score predicted which elderly patients would fall during a hospital stay. Evid Based Nurs 1998 1:(3)90.

    Hill-Westmoreland EE, Soeken K, Spellbring AM. A meta-analysis of fall prevention programs for the elderly: how effective are they? Nurs Res 2002 51:(1)1-8.

    Hillsdon M, Thorogood M, Anstiss T, Morris J . Randomised controlled trials of physical activity promotion in free living populations. J Epidemiol Community Health 1995 49:448--453.

    Hoskin AF. Fatal falls: trends and characteristics. Stat Bull Metrop Insur Co 1998 79:(2)10-5.

    Josephson KR, Fabacher DA, Rubenstein LZ. Home safety and fall prevention. Clin Geriatr Med 1991 7:707-731.

    Kiel DP. The evaluation of falls in the emergency department. Clin Geriatr Med 1993 9:(3)591-9.

    King MB, Tinetti ME. Falls in community-dwelling older persons. J Am Geriatr Soc 1995 43:1146-1154.

    King MB, Tinetti ME. A multifactorial approach to reducing injurious falls. Clin Geriatr Med 1996 12:(4)745-59.

    Lacroix AZ. Thiazide diuretic agents and prevention of hip fracture. Compr Ther 1991 17:(8)30-9.

    Lange M. The challenge of fall prevention in home care: A review of the literature. Home Healthcare Nurse 1996 14:(3)198-206.

    Lauritzen JB. Hip fractures. Epidemiology, risk factors, falls, energy absorption, hip protectors, and prevention. Dan Med Bull 1997 44:(2)155-68.

    Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc 1999 47:(1)30-39.

    Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs. J Am Geriatr Soc 1999 47:(1)40-50.

    Lewis RD, Modlesky CM. Nutrition, physical activity, and bone health in women. Int J Sport Nutr 1998 8:(3)250-284.

    Mahoney JE. Immobility and falls. Clin Geriatr Med 1998 14:(4)699-726.

    Maki BE, Mcllroy WE. Control of compensatory stepping reactions: age-related impairment and the potential for remedial intervention. Physiother Theory Pract 1999 15:(2)69-92.

    Mihalko S. Strength training in older women: Does self-efficacy mediate improvements in physical function? University of Illinois at Urbana-Champaign. 1997.

    Monane M, Avorn J. Medications and Falls. Causation, correlation and convention. Clin Geriatr Med 1996 12:847-858.

    Myers AH, Young Y, Langlois JA. Prevention of falls in the elderly. Bone 1996 18:(1 Suppl)87S-101S.

    Nakamura DM, Holm MB, Wilson A. Measures of balance and fear of falling in the elderly: a review. Phys Occup Ther Geriatr 1998 15:(4)17-32.

    Newbury J, Marley J. Preventive home visits to elderly people in the community. Visits are most useful for people aged >/= 75. BMJ 2000 321:(7259)512; discussion 513.

    Nicholl JP, Coleman P, Brazier JE. Health and healthcare costs and benefits of exercise. Pharmacoeconomics 1994 5:109-122.

    Nichols AW. Moderate exercise improves stability in elders. Phys Sportsmed 1999 27:(11)16-28.

    Nickens H. Intrinsic factors in falling among the elderly. Arch Intern Med 1985 145:1089-1093.

    Norton R. Preventing falls and fall-related injuries among older-people. Austral J A 1999 18:(4)160-166.

    Oakley AE, France Dawson M, Holland J, Arnold S, Cryer C, Doyle Y, et al. Preventing falls and subsequent injury in older people. Qual Health Care 1996 5:243-9.

    Oliver D, Hopper A, Seed P. Do hospital fall prevention programs work? A systematic review. J Am Geriatr Soc 2000 48:(12)1679-89.

    Overstall PW. Prevention of falls in the elderly. J Am Geriatr Soc 1980 28:(11)481-4.

    Perle SM, Mutell DB, Romanelli R. Age-related changes in skeletal muscle strength and modifications through exercise: A literature review. J Sports Chiro Rehab 1997 11:(3)97-103.

    Perry BC. Falls among the elderly: a review of the methods and conclusions of epidemiologic studies. J Am Geriatr Soc 1982 30:(6)367-71.

    Province MA, Hadley EC, Hornbrook MC, Lipsitz LA, Miller JP, Mulrow CD, et al. The effects of exercise on falls in elderly patients. A preplanned meta- analysis of the FICSIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques. JAMA 1995 273:(17)1341-7.

    Rawsky E. Review of the literature on falls among the elderly. Image J Nurs Sch 1998 30:(1)47-52.

    Rhymes J, Jaeger R. Falls: Prevention and management in the institutional setting. Clinics Geriatr Med 1988 4:613-622.

    Robertson MC, Campbell AJ, Gardner MM, Devlin N. Preventing injuries in older people by preventing falls: a meta- analysis of individual-level data. J Am Geriatr Soc 2002 50:(5)905-11.

    Rubenstein L, Robbins A, Josephson K, Tureblood P, Wallis RA, Loy S. Effects of an exercise intervention on fall-prone elderly men. J Am Geriatr Soc 1994 149:(suppl)SA5.

    Rubenstein LA, Robbins AS, Schulman BL, et al . Falls and instability in the elderly. J Am Geriatr Soc 1988 36:266-278.

    Rubenstein LZ, Josephson KR, Osterweil D. Falls and fall prevention in the nursing home. Clin Geriatric Med 1996 12:(4)881-902.

    Rubenstein LZ, Josephson KR, Robbins AS. Falls in the nursing home. Ann Intern Med 1994 121(6):442-51.

    Sattin RW. Falls among older persons: A public health perspective. Annu Rev Public Health 1992 13:489-508.

    Simpson JM, Marsh N, Harrington R. Guidelines for managing falls among elderly people. Br J Occup Ther 1998 61:(4)165-8.

    Skelton DA, Dinan SM. Exercise for falls management: rationale for an exercise programme aimed at reducing postural instability. Physiother Theory Pract 1999 15:(2)105-20.

    Smith EL, Tommerup L. Exercise - A prevention and treatment for osteoporosis and injurious falls in the older adult. J Aging Phys Activity 1995 3:(2)178-92.

    Snow CM. Exercise effects on falls in frail elderly: Focus on strength. J Appl Biomech 1999 15:(1)84-91.

    Sorock GS. Falls among the elderly: Epidemiology and prevention. Am J Prev Med 1988 4:282-288.

    Stalenhoef PA, Crebolder H, Knottnerus A, Van Der Horst F. Incidence, risk factors and consequences of falls among elderly subjects living in the community: A criteria-based analysis. Eur J Public Health 1997 7:328-334.

    Steinmetz HM, Hobson SJ. Prevention of falls among the community-dwelling elderly: An overview. Phys Occup Ther Geriatr 1994 12 :(4)13-29.

    Tinetti ME, Speechley M. Prevention of falls among the elderly. N Engl J Med 1989 320:1055-1059.

    Udani JK, Ofman JJ. Tai Chi for the prevention of falls in the elderly. Integr Med 1998 1:(4)167-169.

    Vandervoort AA. Ankle mobility and postural stability. Physiother Theory Pract 1999 15:(2)91-103.

    Wagner SG, Pfeifer A, Cranfield TL, Craik RL . The effects of ageing on muscle strength and function: a review of the literature. Physiother Theory Pract 1994 10:(1)9-16.

    Weinstein BE, Devons CA. The dizzy patient: stepwise workup of a common complaint. Geriatrics 1995 50:(6)42-6, 49.

    Whitney SL, Poole JL, Cass SP. A review of balance instruments for older adults. Am J Occup Ther 1998 52:(8)666-71.

    Wolter LL, Studenski SA. A clinical synthesis of falls intervention trials. Top Geriatr Rehabil 1996 11:(3)9-19.
     
     

    Table A Randomised controlled trials included in meta-analysis
     

    Trial
    Sample size
    Jadad Score
    Concealment
    Principal intervention (No entering; No completing)
    Outcomes
    Buchner 1997w11052Not doneArm 1, usual care (30; 29); arm 2, exercise (endurance training: 25; 21); arm 3, exercise (strength training: 25; 22); arm 4, exercise (endurance and strength training: 25; 24)Proportion (60%) who had at least one fall in 7-18 months and number of falls (23) in 12 months 

    Proportion (42%) who had at least one fall in 7-18 months and number of falls (61) in 12 months: 30 for arms 2-4 combined

    Campbell 1997w22233YesArm 1, control (117; 110); arm 2, exercise (general physical activity, balance, gait, and strength training: 116; 103)Proportion (54%) who had at least one fall in 12 months and number of falls (152) in 11.6 months

    Proportion (46%) who had at least one fall in 12 months and number of falls (88) in 10.5 months

    Campbell 1999bw3933YesArm 1, usual care (24; 22); arm 2, drug review; arm 3, exercise (balance and strength training: 24; 18) arm 4, exercise (balance and strength training: 21; 17) and drug review (24; 15)Number of falls (arm 1=35; arm 3=22) in 8.7 months
    Carpenter 1990w45393Not doneArm 1, usual care (267; 186); arm 2, falls risk assessment and management (272; 181)Number of falls (36; 12) in one month
    Cerny 1998w5281Not doneArm 1, usual care (13; not reported); arm 2, exercise (general physical activity, balance and strength training: 15; not reported)Proportion (23%; 20%) who had at least one fall in six months
    Close 1999w63973YesArm 1, usual care (213; 163); arm 2, falls risk assessment and management (184; 141)Proportion (52%; 32%) who had at least one fall in 12 months and number of falls (510; 183) in 12 months
    Coleman 1999w71692Not doneArm, usual care (73 (50)*; 49); arm 2, falls risk assessment and management (96 (52*); 78)Proportion (38%; 44%) who had at least one fall in 12 months
    Crome 2000w8781Not doneArm 1, usual care (38; 27); arm 2, exercise (general physical activity, balance: 40; 29)Number of falls (127; 122) in six months
    Cumming 1999w95303YesArm 1, usual care (266; 190); arm 2, environmental modifications (264; 198)Proportion (45%; 36%) who had at least one fall in 12 months
    Day 2002w1010902Not doneArm 1, control (137; 47); arm 2, exercise (135; 70); arm 3, environmental modifications (136; 58); arm 4, vision (139; 51); arm 5, exercise and environmental modifications (135; 61); arm 6, exercise and vision (136; 49); arm 7, vision and environmental modifications (137; 51) arm 8, exercise, environmental modifications, and vision (135; 55)Proportion who had at least one fall in 18 months (arm 1, 64%; arm 2, 56% (fall rate ratio compared with arm 1, 0.82); arm 3, 57% (fall rate ratio compared with arm 1=0.92); arm 5, 53% (fall rate ratio compared with arm 1, 0.76) 
    Ebrahim 1997w111653YesArm 1, control (84; 50); arm 2, exercise (general physical activity: 81; 52)Proportion (36%; 42%) who had at least one fall in 12 months and number of falls (54; 71) in 24 months
    El-Faizy 1994w12282Not doneArm 1, control (14; 11); arm 2, environmental modifications (14; 13)Number of falls (5; 9) in nine months
    Fabacher 1994w132543YesArm 1, usual care (123; 95); arm 2, falls risk assessment and management (131; 100)Proportion (23%; 14%) who had at least one fall in 12 months
    Fiatarone 1993w141003Not doneArm 1, control (26; 26); arm 2, exercise (strength training: 25; 25); arm 3, nutritional Supplement (24; 22); arm 4, exercise (strength training) and nutritional supplement (25; 25)Number of falls (arm 1, 72; arm 2, 58) in 18 months 
    Gallagher 1996w151002Not doneArm 1, control (50; 50); arm 2, falls risk assessment and management (50; 50)Number of falls in six months (arm 1, 105; arm 2, 85)
    Hornbrook 1994w1631822Not doneArm 1, control (1571; not reported); arm 2, environmental modifications (1611; 1455)Number of falls (2084) in 22.8 months and number of falls (1730) in 22 months
    Jensen 2002w174023Not doneArm 1, usual care (208; 167); arm 2, falls risk assessment and management (194 (188)*; 157)Proportion (56%; 44%) who had at least one fall in 8.5 months and number of falls (346; 273) in 7.1 months
    Lord 1995w181972Not doneArm 1, usual care (97 (94)*; 76); arm 2, exercise (general physical activity, balance and strength: 100 (75)*; 75) Proportion (35%; 35%) who had at least one fall in 12 months and number of falls (59; 40) in 12 months
    Mayo 1994w191342Not doneArm 1, usual care (69; 69); arm 2, education (65; 65)Proportion 30%; 42%) who had at least one fall in 12 months
    McMurdo 1997w201182Not doneArm 1, calcium supplement (60; 48); arm 2, exercise (general physical activity) and calcium supplement (58; 44)Number of falls (31; 15) in 24 months
    McMurdo 2000w211332Not doneArm 1, control (56; 38); arm 2, exercise (balance: 77; 25)Proportion (58%; 43%) who had at least one fall in a 7-12 month period after a 6 month intervention and number of falls (67; 68) in 5.2 months
    McRae 1994w22802Not doneArm 1, control (38; 31); arm 2, exercise (general physical activity, balance and strength: 42; 28)Proportion (45%; 36%) who had at least one fall in 12 months
    Means 1996w23993Not doneArm 1, control (balance: 52; 34); arm 2, exercise (balance, obstacle course training:47; 30)Number of falls (65; 45) in six months
    Millar 1999w24842Not doneArm 1, control (not reported; 38); arm 2, falls risk assessment and management (not reported; 46)Proportion (44%; 57%) who had at least one fall in 12 months
    Mulrow 1994w251942Not doneArm 1, control (97; 88); arm 2, exercise (general physical activity, balance, gait, and strength training, tailored physical therapy: 97; 92)Number of falls (60; 79) in four months
    Pardessus 2002w26602Not doneArm 1, control (30; 27); arm 2, home visit (environmental modification: 30; 24)Proportion (50%; 43%) who had at least one fall in 12 months
    Pereira 1998w272292Not doneArm 1, usual care (115; 100); arm 2, exercise (general physical activity: 114; 96)Proportion (33%; 27%) who had at least one fall in 12 months
    Reinsch 1992w282302Not doneArm 1, control (50; 42); arm 2, exercise (general physical activity, balance, and strength: 57; 44); arm 3, education (community centre (51; 37); arm 4, exercise (general physical activity) and education (72; 61)Proportion (40%; 50%; 46%; 54%) who had at least one fall in 12 months
    Robertson 2001w292403YesArm 1, usual care (119; 98); arm 2, exercise (general physical activity, balance, and strength: 121; 113) Number of falls (109; 80) in 12 months
    Rubenstein 1990w301602YesArm 1, usual care (81; 81); arm 2, falls risk assessment and management (79; 79)Proportion (75%; 71%) who had at least one fall in 12 months
    Rubenstein 2000w31593YesArm 1, usual care (strength training: 28; 27); arm 2, exercise (general physical activity, balance, and strength: 31; 28)Number of falls (14; 13) in 3 months
    Ryan 1996w32451Not doneArm 1, control (15; 15); arm 2, education group counselling: 15; 16); arm 3, education (individual counselling: 15; 14)Number of falls in 3 months (arm 1=6; arms 2 and 3 combined=4)
    Salkeld 2000w335301Not doneArm 1, usual care (266 (258)*; 266); arm 2, environmental modifications (264 (257)*; 264)Number of falls (324; 226) in 12 months
    Schoenfelder 2000w34162Not doneArm 1, usual care (7; 7); arm 2, exercise (general physical activity and strength training: 9; 9)Number of falls (12; 42) in six months
    Steinberg 2000w352522Not doneArm 1, control (group counselling: 63; 63); arm 2, education (group counselling) and general physical activity (69; 69); arm 3, education (group counselling), general physical activity, and environmental modifications (61; 60); arm 4, education (group and individual counselling), general physical activity, and environmental modifications (59; 57)Incidence rate (persons) 4.00/100 person months of observation, number of falls in 12 months 76 person months of observation; incidence rate 3.43/100 person months of observation, number of falls in 12 months 75 person months of observation; incidence rate 3.62/100 person months of observation; incidence rate 3.88/100 person months of observation
    Stevens 2001w3618792Not doneArm 1, control (1244; 1091); arm 2, environmental modification (635; 524)Number of falls (437; 899) in 12 months
    Tinetti 1994w373012Not doneArm 1, control (148; 144); arm 2, falls risk assessment and management and exercise (balance, gait, and strength: 153; 147) Proportion (47%; 35%) who had at least one fall in 12 months and number of falls (164; 94) in 12 months
    Van Haastregt 2000w383163Not doneArm 1, usual care (157 (123)*; 115); arm 2, environmental modifications and falls risk assessment and management (159 (129)*; 120)Proportion (44%; 50%) who had at least one fall in 12 months
    Wagner 1994w3915592Not doneArm 1, usual care (607; not reported); arm 2, falls risk assessment and management and exercise (general physical activity: 635; not reported); arm 3, education (individual counselling: 317; not reported) Proportion (37%; 28%; 30%) who had at least one fall in 12 months
    Wolf 1996w402003Not doneArm 1, control (drugs or drug review, group counselling: 64; 61) arm 2, exercise (balance training: 64; 60); arm 3, exercise (t’ai chi: 72; 66)Number of falls (arm 1, 77; arm 2, 76) in 5.39 months and number of falls (arm 3, 56) in 5.62 months

    w1 Buchner DM, Cress ME, de Lateur BJ, Esselman PC, Margherita AJ, Price R, et al. The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults. J Gerontol A Biol Sci Med Sci 1997;52:M218-24.

    w2 Campbell AJ, Robertson MC, Gardner MM, Norton RN, Tilyard MW, Buchner DM. Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ 1997;315:1065-9.

    w3 Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM. Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial. J Am Geriatr Soc 1999;47:850-3.

    w4 Carpenter GI, Demopoulos GR. Screening the elderly in the community: controlled trial of dependency surveillance using a questionnaire administered by volunteers. BMJ 1990;300:1253-6.

    w5 Cerny K, Blanks R, Mohamed O, Schwab D, Robinson B, Russo A, et al. The effect of a multidimensional exercise program on strength, range of motion, balance, and gait in the well elderly. Gait Posture 1998;7:185-6.

    w6 Close J, Ellis M, Hooper R, Glucksman E, Jackson S, Swift C, et al. Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. Lancet 1999;353:93-7.

    w7 Coleman EA, Grothaus LC, Sandhu N, Wagner EH. Chronic care clinics: a randomized controlled trial of a new model of primary care for frail older adults. J Am Geriatr Soc 1999;47:775-83.

    w8 Crome P, Hill S, Mossman J, Stockdale P. A randomised controlled trial of a nurse led falls prevention clinic [abstract]. J Am Geriatr Soc 2000;48:S78.

    w9 Cumming RG, Thomas M, Szonyi G, Salkeld G, O'Neill E, Westbury C, et al. Home visits by an occupational therapist for assessment and modification of environmental hazards: a randomized trial of falls prevention. J Am Geriatr Soc 1999;47:1397-402.

    w10 Day L, Fildes B, Gordon I, Fitzharris M, Flamer H, Lord S. Randomised factorial trial of falls prevention among older people living in their own homes. BMJ 2002;325:128.

    w11 Ebrahim S, Thompson PW, Baskaran V, Evans K. Randomized placebo-controlled trial of brisk walking in the prevention of postmenopausal osteoporosis. Age Ageing 1997;26:253-60.

    w12 El Faizy M, Reinsch S. Home safety intervention for the prevention of falls. Phys Occup Ther Geriatr 1994;12:33-49.

    w13 Fabacher D, Josephson K, Pietruszka F, Linderborn K, Morley JE, Rubenstein LZ. An in-home preventive assessment program for independent older adults: a randomized controlled trial. J Am Geriatr Soc 1994;42:630-8.

    w14 Fiatarone MA, O'Neill EF, Doyle N, Clements KM, Roberts SB, Kehayias JJ, et al. The Boston FICSIT study: the effects of resistance training and nutritional supplementation on physical frailty in the oldest old. J Am Geriatr Soc 1993;41:333-7.

    w15 Gallagher EM, Brunt H. Head over heels: impact of a health promotion program to reduce falls in the elderly. Can J Aging 1996;15:84-96.

    w16 Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, Greenlick MR, Ory MG. Preventing falls among community-dwelling older persons: results from a randomized trial. Gerontologist 1994;34:16-23.

    w17 Jensen J, Lundin-Olsson L, Nyberg L, Gustafson Y. Fall and injury prevention in older people living in residential care facilities. Ann Intern Med 2002;136:733-41.

    w18 Lord SR, Ward JA, Williams P, Strudwick M. The effect of a 12-month exercise trial on balance, strength, and falls in older women: a randomized controlled trial. J Am Geriatr Soc 1995;43:1198-206.

    w19 Mayo NE, Gloutney L, Levy AR. A randomized trial of identification bracelets to prevent falls among patients in a rehabilitation hospital. Arch Phys Med Rehabil 1994;75:1302-8.

    w20 McMurdo ME, Mole PA, Paterson CR. Controlled trial of weight bearing exercise in older women in relation to bone density and falls. BMJ 1997;314:569.

    w21 McMurdo ME, Millar AM, Daly F. A randomized controlled trial of fall prevention strategies in old peoples’ homes. Gerontology 2000;46:83-7.

    w22 McRae PG, Feltner ME, Reinsch SA. A one-year exercise program for older women: effects on falls, injuries, and physical performance. J Aging Phys Activity 1994;2:127-42.

    w23 Means KM, Rodell DE, O’Sullivan PS, Cranford LA. Rehabilitation of elderly fallers: pilot study of a low to moderate intensity exercise program. Arch Phys Med Rehabil 1996;77:1030-6.

    w24 Millar AM. A trial of falls prevention. Age Ageing 1999;28(suppl 1):15.

    w25 Mulrow CD, Gerety MB, Kanten D, Cornell JE, DeNino LA, Chiodo L, et al. A randomized trial of physical rehabilitation for very frail nursing home residents. JAMA 1994;271:519-24.

    w26 Pardessus V, Puisieux F, Di Pompeo C, Gaudefroy C, Thevenon A, Dewailly P. Benefits of home visits for falls and autonomy in the elderly: a randomized trial study. Am J Phys Med Rehabil 2002;81:247-52.

    w27 Pereira MA, Kriska AM, Day RD, Cauley JA, Laporte RE, Kuller LH. A randomized walking trial in postmenopausal women: effects of physical activity and health 10 years later. Arch Intern Med 1998;158:1695-701.

    w28 Reinsch S, MacRae P, Lachenbruch PA, Tobis JS. Attempts to prevent falls and injury: a prospective community study. Gerontologist 1992;32:450-6.

    w29 Robertson MC, Devlin N, Gardner MM, Campbell AJ. Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: Randomized controlled trial. BMJ 2001;322:697-701.

    w30 Rubenstein LZ, Robbins AS, Josephson KR, Schulman BL, Osterweil D. The value of assessing falls in an elderly population. A randomized clinical trial. Ann Intern Med 1990;113:308-16.

    w31 Rubenstein LZ, Josephson KR, Trueblood PR, Loy S, Harker JO, Pietruszka FM, et al. Effects of group exercise program on strength, mobility and falls among fall-prone elderly men. J Gerontol 2000;6:M1-5.

    w32 Ryan JW, Spellbring AM. Implementing strategies to decrease risk of falls in older women. J Gerontol Nurs 1996;22:25-31.

    w33 Salkeld G, Cumming RG, O'Neill E, Thomas M, Szonyi G, Westbury C. The cost effectiveness of a home hazard reduction program to reduce falls among older persons. Aust NZ J Public Health 2000;24:265-71.

    w34 Schoenfelder DP. A fall prevention program for elderly individuals. Exercise in long- term care settings. J Gerontol Nurs 2000;26:43-51.

    w35 Steinberg M, Cartwright C, Peel N, Williams G. A sustainable programme to prevent falls and near falls in community dwelling older people: results of a randomised trial. J Epidemiol Community Health 2000;54:227-32.

    w36 Stevens M, Holman CD, Bennett N, de Klerk N. Preventing falls in older people: outcome evaluation of a randomized controlled trial. J Am Geriatr Soc 2001;49:1448-55.

    w37 Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P, Gottschalk M, et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med 1994;331:821-7.

    w38 Van Haastregt J, Diederiks J, Crebolder H. Effects of a programme of multifactorial home visits on falls and mobility impairments in elderly people at risk: randomised controlled trial. BMJ 2000;321:994.

    w39 Wagner EH, LaCroix AZ, Grothaus L, Leveille SG, Hecht JA, Artz K, et al. Preventing disability and falls in older adults: a population-based randomized trial. Am J Public Health 1994;84:1800-6.

    w40 Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T. Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. J Am Geriatr Soc 1996;44:489-97.
     
     

    Table B Studies with falls outcomes excluded from meta-analyses
     

    TrialReason for exclusion
    Armstrong 19961No proportion of fallers (who had at least one fall) and no falls rate
    Campbell 19992Duplicate study population
    Capezuti 19953Intervention type not in conceptual model—restraints
    Capezuti 19984Duplicate study population
    Caplan 19995Intervention type not in conceptual model—"hospital in home"
    Gardner 19986Duplicate study population
    Jitapunkul 19987Follow up time not 6-18 months
    Kannus 20008Insufficient statistics
    Kenny 20019Intervention type not in conceptual model—cardiac pacing for carotid sinus syndrome
    Peel 199810Insufficient statistics
    Peel 200011Duplicate study population
    Pereira 199612Duplicate study population
    Ray 199713No proportion of fallers (who had at least one fall) and no falls rate
    Rizzo 199614Duplicate study population
    Robertson 200115Duplicate study population
    Stevens 200116Duplicate study population
    Tennstedt 199817No proportion of fallers (who had at least one fall) and no falls rate
    Tideiksaar 199318Intervention type not in conceptual model—bed alarm
    Tinetti 199619Duplicate study population
    Vellas 199120Intervention type not in conceptual model—use of a drug (raubasine-dihydroergocristine)
    Vetter 199221Follow up not 6-18 months
    Widen Homqvist 199822Intervention type not in conceptual model—home rehabilitation

    1. Armstrong AL. Hormone replacement therapy—effects on strength, balance, and bone density [Dissertation]. Nottingham, UK: University of Nottingham, 1996.

    2. Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM. Falls prevention over 2 years: a randomized controlled trial in women 80 years and older. Age Ageing 1999;28:513-8.

    3. Capezuti EA. The relationship between physical restraint removal and fall-related incidents and injuries among nursing home residents [Dissertation]. Pennsylvania: University of Pennsylvania, 1995.

    4. Capezuti E, Strumpf NE, Evans LK, Grisso JA, Maislin G. The relationship between physical restraint removal and falls and injuries among nursing home residents. J Gerontol A Biol Sci Med Sci 1998;53:M47-52.

    5. Caplan GA, Ward JA, Brennan NJ, Coconis J, Board N, Brown A. Hospital in the home: a randomised controlled trial. Med J Aust 1999;170:156-60.

    6. Gardner M. Home-based exercises to prevent falls in elderly women. NZ J Physiother 1998;26:6.

    7. Jitapunkul S. A randomised controlled trial of regular surveillance in Thai elderly using a simple questionnaire administered by non-professional personnel. J Med Assoc Thai 1998;81:352-6.

    8. Kannus P, Parkkari J, Niemi S, Pasanen M, Palvanen M, Jarvinen M, et al. Prevention of hip fracture in elderly people with use of a hip protector. N Engl J Med 2000;343:1506-13.

    9. Kenny RA, Richardson DA. Carotid sinus syndrome and falls in older adults. Am J Geriatr Cardiol 2001;10:97-9.

    10. Peel N, Cartwright C, Steinberg M. Monitoring slips, trips and falls in the older community: preliminary results. Health Promot J Aust 1998;8:148-50.

    11. Peel N, Steinberg M, Williams G. Home safety assessment in the prevention of falls among older people. Aust N Z J Public Health 2000;24:536-9.

    12. Pereira MA. Ten year follow-up of a randomized exercise trial in post-menopausal women [Dissertation]. 1996. Pittsburgh, PA: University of Pittsburgh.

    13. Ray WA, Taylor JA, Meador KG, Thapa PB, Brown AK, Kajihara HK, et al. A randomized trial of a consultation service to reduce falls in nursing homes. JAMA 1997;278:557-62.

    14. Rizzo JA, Baker DI, McAvay G, Tinetti ME. The cost-effectiveness of a multifactorial targeted prevention program for falls among community elderly persons. Med Care 1996;34:954-69.

    15. Robertson MC, Devlin N, Scuffham P, Gardner MM, Buchner DM, Campbell AJ. Economic evaluation of a community based exercise programme to prevent falls. J Epidemiol Community Health 2001;55:600-6.

    16. Stevens M, Holman CD, Bennett N. Preventing falls in older people: impact of an intervention to reduce environmental hazards in the home. J Am Geriatr Soc 2001;49:1442-7.

    17. Tennstedt S, Howland J, Lachman M, Peterson E, Kasten L, Jette A. A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults. J Gerontol B Psychol Sci Soc Sci 1998;53:P384-92.

    18. Tideiksaar R, Feiner CF, Maby J. Falls prevention: the efficacy of a bed alarm system in an acute-care setting. Mt Sinai J Med 1993;60:522-7.

    19. Tinetti ME, McAvay G, Claus E. Does multiple risk factor reduction explain the reduction in fall rate in the Yale FICSIT Trial? Frailty and Injuries Cooperative Studies of Intervention Techniques. Am J Epidemiol 1996;144:389-99.

    20. Vellas B, Albarede JL. [A randomized clinical trial on the value of raubasine-dihydroergoctistine (Iskedyl (TM)) in the prevention of post fall syndrome]. Psychologie Medicale 1991;23:831-9.

    21. Vetter NJ, Lewis PA, Ford D. Can health visitors prevent fractures in elderly people? BMJ 1992;304:888-90.

    22. Widen Holmqvist L, von Koch L, Kostulas V, Holm M, Widsell G, Tegler H, et al. A randomized controlled trial of rehabilitation at home after stroke in southwest Stockholm. Stroke 1998;29:591-7.

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