Intended for healthcare professionals


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 2008; 336 doi: (Published 17 January 2008) Cite this as: BMJ 2008;336:130
  1. S Gates, principal research fellow1,
  2. J D Fisher, senior research fellow2,
  3. M W Cooke, professor of emergency medicine2,
  4. Y H Carter, dean2,
  5. S E Lamb, director and professor of rehabilitation13
  1. 1Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL
  2. 2Warwick Medical School, University of Warwick
  3. 3Kadoorie Critical Care Research Centre, University of Oxford
  1. Correspondence to: S Gates s.gates{at}
  • Accepted 5 November 2007


Objective To evaluate the effectiveness of multifactorial assessment and intervention programmes to prevent falls and injuries among older adults recruited to trials in primary care, community, or emergency care settings.

Design Systematic review of randomised and quasi-randomised controlled trials, and meta-analysis.

Data sources Six electronic databases (Medline, Embase, CENTRAL, CINAHL, PsycINFO, Social Science Citation Index) to 22 March 2007, reference lists of included studies, and previous reviews.

Review methods Eligible studies were randomised or quasi-randomised trials that evaluated interventions to prevent falls that were based in emergency departments, primary care, or the community that assessed multiple risk factors for falling and provided or arranged for treatments to address these risk factors.

Data extraction Outcomes were number of fallers, fall related injuries, fall rate, death, admission to hospital, contacts with health services, move to institutional care, physical activity, and quality of life. Methodological quality assessment included allocation concealment, blinding, losses and exclusions, intention to treat analysis, and reliability of outcome measurement.

Results 19 studies, of variable methodological quality, were included. The combined risk ratio for the number of fallers during follow-up among 18 trials was 0.91 (95% confidence interval 0.82 to 1.02) and for fall related injuries (eight trials) was 0.90 (0.68 to 1.20). No differences were found in admissions to hospital, emergency department attendance, death, or move to institutional care. Subgroup analyses found no evidence of different effects between interventions in different locations, populations selected for high risk of falls or unselected, and multidisciplinary teams including a doctor, but interventions that actively provide treatments may be more effective than those that provide only knowledge and referral.

Conclusions Evidence that multifactorial fall prevention programmes in primary care, community, or emergency care settings are effective in reducing the number of fallers or fall related injuries is limited. Data were insufficient to assess fall and injury rates.


  • doi: 10.1136/bmj.39428.470752.AD
  • doi: 10.1136/bmj.39435.656250.AD
  • We thank Lesley Gillespie for her detailed and helpful comments on an earlier draft and Chris McCarthy for help with data extraction.

  • Contributors: SG, SEL, MWC, and YHC designed the study. SG searched the literature. SG, JDF, and SEL selected the studies, extracted the data, and did the quality assessment. SG and SEL analysed and interpreted the data. SG wrote the drafts of the manuscript. SEL, MWC, and YHC revised the manuscript. SG is the guarantor.

  • Funding: This study was funded by the National Institute of Health Research service delivery and organisation programme, project No SDO/139/2006.

  • Competing interests: None declared.

  • Ethical approval: Not required.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

  • Accepted 5 November 2007
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