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Objective: To compare the effectiveness of single, multiple, and multifactorial interventions to prevent falls and fall-related fractures in community-dwelling older persons., Methods: MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were systematically searched for randomized controlled trials (RCTs) evaluating the effectiveness of fall prevention interventions in community-dwelling adults aged ≥65 years, from inception until February 27, 2019. Two large RCTs (published in 2020 after the search closed) were included in post hoc analyses. Pairwise meta-analysis and network meta-analysis (NMA) were conducted., Results: NMA including 192 studies revealed that the following single interventions, compared with usual care, were associated with reductions in number of fallers: exercise (risk ratio [RR] 0.83; 95% confidence interval [CI] 0.77-0.89) and quality improvement strategies (e.g., patient education) (RR 0.90; 95% CI 0.83-0.98). Exercise as a single intervention was associated with a reduction in falls rate (RR 0.79; 95% CI 0.73-0.86). Common components of multiple interventions significantly associated with a reduction in number of fallers and falls rate were exercise, assistive technology, environmental assessment and modifications, quality improvement strategies, and basic falls risk assessment (e.g., medication review). Multifactorial interventions were associated with a reduction in falls rate (RR 0.87; 95% CI 0.80-0.95), but not with a reduction in number of fallers (RR 0.95; 95% CI 0.89-1.01). The following single interventions, compared with usual care, were associated with reductions in number of fall-related fractures: basic falls risk assessment (RR 0.60; 95% CI 0.39-0.94) and exercise (RR 0.62; 95% CI 0.42-0.90)., Conclusions: In keeping with Tricco et al. (2017), several single and multiple fall prevention interventions are associated with fewer falls. In addition to Tricco, we observe a benefit at the NMA-level of some single interventions on preventing fall-related fractures., (© 2021 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)

Patients with chronic kidney disease (CKD) are more likely to experience falls and fractures due to renal osteodystrophy and the high prevalence of risk factors for falls. However, it is not well established how great the risk is for falls and fractures for the different stages of CKD compared to the general population. The objective of this systematic review and meta-analysis was to assess whether, and in which degree, CKD was associated with falls and fractures in adults. A systematic search in PubMed, Embase, CINAHL, and The Cochrane Library was performed on 7 September 2018. All retrospective, cross-sectional, and longitudinal studies of adults (18 years of older) that studied the association between CKD, fractures, and falls were included. Additional studies were identified by cross-referencing. A total of 39 publications were included, of which two publications assessed three types of outcome and four publications assessed two types of outcome. Ten studies focused on accidental falling; seventeen studies focused on hip, femur, and pelvis fractures; seven studies focused on vertebral fractures; and thirteen studies focused on any type of fracture without further specification. Generally, the risk of fractures increased when kidney function worsened, with the highest risks in the patients with stage 5 CKD or dialysis. This effect was most pronounced for hip fractures and any type of fractures. Furthermore, results on the association between CKD and accidental falling were contradictory. Compared to the general population, fractures are highly prevalent in patients with CKD. Besides more awareness of timely fracture risk assessment, there also should be more focus on fall prevention.

Falls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor. In the present statement, the European Geriatric Medicine Society (EuGMS) Task and Finish group on fall-risk-increasing drugs (FRIDs), in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge dissemination on medication-related falls in older people across Europe. The EuGMS Task and Finish group is developing educational materials to facilitate knowledge dissemination for healthcare professionals and older people. In addition, steps in primary prevention through judicious prescribing, deprescribing of FRIDs (withdrawal and dose reduction), and gaps in current research are outlined in this position paper.

Background: Although it is recognised that the dialysis population is ageing rapidly, geriatric complications such as falls are poorly appreciated, despite the many risk factors for falls in this population. The objective of this study was to determine the incidence, complications and risk factors for falls in an elderly dialysis population., Methods: A one-year observational study of chronic dialysis patients aged ≥ 70 years. At baseline, patient characteristics were noted and during follow-up the vital parameters and laboratory values were recorded. Patients were questioned weekly about falls, fall circumstances and consequences by trained nurses., Results: 49 patients were included with a median age of 79.3 years (70-89 years). During follow-up 40 fall accidents occurred in 27 (55%) patients. Falls resulted in fractures in 15% of cases and in hospital admissions in 15%. In haemodialysis (HD) patients, the mean systolic blood pressure (SBP) before HD was lower in fallers compared with non-fallers (130 vs. 143 mmHg). Several patients in the lower blood pressure category received antihypertensive medication. For every 5 mmHg lower SBP (before HD) the fall risk increased by 30% (hazard ratio (HR) 1.30, 95% CI 1.03-1.65, p = 0.03). Furthermore, fall risk increased by 22% for every 10 pmol/l rise of parathyroid hormone (HR 1.22, 95% CI 1.06-1.39, p = 0.004)., Conclusions: Elderly dialysis patients have a high incidence of falls accompanied by a high fracture rate. Given the high complication rate, elderly patients at risk of falling should be identified and managed. Reduction of blood pressure-lowering medication might be a treatment strategy to reduce falls.

Aims and Objectives: This study examined the feasibility of nursing falls prevention advice and factors influencing feasibility., Background: The frequency and seriousness of falls in hospitalised patients are underestimated, and such falls should be preventable because of the presence of professionals. A best practice-based falls prevention advice was developed to decrease the incidence of secondary falls and the incidence of primary falls in the long term and to increase the knowledge of nurses about falls prevention and the seriousness of falls., Design: A descriptive, explorative study., Methods: Feasibility of the advice for 30 patients was assessed 82 times (theoretically, three times per patient) by observation and by interviewing nurses, patients and their families., Results: The falls prevention advice was used in 48% of the assessments. There was a difference in use between interventions. Interventions that required more knowledge, communication and extra activities were implemented the least. The absence of materials and knowledge about falls prevention were important determinants of the non-implementation of certain interventions., Conclusion: Before falls prevention advice is implemented, it is important to educate nurses about falls, communication skills and implementation of the advice., Relevance to Clinical Practice: The falls prevention advice might help nurses to prevent falls and increase their knowledge about falls prevention., (© 2011 Blackwell Publishing Ltd.)

Recently, two articles are published about the effectiveness of a multifactorial fall prevention programme performed by two falls clinics in the Netherlands. Both studies have shown negative results. The question is if those two studies are representative for the real situation in most falls clinics in the Netherlands. Two important differences are the selection of the patients and the completion of the fall prevention program. It is important to select the patients with the highest fall risk (> or = 2 falls/year and/or > or = 4 fall risk factors) and to provide an active and direct management of the identified fall risk factors to improve the effectiveness of falls clinics.

The aim of this single-center retrospective cohort study was to evaluate the effect of a multidisciplinary falls-assessment, consisting of identification and possible modification of risk factors for falls, on the frequency of falls among elderly individuals attending the geriatric outpatient department of the University Medical Center (UMC) Utrecht, the Netherlands. The characteristics of 70 elderly people who visited the outpatient department because of a fall in the period from May 2005 till February 2007 were evaluated. The effectiveness of the falls-assessment was evaluated by telephone interview of those individuals who had attended the falls-assessment. Fifty-three patients (mean age=79.8 years) were interviewed after a mean+/-S.D. of 1.47+/-0.41 years (ranging 0.72-2.34 years) subsequent to the falls-assessment. Falls-assessment led to significantly fewer falls, from 3.78+/-4.66 at the time of the assessment at baseline to 1.10+/-1.86 at the time of the interview (p=0.000041). Fear of falling was also significantly diminished. In conclusion, falls-assessment leads to fewer falls and less fear of falling among elderly individuals.

Falls are a major health problem among elderly people, because of the incidence and because of the consequences. Current practice commonly focuses on the injury with little attention of the underlying cause, the risk factors for a new fall and the possibilities for future prevention. Most of the falls are a result of multiple risk factors. Several of this risk factors are potentially modifiable. The Dutch Falls Prevention Collaboration have made a protocol to assist health care professionals at a standardised and evidence based way with their assessment of fall risk. With the risk factors identified in the assessment it is possible to make an individual multifactorial fall prevention program. Such an intervention can give a significant reduction of falls in the elderly. The protocol is presented in this article.