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Interventions for preventing falls and fall-related fractures in community-dwelling older adults: A systematic review and network meta-analysis.
- Source :
-
Journal of the American Geriatrics Society [J Am Geriatr Soc] 2021 Oct; Vol. 69 (10), pp. 2973-2984. Date of Electronic Publication: 2021 Jul 28. - Publication Year :
- 2021
-
Abstract
- Objective: To compare the effectiveness of single, multiple, and multifactorial interventions to prevent falls and fall-related fractures in community-dwelling older persons.<br />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.<br />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).<br />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.<br /> (© 2021 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)
- Subjects :
- Aged
Aged, 80 and over
Environment Design
Exercise Therapy
Female
Humans
Independent Living
Male
Network Meta-Analysis
Randomized Controlled Trials as Topic
Risk Assessment
Self-Help Devices
Accidental Falls prevention & control
Accidents, Home prevention & control
Fractures, Bone prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1532-5415
- Volume :
- 69
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Journal of the American Geriatrics Society
- Publication Type :
- Academic Journal
- Accession number :
- 34318929
- Full Text :
- https://doi.org/10.1111/jgs.17375