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- Title
Comparisons of Interventions for Preventing Falls in Older Adults: A Systematic Review and Meta-analysis.
- Authors
Tricco, Andrea C.; Thomas, Sonia M.; Veroniki, Areti Angeliki; Hamid, Jemila S.; Cogo, Elise; Strifler, Lisa; Khan, Paul A.; Robson, Reid; Sibley, Kathryn M.; MacDonald, Heather; Riva, John J.; Thavorn, Kednapa; Wilson, Charlotte; Holroyd-Leduc, Jayna; Kerr, Gillian D.; Feldman, Fabio; Majumdar, Sumit R.; Jaglal, Susan B.; Wing Hui; Straus, Sharon E.
- Abstract
<bold>Importance: </bold>Falls result in substantial burden for patients and health care systems, and given the aging of the population worldwide, the incidence of falls continues to rise.<bold>Objective: </bold>To assess the potential effectiveness of interventions for preventing falls.<bold>Data Sources: </bold>MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Ageline databases from inception until April 2017. Reference lists of included studies were scanned.<bold>Study Selection: </bold>Randomized clinical trials (RCTs) of fall-prevention interventions for participants aged 65 years and older.<bold>Data Extraction and Synthesis: </bold>Pairs of reviewers independently screened the studies, abstracted data, and appraised risk of bias. Pairwise meta-analysis and network meta-analysis were conducted.<bold>Main Outcomes and Measures: </bold>Injurious falls and fall-related hospitalizations.<bold>Results: </bold>A total of 283 RCTs (159 910 participants; mean age, 78.1 years; 74% women) were included after screening of 10 650 titles and abstracts and 1210 full-text articles. Network meta-analysis (including 54 RCTs, 41 596 participants, 39 interventions plus usual care) suggested that the following interventions, when compared with usual care, were associated with reductions in injurious falls: exercise (odds ratio [OR], 0.51 [95% CI, 0.33 to 0.79]; absolute risk difference [ARD], -0.67 [95% CI, -1.10 to -0.24]); combined exercise and vision assessment and treatment (OR, 0.17 [95% CI, 0.07 to 0.38]; ARD, -1.79 [95% CI, -2.63 to -0.96]); combined exercise, vision assessment and treatment, and environmental assessment and modification (OR, 0.30 [95% CI, 0.13 to 0.70]; ARD, -1.19 [95% CI, -2.04 to -0.35]); and combined clinic-level quality improvement strategies (eg, case management), multifactorial assessment and treatment (eg, comprehensive geriatric assessment), calcium supplementation, and vitamin D supplementation (OR, 0.12 [95% CI, 0.03 to 0.55]; ARD, -2.08 [95% CI, -3.56 to -0.60]). Pairwise meta-analyses for fall-related hospitalizations (2 RCTs; 516 participants) showed no significant association between combined clinic- and patient-level quality improvement strategies and multifactorial assessment and treatment relative to usual care (OR, 0.78 [95% CI, 0.33 to 1.81]).<bold>Conclusions and Relevance: </bold>Exercise alone and various combinations of interventions were associated with lower risk of injurious falls compared with usual care. Choice of fall-prevention intervention may depend on patient and caregiver values and preferences.
- Subjects
PREVENTION of falls in old age; ELDER care; SYSTEMATIC reviews; CLINICAL trials; META-analysis; CALCIUM; ACCIDENTAL fall prevention; THERAPEUTIC use of vitamin D; VISION disorders; GERIATRIC assessment; COMPARATIVE studies; DIETARY supplements; ECOLOGY; EXERCISE; RESEARCH methodology; MEDICAL cooperation; RESEARCH; SAFETY; HEALTH self-care; SELF-evaluation; EVALUATION research; BURDEN of care; FERRANS &; Powers Quality of Life Index; DIAGNOSIS; THERAPEUTICS
- Publication
JAMA: Journal of the American Medical Association, 2017, Vol 318, Issue 17, p1687
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.2017.15006