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- Title
Interventions to Prevent Falls in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.
- Authors
Guirguis-Blake, Janelle M.; Michael, Yvonne L.; Perdue, Leslie A.; Coppola, Erin L.; Beil, Tracy L.
- Abstract
<bold>Importance: </bold>Falls are the most common cause of injury-related morbidity and mortality among older adults.<bold>Objective: </bold>To systematically review literature on the effectiveness and harms of fall prevention interventions in community-dwelling older adults to inform the US Preventive Services Task Force.<bold>Data Sources: </bold>MEDLINE, PubMed, Cumulative Index for Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials for relevant English-language literature published through August 2016, with ongoing surveillance through February 7, 2018.<bold>Study Selection: </bold>Randomized clinical trials of interventions to prevent falls in community-dwelling adults 65 years and older.<bold>Data Extraction and Synthesis: </bold>Independent critical appraisal and data abstraction by 2 reviewers. Random-effects meta-analyses using the method of DerSimonian and Laird.<bold>Main Outcomes and Measures: </bold>Number of falls (number of unexpected events in which a person comes to rest on the ground, floor, or lower level), people experiencing 1 or more falls, injurious falls, people experiencing injurious falls, fractures, people experiencing fractures, mortality, hospitalizations, institutionalizations, changes in disability, and treatment harms.<bold>Results: </bold>Sixty-two randomized clinical trials (N = 35 058) examining 7 fall prevention intervention types were identified. This article focused on the 3 most commonly studied intervention types: multifactorial (customized interventions based on initial comprehensive individualized falls risk assessment) (26 trials [n = 15 506]), exercise (21 trials [n = 7297]), and vitamin D supplementation (7 trials [n = 7531]). Multifactorial intervention trials were associated with a reduction in falls (incidence rate ratio [IRR], 0.79 [95% CI, 0.68-0.91]) but were not associated with a reduction in other fall-related morbidity and mortality outcomes. Exercise trials were associated with statistically significant reductions in people experiencing a fall (relative risk, 0.89 [95% 13 CI, 0.81-0.97]) and injurious falls (IRR, 0.81 [95% CI, 0.73-0.90]) and with a statistically nonsignificant reduction in falls (IRR, 0.87 [95% CI, 0.75-1.00]) but showed no association with mortality. Few exercise trials reported fall-related fractures. Seven heterogeneous trials of vitamin D formulations (with or without calcium) showed mixed results. One trial of annual high-dose cholecalciferol (500 000 IU), which has not been replicated, showed an increase in falls, people experiencing a fall, and injuries, while 1 trial of calcitriol showed a reduction in falls and people experiencing a fall; the remaining 5 trials showed no significant difference in falls, people experiencing a fall, or injuries. Harms of multifactorial and exercise trials were rarely reported but generally included minor musculoskeletal injuries.<bold>Conclusions and Relevance: </bold>Multifactorial and exercise interventions were associated with fall-related benefit, but evidence was most consistent across multiple fall-related outcomes for exercise. Vitamin D supplementation interventions had mixed results, with a high dose being associated with higher rates of fall-related outcomes.
- Subjects
PREVENTION of falls in old age; ACCIDENTAL falls in old age; U.S. Preventive Services Task Force; GROUP homes; CLINICAL trials; THERAPEUTIC use of vitamin D; VITAMIN therapy; COMPARATIVE studies; DIETARY supplements; EXERCISE therapy; ACCIDENTAL falls; RESEARCH methodology; MEDICAL cooperation; RESEARCH; VITAMIN D; VITAMINS; SYSTEMATIC reviews; EVALUATION research; INDEPENDENT living
- Publication
JAMA: Journal of the American Medical Association, 2018, Vol 319, Issue 16, p1705
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.2017.21962