Primary Care–Relevant Interventions to Prevent Falling in Older Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force

Epidemiology and Biostatistics, Drexel University School of Public Health, 1505 Race Street, 6th Floor, MS 1033, Philadelphia, PA 19102, USA.
Annals of internal medicine (Impact Factor: 17.81). 12/2010; 153(12):815-25. DOI: 10.1059/0003-4819-153-12-201012210-00008
Source: PubMed


Falls among older adults are both prevalent and preventable.
To describe the benefits and harms of interventions that could be used by primary care practitioners to prevent falling among community-dwelling older adults.
The reviewers evaluated trials from a good-quality systematic review published in 2003 and searched MEDLINE, the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL from the end of that review's search date to February 2010 to identify additional English-language trials. STUDY SELECTion: Two reviewers independently screened 3423 abstracts and 638 articles to identify randomized, controlled trials (RCTs) of primary care-relevant interventions among community-dwelling older adults that reported falls or fallers as an outcome. Trials were independently critically appraised to include only good- or fair-quality trials; discrepancies were resolved by a third reviewer.
One reviewer abstracted data from 61 articles into standardized evidence tables that were verified by a second reviewer.
Overall, the included evidence was of fair quality. In 16 RCTs evaluating exercise or physical therapy, interventions reduced falling (risk ratio, 0.87 [95% CI, 0.81 to 0.94]). In 9 RCTs of vitamin D supplementation, interventions reduced falling (risk ratio, 0.83 [CI, 0.77 to 0.89]). In 19 trials involving multifactorial assessment and management, interventions with comprehensive management seemed to reduce falling, although overall pooled estimates were not statistically significant (risk ratio, 0.94 [CI, 0.87 to 1.02]). Limited evidence suggested that serious clinical harms were no more common for older adults in intervention groups than for those in control groups. Limitations: Interventions and methods of fall ascertainment were heterogeneous. Data on potential harms of interventions were scant and often not reported.
Primary care-relevant interventions exist that can reduce falling among community-dwelling older adults.
Agency for Healthcare Research and Quality.

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    • "advice on footwear or fall risks. The first, a meta-analysis of three RCTs found this intervention was more effective than a control condition (Michael et al. 2010). The second, a narrative review, also found a significant positive impact on falls reduction (Costello & Edelstein 2008). "
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    Health & Social Care in the Community 10/2015; DOI:10.1111/hsc.12300 · 1.15 Impact Factor
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    • "In the next decades a rise in the proportion of people aged 65 years and older is expected [1,2]. Successful independent living in older people can be compromised by a number of key health conditions including heart disease, stroke, diabetes, and falls [3]. About one third of community-dwelling older people falls at least once a year [4], increasing to half of people aged 80 years and over [5]. "
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    • "These data are based on patients’ self-reporting and thus it is difficult to draw any firm conclusions. However, the finding could strengthen the impression that the recommended supplement dose of vitamin D in Norway (400 IE vitamin D3) is not enough to maintain an adequate level of vitamin D in elderly individuals, and several authors have recommended 800–1000 IE vitamin D3 as a daily supplement for the elderly [6,55,56]. "
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    BMC Psychiatry 05/2014; 14(1):134. DOI:10.1186/1471-244X-14-134 · 2.21 Impact Factor
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