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. 2018 Mar 12;15(3):498.
doi: 10.3390/ijerph15030498.

Comparative Effectiveness of Published Interventions for Elderly Fall Prevention: A Systematic Review and Network Meta-Analysis

Peixia Cheng  1 , Liheng Tan  2 , Peishan Ning  3 , Li Li  4 , Yuyan Gao  5 , Yue Wu  6 , David C Schwebel  7 , Haitao Chu  8 , Huaiqiong Yin  9 , Guoqing Hu  10
Affiliations

Comparative Effectiveness of Published Interventions for Elderly Fall Prevention: A Systematic Review and Network Meta-Analysis

Peixia Cheng et al. Int J Environ Res Public Health. .

Abstract

Background: Falls are a major threat to older adults worldwide. Although various effective interventions have been developed, their comparative effectiveness remains unreported.

Methods: A systematic review and network meta-analysis was conducted to determine the most effective interventions to prevent falls in community-dwelling adults aged 60 and over. Combined odds ratio (OR) and 95% credible interval (95% CrI) were calculated.

Results: A total of 49 trials involving 27,740 participants and 9271 fallers were included. Compared to usual care, multifactorial interventions (MFI) demonstrated the greatest efficacy (OR: 0.64, 95% CrI: 0.53 to 0.77) followed by interventions combining education and exercise (EDU + EXC) (OR: 0.65, 95% CrI: 0.38 to 1.00) and interventions combining exercise and hazard assessment and modification (EXC + HAM) (OR: 0.66, 95% CrI: 0.40 to 1.04). The effect of medical care performed the worst (OR: 1.02, 95% CrI: 0.78 to 1.34). Model fit was good, inconsistency was low, and publication bias was considered absent. The overall quality of included trials was high. The pooled odds ratios and ranking probabilities remained relatively stable across all sensitivity analyses.

Conclusions: MFI and exercise appear to be effective to reduce falls among older adults, and should be considered first as service delivery options. Further investigation is necessary to verify effectiveness and suitableness of the strategies to at-risk populations.

Keywords: elderly; falls; network meta-analysis; prevention.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of study selection in systematic review of fall prevention interventions. Note: Abbreviations: 1. Embase: Excerpta Medica Database; 2. CINAHL: Cumulative Index to Nursing and Allied Health Literature; 3. CMBdisc: China Biology Medicine disc; 4. WanFang DATA: WanFang Data Knowledge Service Platform 5. VIP: VIP Database for Chinese Technical Periodical.
Figure 2
Figure 2
Pooled odds ratio, SUCRA and mean rank for each regimen, compared with usual care. Note: Labels of interventions: 1. Usual care (No specific fall intervention); 2. EDU (Education); 3. RAS (Risk assessment and suggestions); 4. EXC (Exercise); 5. MED (Medical care) 6. HAM (Hazard assessment and modification); 7. EDU + RAS (Education + risk assessment and suggestions); 8. EDU + EXC (Education + exercise); 9. RAS + EXC (Risk assessment and suggestions + exercise); 10. EXC + HAM (Exercise + hazard assessment and modification); 11. MFI (Multifactorial interventions). SUCRA (surface under the cumulative ranking curve probabilities) is a percentage of the efficacy or safety of every intervention relative to an imaginary intervention that is always the best without uncertainty. SUCRA = 1 means best intervention, worst SUCRA = 0).
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References

    1. WHO Global Report on Falls Prevention in Older Age. [(accessed on 10 February 2018)]; Available online: http://www.who.int/ageing/publications/Falls_prevention7March.pdf?ua=1.
    1. Gelbard R., Inaba K., Okoye O.T., Morrell M., Saadi Z., Lam L., Talving P., Demetriades D. Falls in the elderly: A modern look at an old problem. Am. J. Surg. 2014;208:249–253. doi: 10.1016/j.amjsurg.2013.12.034. - DOI - PubMed
    1. Campbell A.J., Reinken J., Allan B.C., Martinez G.S. Falls in old age: A study of frequency and related clinical factors. Age Ageing. 1981;10:264–270. doi: 10.1093/ageing/10.4.264. - DOI - PubMed
    1. Carty C.P., Cronin N.J., Nicholson D., Lichtwark G.A., Mills P.M., Kerr G., Cresswell A.G., Barrett R.S. Reactive stepping behaviour in response to forward loss of balance predicts future falls in community-dwelling older adults. Age Ageing. 2015;44:109–115. doi: 10.1093/ageing/afu054. - DOI - PubMed
    1. Chang V.C., Do M.T. Risk factors for falls among seniors: Implications of gender. Am. J. Epidemiol. 2015;181:521–531. doi: 10.1093/aje/kwu268. - DOI - PubMed

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