Interventions for preventing falls and fall-related fractures in community-dwelling older adults: A systematic review and network meta-analysis

Lauren Dautzenberg¹, Shanthi Beglinger^{2

3}, Sofia Tsokani⁴, Stella Zevgiti⁴, Renee C M A Raijmann¹, Nicolas Rodondi^{2

3}, Rob J P M Scholten⁵, Anne W S Rutjes^{3

6}, Marcello Di Nisio⁷, Marielle Emmelot-Vonk¹, Andrea C Tricco^{8

9}, Sharon E Straus^{8

9

10}, Sonia Thomas⁸, Lisa Bretagne^{2

3}, Wilma Knol¹, Dimitris Mavridis^{4

11}, Huiberdina L Koek¹

Affiliations

¹ Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
² Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
³ Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
⁴ Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece.
⁵ Cochrane Netherlands/Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
⁶ Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
⁷ Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti, Italy.
⁸ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
⁹ Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health and Institute for Health, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
¹⁰ Department of Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada.
¹¹ Paris Descartes University, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.

PMID: 34318929
PMCID: PMC8518387
DOI: 10.1111/jgs.17375

Interventions for preventing falls and fall-related fractures in community-dwelling older adults: A systematic review and network meta-analysis

Lauren Dautzenberg et al. J Am Geriatr Soc. 2021 Oct.

. 2021 Oct;69(10):2973-2984.

doi: 10.1111/jgs.17375. Epub 2021 Jul 28.

Authors

Affiliations

¹ Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
² Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
³ Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
⁴ Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece.
⁵ Cochrane Netherlands/Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
⁶ Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
⁷ Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti, Italy.
⁸ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
⁹ Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health and Institute for Health, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
¹⁰ Department of Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada.
¹¹ Paris Descartes University, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.

PMID: 34318929
PMCID: PMC8518387
DOI: 10.1111/jgs.17375

Abstract

Objective: To compare the effectiveness of single, multiple, and multifactorial interventions to prevent falls and fall-related fractures in community-dwelling older persons.

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.

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).

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.

Keywords: community-dwelling; fall-related fractures; falls; older adults.

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Conflict of interest statement

Dr Tricco reports receiving a Tier 2 Canada Research Chair in Knowledge Synthesis grant. Dr Straus reports receiving a Tier 1 Canada Research Chair in Knowledge Translation grant. No other financial or personal conflicts were reported.

Figures

**FIGURE 1**
Flow diagram of study selection. RCT, randomized controlled trial

See this image and copyright information in PMC

References

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Interventions for preventing falls and fall-related fractures in community-dwelling older adults: A systematic review and network meta-analysis

Affiliations

Interventions for preventing falls and fall-related fractures in community-dwelling older adults: A systematic review and network meta-analysis

Authors

Affiliations

Abstract

Conflict of interest statement

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References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical