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Meta-Analysis
. 2021 Dec 10;21(1):689.
doi: 10.1186/s12877-021-02641-9.

Fall prevention in community-dwelling adults with mild to moderate cognitive impairment: a systematic review and meta-analysis

M Racey  1 , M Markle-Reid  2 , D Fitzpatrick-Lewis  3 , M U Ali  4 , H Gagne  5 , S Hunter  6 , J Ploeg  7 , R Sztramko  8 , L Harrison  9 , R Lewis  10 , M Jovkovic  10 , D Sherifali  11
Affiliations
Meta-Analysis

Fall prevention in community-dwelling adults with mild to moderate cognitive impairment: a systematic review and meta-analysis

M Racey et al. BMC Geriatr. .

Abstract

Background: Cognitive impairment (CI) increases an individual's risk of falls due to the role cognition plays in gait control. Older adults with dementia fall 2-3 times more than cognitively healthy older adults and 60-80% of people with dementia fall annually. Practitioners require evidence-based fall prevention best practices to reduce the risk of falls in cognitively impaired adults living in the community.

Methods: We conducted a systematic review and meta-analysis to identify the effectiveness of primary and secondary fall prevention interventions in reducing falls and fear of falling, and improving gait, balance, and functional mobility. We searched 7 databases for fall prevention interventions involving community-dwelling adults ≥50 years with mild to moderate CI. Reviewers screened citations, extracted data, and assessed risk of bias and certainty of evidence (GRADE). We assessed statistical and methodological heterogeneity and performed a meta-analysis of studies including subgroup analysis based on intervention and risk of bias groupings.

Results: Five hundred nine community-dwelling adults (mean age 67.5 to 84.0 years) with mild to moderate CI from 12 randomized or clinical controlled trials (RCTs/CCTs) were included in this review. Eight studies were exercise interventions, 3 were multifactorial, and 1 provided medication treatment. Fall prevention interventions had significant effects of medium magnitude on fear of falling (standardized mean difference (SMD) -0.73 [- 1.10, - 0.36]), balance (SMD 0.66 [0.19, 1.12]), and functional mobility measured as Timed Up and Go test (SMD -0.56 [- 0.94, - 0.17]) and significant effects of small magnitude on gait control (SMD 0.26 [0.08, 0.43]) all with moderate certainty of evidence. The meta-analysis showed no significant effects for falls (number of events or falls incidence). Sub-analysis showed that exercise and low risk of bias studies remained significant for balance and perceived risk of falls.

Conclusion: The effect of fall prevention interventions on direct outcomes, such as falls, remains unclear in cognitively impaired individuals. Exercise interventions are effective at improving fall risk factors, however, high quality studies with longer follow-up and adequate sample sizes are needed to determine their effectiveness on falls directly. There remains a gap in terms of effective fall prevention interventions for older adults with CI.

Keywords: Cognitive impairment; Fall prevention; Meta analysis; Older adults; Systematic review.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA Flowchart
Fig. 2
Fig. 2
Effects of fall prevention interventions on perceived risk of falls (A), balance (B), gait speed and control (C), and timed up and go (D) outcomes. Weights are from random effects multi-level model analysis. Note: SMD = standardized mean difference, CI = confidence interval
See this image and copyright information in PMC

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