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Meta-Analysis
. 2024 Oct 3;10(10):CD013480.
doi: 10.1002/14651858.CD013480.pub2.

Psychological and educational interventions for preventing falls in older people living in the community

Amy Drahota  1 , Julie E Udell  2 , Heather Mackenzie  3 , Mark T Pugh  1   4
Affiliations
Meta-Analysis

Psychological and educational interventions for preventing falls in older people living in the community

Amy Drahota et al. Cochrane Database Syst Rev. .

Abstract

Background: Older adults are at increased risk of both falls and fall-related injuries. Falls have multiple causes and many interventions exist to try and prevent them, including educational and psychological interventions. Educational interventions aim to increase older people's understanding of what they can do to prevent falls and psychological interventions can aim to improve confidence/motivation to engage in activities that may prevent falls. This review is an update of previous evidence to focus on educational and psychological interventions for falls prevention in community-dwelling older people.

Objectives: To assess the benefits and harms of psychological interventions (such as cognitive behavioural therapy; with or without an education component) and educational interventions for preventing falls in older people living in the community.

Search methods: We searched CENTRAL, MEDLINE, Embase, four other databases, and two trials registries to June 2023. We also screened reference lists and conducted forward-citation searching.

Selection criteria: We included randomised controlled trials of community-dwelling people aged 60 years and older exploring the effectiveness of psychological interventions (such as cognitive behavioural therapy) or educational interventions (or both) aiming to prevent falls.

Data collection and analysis: We used standard methodological procedures expected by Cochrane. Our primary outcome was rate of falls. We also explored: number of people falling; people with fall-related fractures; people with falls that required medical attention; people with fall-related hospital admission; fall-related psychological outcomes (i.e. concerns about falling); health-related quality of life; and adverse events.

Main results: We included 37 studies (six on cognitive behavioural interventions; three on motivational interviewing; three on other psychological interventions; nine on multifactorial (personalised) education; 12 on multiple topic education; two on single topic education; one with unclear education type; and one psychological plus educational intervention). Studies randomised 17,478 participants (71% women; mean age 73 years). Most studies were at high or unclear risk of bias for one or more domains. Cognitive behavioural interventions Cognitive behavioural interventions make little to no difference to the number of fallers (risk ratio (RR) 0.92, 95% confidence interval (CI) 0.82 to 1.02; 4 studies, 1286 participants; low-certainty evidence), and there was a slight reduction in concerns about falling (standardised mean difference (SMD) -0.30, 95% CI -0.42 to -0.19; 3 studies, 1132 participants; low-certainty evidence). The evidence is very uncertain or missing about the effect of cognitive behavioural interventions on other outcomes. Motivational interviewing The evidence is very uncertain about the effect of motivational interviewing on rate of falls, number of fallers, and fall-related psychological outcomes. No evidence is available on the effects of motivational interviewing on people experiencing fall-related fractures, falls requiring medical attention, fall-related hospital admission, or adverse events. Other psychological interventions The evidence is very uncertain about the effect of health coaching on rate of falls, number of fallers, people sustaining a fall-related fracture, or fall-related hospital admission; the effect of other psychological interventions on these outcomes was not measured. The evidence is very uncertain about the effect of health coaching, guided imagery, and mental practice on fall-related psychological outcomes. The effect of other psychological interventions on falls needing medical attention or adverse events was not measured. Multifactorial education Multifactorial (personalised) education makes little to no difference to the rate of falls (rate ratio 0.95, 95% CI 0.77 to 1.17; 2 studies, 777 participants; low-certainty evidence). The effect of multifactorial education on people experiencing fall-related fractures was very imprecise (RR 0.66, 95% CI 0.29 to 1.48; 2 studies, 510 participants; low-certainty evidence), and the evidence is very uncertain about its effect on the number of fallers. There was no evidence for other outcomes. Multiple component education Multiple component education may improve fall-related psychological outcomes (MD -2.94, 95% CI -4.41 to -1.48; 1 study, 459 participants; low-certainty evidence). However, the evidence is very uncertain about its effect on all other outcomes. Single topic education The evidence is very uncertain about the effect of single-topic education on rate of falls, number of fallers, and people experiencing fall-related fractures. There was no evidence for other outcomes. Psychological plus educational interventions Motivational interviewing/coaching combined with multifactorial (personalised) education likely reduces the rate of falls (although the size of this effect is not clear; rate ratio 0.65, 95% CI 0.43 to 0.99; 1 study, 430 participants; moderate-certainty evidence), but makes little to no difference to the number of fallers (RR 0.93, 95% CI 0.76 to 1.13; 1 study, 430 participants; high-certainty evidence). It probably makes little to no difference to falls-related psychological outcomes (MD -0.70, 95% CI -1.81 to 0.41; 1 study, 353 participants; moderate-certainty evidence). There were no adverse events detected (1 study, 430 participants; moderate-certainty evidence). There was no evidence for psychological plus educational intervention on other outcomes.

Authors' conclusions: The evidence suggests that a combined psychological and educational intervention likely reduces the rate of falls (but not fallers), without affecting adverse events. Overall, the evidence for individual psychological interventions or delivering education alone is of low or very-low certainty; future research may change our confidence and understanding of the effects. Cognitive behavioural interventions may improve concerns about falling slightly, but this may not help reduce the number of people who fall. Certain types of education (i.e. multiple component education) may also help reduce concerns about falling, but not necessarily reduce the number of falls. Future research should adhere to reporting standards for describing the interventions used and explore how these interventions may work, to better understand what could best work for whom in what situation. There is a particular dearth of evidence for low- to middle-income countries.

Trial registration: ClinicalTrials.gov NCT01778972 NCT03824015 NCT01358032 NCT02128789 NCT02333994 NCT02774889 NCT01858493 NCT00877058 NCT02629666 NCT01528761 NCT04997681 NCT03189342 NCT04759690 NCT03147625 NCT00298558 NCT03190460 NCT03417635 NCT02645006 NCT05689554 NCT04313062 NCT04717258 NCT05192408.

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Conflict of interest statement

JU: none.

HM: none.

AD is Principal Investigator for another systematic review (published in 2022) exploring the use of shock‐absorbing flooring in hospitals and care homes for fall‐related injury prevention, funded by National Institute for Health Research (NIHR Health Technology Assessment, 17/148/11 – The SAFEST Review: The Shock‐Absorbing Flooring Effectiveness SysTematic Review including older adults and staff in care settings).

MP: none.

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  • doi: 10.1002/14651858.CD013480

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References

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Zareipour 2020 {published data only}
    1. Zareipour M, Mazloomy Mahmoodabad SS. The effect of educational intervention on promoting knowledge and self-efficacy of elderly in preventing falling. Journal of Safety Promotion and Injury Prevention 2020;7(4):226-33.
Zidén 2014 {published data only}
    1. Behm L, Eklund K, Wilhelmson K, Zidén L, Gustafsson S, Falk K, et al. Health promotion can postpone frailty: results from the RCT elderly persons in the risk zone. Public Health Nursing 2015;33(4):303-15. [DOI: 10.1111/phn.12240] - DOI - PubMed
    1. Behm L, Wilhelmson K, Falk K, Eklund K, Zidén L, Dahlin-Ivanoff S. Positive health outcomes following health-promoting and disease-preventive interventions for independent very old persons: long-term results of the three-armed RCT elderly persons in the risk zone. Archives of Gerontology and Geriatrics 2014;58:376-83. [DOI: 10.1016/j.archger.2013.12.010] - DOI - PubMed
    1. Dahlin-Ivanoff S, Gosman-Hedström G, Edberg A-K, Wilhelmson K, Eklund K, Duner A, et al. Elderly persons in the risk zone. Design of a multidimensional, health-promoting, randomised three-armed controlled trial for "prefrail" people of 80+ years living at home. BMC Geriatrics 2010;10:27. [DOI: 10.1186/1471-2318-10-27] - DOI - PMC - PubMed
    1. Gustafsson S, Wilhelmson K, Eklund K, Gosman-Hedström G, Zidén L, Kronlöf GH, et al. Health-promoting interventions for persons aged 80 and older are successful in the short term – results from the randomized and three-armed elderly persons in the risk zone study. Journal of the American Geriatrics Society 2012;60:447-54. [DOI: 10.1111/j.1532-5415.2011.03861.x] - DOI - PubMed
    1. NCT00877058. Support for frail elderly persons – from prevention to palliation. clinicaltrials.gov/ct2/show/NCT00877058 (first received 7 April 2009).
Zijlstra 2012 {published data only}ISRCTN43792817
    1. ISRCTN43792817. Reduction of fear of falling and associated increase in functional ability, activity level and quality of life in community-living older adults who are at risk for falling: a randomised controlled trial. www.isrctn.com/ISRCTN43792817 (first received 7 October 2004). [DOI: 10.1186/ISRCTN43792817] - DOI
    1. Zijlstra G, Haastregt JC, Eijk JT, Kempen GI. Evaluating an intervention to reduce fear of falling and associated activity restriction in elderly persons: design of a randomised controlled trial [ISRCTN43792817]. BMC Public Health 2005;5:26. [DOI: 10.1186/1471-2458-5-26] - DOI - PMC - PubMed
    1. Zijlstra GA, Haastregt JC, Amergen T, Rossum E, Eijk JT, Tennstedt SL, et al. Effects of a multicomponent cognitive behavioral group intervention on fear of falling and activity avoidance in community-dwelling older adults: results of a randomized controlled trial. Journal of the American Geriatrics Society 2009;57:2020-8. [DOI: 10.1111/j.1532-5415.2009.02489.x] - DOI - PubMed
    1. Zijlstra GA, Haastregt JC, Kempen GI. "A matter of balance--Netherlands": an effective intervention to reduce concerns about falls and related avoidance of activity in older people ['Zicht op Evenwicht': een effectieve interventie om bezorgdheid om te vallen en gerelateerd vermijdingsgedrag bij ouderen te verminderen]. Tijdschrift voor Gerontologie en Geriatrie 2012;43(4):164-74. [DOI: 10.1007/s12439-012-0026-9] - DOI - PubMed
    1. Haastregt JC, Zijlstra GA, Hendriks MR, Goossens ME, Eijk JT, Kempen GI. Cost-effectiveness of an intervention to reduce fear of falling. International Journal of Technology Assessment in Health Care 2013;29(3):219-26. [DOI: 10.1017/S0266462313000275] - DOI - PubMed

References to studies excluded from this review

ACTRN12620000607976 {published data only}
    1. ACTRN12620000607976. Does provision of computerised cognitive training for an extended period of time in older hospitalised patients help in improving their frailty status? trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12620000607976 (first received 25 May 2020). [ACTRN12620000607976]
ACTRN12621001673831 {published data only}
    1. ACTRN12621001673831. Testing the effectiveness of a multicomponent frailty management program in Singapore. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382093&isRe... (first received 7 December 2021).
Althomali 2019 {published data only}
    1. Althomali MM, Vallis LA, Leat SJ. Can older adults' balance and mobility improve with visual attention training? European Journal of Applied Physiology 2019;119(7):1649-61. [DOI: 10.1007/s00421-019-04153-2] - DOI - PubMed
Bajraktari 2022 {published data only}
    1. Bajraktari S, Zingmark M, Pettersson B, Rosendahl E, Lundin-Olsson L, Sandlund M. Reaching older people with a digital fall prevention intervention in a Swedish municipality context-an observational study. Frontiers in Public Health 2022;10:857652. [DOI: 10.3389/fpubh.2022.857652] - DOI - PMC - PubMed
    1. NCT04161625. Evaluation of reach, effects and cost effectiveness of a fall preventive intervention including a mHealth application. clinicaltrials.gov/ct2/show/NCT04161625 (first received 13 November 2019).
Barban 2015 {published data only}
    1. Barban F, Annicchiarico R, Federici A, Mazzu ID, Lombardi MG, Giuli S, et al. ICT solutions to develop an effective motor and cognitive training to reduce risk of falls. The I-DONT-FALL project. In: 1st International Conference on Information and Communication Technologies for Ageing Well and E-Health (ICT4AgeingWell2015). Lisbon, Portugal: Scitepress, 2015:259-63. [DOI: 10.5220/0005490802590263] - DOI
    1. Barban F, Annicchiarico R. Integrated prevention and Detection sOlutioNs Tailored to the population and risk factors associated with FALLs. I-DONT-FALL. Deliverable D7.7. Medical and Scientific Evaluation Final Version 2015:54. [CIP-297225]
    1. Fernández NP. Eficacia de un Programa de Entrenamiento Combinado Cognitivo y Físico en la Disminución del Riesgo de Caídas y del Miedo a Caer en Ancianos. [Efficacy of a Combined Cognitive and Physical Training Program in Reducing the Risk of Falls and the Fear of Falling in the Elderly] [Thesis]. Madrid (Spain): Universidad Complutense de Madrid, 2019.
Chippendale 2023 {published data only}
    1. Chippendale T, Albert SM, Mahmood A. Efficacy of the stroll safe outdoor fall prevention program: a randomized controlled trial. Gerontologist 2023;63(9):1556-65. [DOI: 10.1093/geront/gnac145] - DOI - PubMed
    1. Chippendale T, Chen S-W. The Stroll Safe outdoor falls prevention program: participant experiences in eight community sites. Archives of Gerontology and Geriatrics 2023;108:104926. [DOI: 10.1016/j.archger.2023.104926] - DOI - PubMed
CTRI/2022/02/040019 {published data only}
    1. CTRI/2022/02/040019. Effect of strength training and fall prevention guide on balance in community dwelling elderly population. ctri.nic.in/Clinicaltrials/login.php (first received 4 February 2022).
Deidda 2022 {published data only}
    1. Blackburn NE, Skjodt M, Tully MA, McMullan I, Giné-Garriga M, Caserotti P, et al. Older adults' experiences of a physical activity and sedentary behaviour intervention: a nested qualitative study in the SITLESS multi-country randomised clinical trial. International Journal of Environmental Research and Public Health 2021;18:4730. [DOI: 10.3390/ijerph18094730] - DOI - PMC - PubMed
    1. Coll-Planas L, Blancafort Alias S, Tully M, Caserotti P, Giné-Garriga M, Blackburn N, et al. Exercise referral schemes enhanced by self-management strategies to reduce sedentary behaviour and increase physical activity among community dwelling older adults from four European countries: protocol for the process evaluation of the SITLESS randomised controlled trial. BMJ Open 2019;9(6):e027073. [DOI: 10.1136/ bmjopen-2018-027073] - PMC - PubMed
    1. Deidda M, Coll-Planas L, Tully MA, Giné-Garriga M, Kee F, Roqué i Figuls M, et al. Cost-effectiveness of a programme to address sedentary behaviour in older adults: results from the SITLESS RCT. European Journal of Public Health 2022;32(3):415-21. [DOI: 10.1093/eurpub/ckac017] - DOI - PMC - PubMed
    1. Giné-Garriga M, Coll-Planas L, Guerra M, Domingo A, Roqué M, Caserotti P, et al. The SITLESS project: exercise referral schemes enhanced by self-management strategies to battle sedentary behaviour in older adults: study protocol for a randomised controlled trial. Trials 2017;18:221. [DOI: 10.1186/s13063-017-1956-x] - DOI - PMC - PubMed
    1. McMullan II, Bunting BP, Blackburn NE, Wilson JJ, Deidda M, Caserotti P, et al. The mediating role of self-regulation and self-efficacy on physical activity change in community-dwelling older adults (≥65 years): an experimental cross-lagged analysis using data from SITLESS. Journal of Ageing and Physical Activity 2021;29(6):931-40. [DOI: 10.1123/japa.2020-0322] - DOI - PubMed
de Oliveira 2021a {published data only}
    1. RBR-7wcmd6. The effect of strength training on unstable surfaces on the functional performance of the elderly. ensaiosclinicos.gov.br/rg/RBR-7wcmd6/ (first received 8 August 2017).
    1. Oliveira VM, Pirauá AL, Cavalcante BR, Beltrão NB, Farias WM, Pitangui AC, et al. Additional functional performance gains after 24-week unstable strength training with cognitive training in community-dwelling healthy older adults: a randomized trial. Journal of Aging and Physical Activity 2021;29:412-22. [DOI: 10.1123/japa.2020-0050] - DOI - PubMed
Edgren 2019 {published data only}
    1. Edgren J, Karinkanta S, Rantanen T, Daly R, Kujala UM, Törmäkangas T, et al. Counselling for physical activity, life-space mobility and falls prevention in old age (COSMOS): protocol of a randomised controlled trial. BMJ Open 2019;9:e029682. [DOI: 10.1136/bmjopen-2019-029682] - DOI - PMC - PubMed
Eggenberger 2015 {published data only}
    1. Eggenberger P, Theill N, Holenstein S, Schumacher V, Bruin ED. Multicomponent physical exercise with simultaneous cognitive training to enhance dual-task walking of older adults: a secondary analysis of a 6-month randomized controlled trial with 1-year follow-up. Clinical Interventions in Aging 2015;10:1711-32. [DOI: 10.2147/CIA.S91997] - DOI - PMC - PubMed
    1. ISRCTN70130279. Effects of the six-month multimodal training intervention on cognitive, physical performance, and daily physical activity in older adults. trialsearch.who.int/?trialid=ISRCTN70130279 (first received 10 July 2013).
Foy 2013 {published data only}
    1. Foy CG, Vitolins MZ, Case LD, Harris SJ, Massa-Fanale C, Hopley RJ, et al. Incorporating prosocial behavior to promote physical activity in older adults: rationale and design of the Program for Active Aging and Community Engagement (PACE). Contemporary Clinical Trials 2013;36(1):284-97. [DOI: 10.1016/j.cct.2013.07.004] - DOI - PMC - PubMed
    1. NCT01528761. Prosocial behavior and volunteerism to promote physical activity in older adults. www.clinicaltrials.gov/study/NCT01528761 (first received 8 February 2012).
Hawley‐Hague 2023 {published data only}
    1. Hawley-Hague H, Tacconi C, Mellone S, Martinez E, Easdon A, Yang FB, et al. Can smartphone technology be used to support an effective home exercise intervention to prevent falls amongst community dwelling older adults? : the TOGETHER feasibility RCT study protocol. BMJ Open 2019;9:e028100. [DOI: 10.1136/ bmjopen-2018-028100] - PMC - PubMed
    1. Hawley-Hague H, Tacconi C, Mellone S, Martinez E, Yang F, Su T-l, et al. Using smartphone technology to support an effective home exercise intervention to prevent falls amongst community-dwelling older adults: the TOGETHER feasibility RCT. Gerontology 2023;69:783-97. [DOI: 10.1159/000528471] - DOI - PMC - PubMed
IRCT2014112720115N1 {published data only}
    1. IRCT2014112720115N1. Investigating the effect of education based on need prevention of fall on activity of daily living in the elderly. en.irct.ir/trial/17855 (first received 4 February 2015). [IRCT2014112720115N1]
Jehu 2017 {published data only}
    1. Jehu DA, Paquet N, Lajoie Y. Balance and mobility training with or without concurrent cognitive training improves the timed up and go (TUG), TUG cognitive, and TUG manual in healthy older adults: an exploratory study. Aging Clinical and Experimental Research 2017;29:711-20. [DOI: 10.1007/s40520-016-0618-2] - DOI - PubMed
Kerse 2005 {published data only}
    1. Elley C, Kerse N, Arroll B. Why target sedentary adults in primary health care? Baseline results from the Waikato Heart, Health and Activity Study. Preventive Medicine 2003;37:342-8. [DOI: 10.1016/S0091-7435(03)00142-7] - DOI - PubMed
    1. Elley CR, Kerse N, Arroll B, Robinson E. Effectiveness of counselling patients on physical activity in general practice: cluster randomised controlled trial. BMJ (Clinical Research Ed.) 2003;326:793. [DOI: 10.1136/bmj.326.7393.793] - DOI - PMC - PubMed
    1. Kerse N, Elley CR, Robinson E, Arroll B. Is physical activity counseling effective for older people? A cluster randomized, controlled trial in primary care. Journal of the American Geriatrics Society 2005;53:1951-6. [DOI: 10.1111/j.1532-5415.2005.00466.x] - DOI - PubMed
Leem 2019 {published data only}
    1. Leem S-H, Kim J-H, Lee B-H. Effects of Otago exercise combined with action observation training on balance and gait in the old people. Journal of Exercise Rehabilitation 2019;15(6):848-54. [DOI: 10.12965/jer.1938720.360] - DOI - PMC - PubMed
McGibbon 2022 {published data only}
    1. McGibbon C, Jarrett P, Handrigan G. The Canadian Consortium on Neurodegeneration in Aging (CCNA), CAN-THUMBS UP Group, et al. Protocol for SYNchronising Exercises, Remedies in GaIt and Cognition at Home (SYNERGIC@Home): feasibility of a home-based double-blind randomised controlled trial to improve gait and cognition in individuals at risk for dementia. BMJ Open 2022;12:e059988. [DOI: 10.1136/bmjopen-2021-059988] - DOI - PMC - PubMed
McKay 2012 {published data only}
    1. McKay S, Middleton SL, King EC, Cheng KC, Maki BE. Efficacy of computer-based "visual-training" programs in improving reach-to-grasp balance-recovery reactions in older adults. ISPGR / Gait & Mental Function 1st Joint World Congress; 2012 Jun 24-28; Trondheim, Norway.
    1. NCT00549406. Visual training program to improve balance and prevent falls in older adults. clinicaltrials.gov/ct2/show/NCT00549406 (first received 25 October 2007).
NCT02769182 {published data only}
    1. NCT02769182. Development and validation of a smart phone based system to enhance gait, cognition and socialization in elderly fallers. clinicaltrials.gov/ct2/show/NCT02769182 (first received 11 May 2016).
NCT03189342 {published data only}
    1. NCT03189342. Effects of training on fall risk and balance performances. clinicaltrials.gov/ct2/show/NCT03189342 (first received 16 June 2017).
NCT04759690 {published data only}
    1. NCT04759690. Effects of action observation training and exercises over 65 years old. clinicaltrials.gov/ct2/show/NCT04759690 (first received 18 February 2021).
O'Halloran 2016 {published data only}
    1. ACTRN12613000680763. A randomised controlled trial evaluating the use of motivational interviewing compared to usual care to increase physical activity in people living in the community after a hip fracture. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364404 (first received 16 June 2013).
    1. O'Halloran PD, Shields N, Blackstock F, Wintle E, Taylor N. Motivational interviewing increases physical activity and self-efficacy in people living in the community after hip fracture: a randomized controlled trial. Clinical Rehabilitation 2016;30(11):1108-19. [DOI: 10.1177/0269215515617814] - DOI - PubMed
Peterson 2015 {published data only}
    1. Peterson DJ, Christiansen AL, Guse CE, Layde PM. Community translation of fall prevention interventions: the methods and process of a randomized trial. Journal of Community Psychology 2015;43(8):1005-18. [DOI: 10.1002/jcop.21728] - DOI
Pradhan 2018 {published data only}
    1. Pradhan A, Raj R, Chaudhuri GR, Agarwal S, Basak T. Functional balance & gait balance in normal geriatric population: by gait training with multiple task. Indian Journal of Physiotherapy & Occupational Therapy 2018;12(4):39-44. [DOI: 10.5958/0973-5674.2018.00077.1] - DOI
Reinsch 1992 {published data only}
    1. Reinsch S, MacRae P, Lachenbruch PA, Tobis JS. Attempts to prevent falls and injury: a prospective community study. Gerontologist 1992;32(4):450-6. [DOI: 10.1093/geront/32.4.450] - DOI - PubMed
Sadeghi 2022 {published data only}
    1. Sadeghi S, Azimkhani A, Abbasi H. The comparison of effectiveness of mindfulness, balance and combined exercises on the balance and fear of falling in the elderly. Aging Psychology 2022;8(1):71-85. [DOI: 10.22126/JAP.2022.7217.1619] - DOI
Seah 2022 {published data only}
    1. NCT03147625. Salutogenic healthy aging program embracement (SHAPE) for elderly-only households. clinicaltrials.gov/ct2/show/NCT03147625 (first received 10 May 2017).
    1. Seah B, Espnes GA, Hong WT, Wang W. Salutogenic healthy ageing programme embracement (SHAPE) – an upstream health resource intervention for older adults living alone and with their spouses only: complex intervention development and pilot randomized controlled trial. BMC Geriatrics 2022;22(1):932. [DOI: 10.1186/s12877-022-03605-3] - DOI - PMC - PubMed
    1. Seah B, Kowitlawakul Y, Chokkanathan S, Fong JJ, Espnes GA, Ang E, et al. Salutogenic healthy ageing programme embracement (SHAPE) for senior-only households: a study protocol. Journal of Advanced Nursing 2018;74:946-56. [DOI: 10.1111/jan.13502] - DOI - PubMed
Shahrbanian 2021 {published data only}
    1. Shahrbanian S, Hashemi A, Hemayattalab R. The comparison of the effects of physical activity and neurofeedback training on postural stability and risk of fall in elderly women: a single-blind randomized controlled trial. Physiotherapy Theory and Practice 2021;37(2):271-8. [DOI: 10.1080/09593985.2019.1630877] - DOI - PubMed
Silveira 2013 {published data only}
    1. Silveira P, de Langenberg R, het Reve E, Daniel F, Casati F, Bruin ED. Tablet-based strength-balance training to motivate and improve adherence to exercise in independently living older people: a phase II preclinical exploratory trial. Journal of Medical Internet Research 2013;15(8):e159. [DOI: 10.2196/jmir.2579] - DOI - PMC - PubMed
    1. het Reve E, Silveira P, Daniel F, Casati F, Bruin ED. Tablet-based strength-balance training to motivate and improve adherence to exercise in independently living older people: part 2 of a phase II preclinical exploratory trial. Journal of Medical Internet Research 2014;16(6):e159. [10.2196/jmir.3055] - PMC - PubMed
Smith‐Ray 2014 {published data only}
    1. Smith-Ray RL, Makowski-Woidan B, Hughes SL. A randomized trial to measure the impact of a community-based cognitive training intervention on balance and gait in cognitively intact black older adults. Health Education & Behavior 2014;41(1S):62S-9S. [DOI: 10.1177/1090198114537068] - DOI - PMC - PubMed
Smith‐Ray 2015 {published data only}
    1. Smith-Ray RL, Hughes SL, Prohaska TR, Little DM, Jurivich DA, Hedeker D. Impact of cognitive training on balance and gait in older adults. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences 2015;70(3):357-66. [DOI: 10.1093/geronb/gbt097] - DOI - PMC - PubMed
    1. Smith-Ray RL. Impact of Cognitive Training on Gait and Balance in Older Adults [thesis]. Chicago (IL): University of Illinois, 2012.
Sprague 2023 {published data only}
    1. Ball K, Berch DB, Helmers KF, Jobe JB, Leveck MD, Marsiske M, et al. Effects of cognitive training interventions with older adults. A randomized controlled trial. JAMA 2002;288:2271-81. - PMC - PubMed
    1. Jobe JJ, Smith DM, Ball K, Tennstedt SL, Marsiske M, Willis SL, et al. ACTIVE: a cognitive intervention trial to promote independence in older adults. Controlled Clinical Trials 2001;22(4):453-79. - PMC - PubMed
    1. Sprague BN, Ross LA, Ball KK. Does cognitive training reduce falls across ten years? : data from the ACTIVE Trial. International Journal of Environmental Research and Public Health 2023;20:4941. [DOI: 10.3390/ ijerph20064941] - PMC - PubMed
    1. Willis SL, Tennstedt SL, Marsiske M, Ball K, Elias J, Koepke KM, et al. Long-term effects of cognitive training on everyday functional outcomes in older adults. JAMA 2006;296:2805-14. - PMC - PubMed
Taylor 2019 {published data only}
    1. Taylor SF, Coogle CL, Cotter JJ, Welleford EA, Copolillo A. Community-dwelling older adults' adherence to environmental fall prevention recommendations. Journal of Applied Gerontology 2019;38(6):755-74. [DOI: 10.1177/0733464817723087] - DOI - PubMed
    1. Taylor SF. Community-Dwelling Older Adults' Adherence to Fall Prevention Recommendations [thesis]. Richmond (VA): Virginia Commonwealth University, 2014.
Tennstedt 1998 {published data only}
    1. Tennstedt S, Howland J, Lachman M, Peterson E, Kasten L, Jette A. A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults. Journals of Gerontology Series B: Psychological Sciences & Social Sciences 1998;53B(6):384-92. [DOI: 10.1093/geronb/53b.6.p384] - DOI - PubMed
Thompson 2020 {published and unpublished data}
    1. NCT03190460. Evaluating technology-based fall prevention interventions (FaCT2). clinicaltrials.gov/ct2/show/results/NCT03190460 (first received 16 June 2017).
    1. Thompson HJ, McGough E, Demiris G. Falls and cognitive training 2 (FaCT2) study protocol: a randomised controlled trial exploring cognitive training to reduce risk of falls in at-risk older adults. Injury Prevention 2020;26(4):370-7. [DOI: 10.1136/injuryprev-2019-043332] - DOI - PMC - PubMed
Turunen 2021 {published data only}ISRCTN52388040
    1. ISRCTN52388040. The PASSWORD Study – promoting safe walking. www.isrctn.com/ISRCTN52388040 (first received 2 January 2017).
    1. Sipilä S, Tirkkonen A, Hänninen T, Laukkanen P, Alen M, Fielding RA, et al. Promoting safe walking among older people: the effects of a physical and cognitive training intervention vs. physical training alone on mobility and falls among older community-dwelling men and women (the PASSWORD study): design and methods of a randomized controlled trial. BMC Geriatrics 2018;18:215. [DOI: 10.1186/s12877-018-0906-0] - DOI - PMC - PubMed
    1. Sipilä S, Tirkkonen A, Savikangas T, Hänninen T, Laukkanen P, Alen M, et al. Effects of physical and cognitive training on gait speed and cognition in older adults: a randomized controlled trial. Scandinavian Journal of Medicine & Science in Sports 2021;31(7):1518-33. [DOI: 10.1111/sms.13960] - DOI - PubMed
    1. Turunen KM, Tirkkonen A, Savikangas T, Hänninen T, Alen M, Fielding RA, et al. Effects of physical and cognitive training on falls and concern about falling in older adults: results from a randomized controlled trial. Journals of Gerontology: Series A 2021;77(7):1430-7. [DOI: 10.1093/gerona/glab375] - DOI - PMC - PubMed
    1. Virkkunen T. Effects of physical and cognitive training on growth factors in 70- to 85- year-old older adults [Liikunta- ja kognitiivisen harjoittelu vaikutus kasvutekijöihin 70–85vuotiailla henkilöillä] [Masters thesis]. University of Jyväskylä (Finland), 2021.
van het Reve 2014 {published data only}
    1. ISRCTN75134517. The effects of physical exercise training in combination with cognitive training on dual task costs of walking in elderly. trialsearch.who.int/?trialid=ISRCTN75134517 (first received 10 August 2011).
    1. het Reve E, Bruin ED. Strength-balance supplemented with computerized cognitive training to improve dual task gait and divided attention in older adults: a multicenter randomized-controlled trial. BMC Geriatrics 2014;14:134. [DOI: 10.1186/1471-2318-14-134] - DOI - PMC - PubMed
Wallbank 2022 {published data only}
    1. ACTRN12619000490178. Active women over 50 online: a pilot trial. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619000490178 (first received 19 March 2019). [ACTRN12619000490178]
    1. Wallbank G, Sherrington C, Hassett L, Kwasnicka D, Chau JY, Martin F, et al. Active women over 50 online information and support to promote physical activity behaviour change: study protocol for a pilot trial. Pilot and Feasibility Studies 2020;6(91):1-13. [DOI: 10.1186/s40814-020-00627-9] - DOI - PMC - PubMed
    1. Wallbank G, Sherrington C, Hassett L, Kwasnicka D, Chau JY, Phongsavan P, et al. Acceptability and feasibility of an online physical activity program for women over 50: a pilot trial. Translational Behavioral Medicine 2022;12(2):225-36. [DOI: 10.1093/tbm/ibab161] - DOI - PubMed
Ye 2022 {published data only}ChiCTR2100052946
    1. Ye Q, Yang Y, Yao M, Yang Y, Lin T. Effects of teach-back health education (TBHE) based on WeChat mini-programs in preventing falls at home for urban older adults in China: a randomized controlled trial. BMC Geriatrics 2022;22:611. [DOI: 10.1186/s12877-022-03297-9] - DOI - PMC - PubMed

References to studies awaiting assessment

Ford 2024 {published data only}
    1. Ford SD, Nagamatsu LS. Four weeks of meditation training improves sustained attention in community-dwelling older adults: a proof-of-concept randomized controlled trial. Frontiers in Aging 2024;5:1322705. [DOI: 10.3389/fragi.2024.1322705] - DOI - PMC - PubMed
    1. NCT03417635. Meditation strategies, attention, and mobility in older adults. clinicaltrials.gov/ct2/show/NCT03417635 (first received 31 January 2018).
    1. Nagamatsu LS, Ford SD. Can meditation improve attention in older adults? Study protocol for a 4-week proof-of-concept intervention. Pilot and Feasibility Studies 2019;5(22):1-6. [DOI: 10.1186/s40814-019-0413-x] - DOI - PMC - PubMed
IRCT2016011626036N1 {published data only}
    1. IRCT2016011626036N1. The effectiveness of a multimedia fall prevention program on home safety, fear of fall, and quality of life among elderly persons. en.irct.ir/trial/21687 (first received 26 February 2016).
ISRCTN21120199 {published data only}
    1. ISRCTN21120199. The effect of an assessment-based falls prevention programme in elderly people utilising day-care services. www.isrctn.com/ISRCTN21120199 (first received 4 August 2008). [DOI: 10.1186/ISRCTN21120199] - DOI
ISRCTN89512790 {published data only}
    1. ISRCTN89512790. Better balance – fall prevention among elderly people. www.isrctn.com/ISRCTN89512790 (first received 6 May 2009). [DOI: 10.1186/ISRCTN89512790] - DOI
McMahon 2024 {published data only}
    1. McMahon SK, Lewis BA, Guan W, Wang Q, Hayes SM, Wyman JF, et al. Effect of intrapersonal and interpersonal behavior change strategies on physical activity among older adults: a randomized clinical trial. JAMA Network Open 2024;7(2):e240298. [DOI: 10.1001/jamanetworkopen.2024.0298] - DOI - PMC - PubMed
    1. McMahon SK, Lewis BA, Guan W, Wyman JF, Rothman AJ. Community-based intervention effects on older adults' physical activity and falls: protocol and rationale for a randomized optimization trial (Ready Steady3.0). Contemporary Clinical Trials 2021;101(106238):1-13. [DOI: 10.1016/j.cct.2020.106238] - DOI - PMC - PubMed
    1. NCT03326141. Community-based Intervention effects on older adults' physical activity. clinicaltrials.gov/ct2/show/NCT03326141 (first received 31 October 2017).
Moradi 2021 {published data only}
    1. Moradi M, Navab E, Sharifi F, Negarandeh R. Effect of lifestyle education based on Pender model on frailty outcomes in community-dwelling older adults [رد یریذپ بیسآ مردنس یاهدمایپ رب ردنپ لدم رب ینتبم یگدنز کبس شزومآ ریثات یسررب هعماج رد نکاس نادنملاس]. Journal of Gerontology 2021;6(3):28-40.
    1. Moradi M. Effect of lifestyle education based on Pender model on frailty outcomes in community-dwelling older adults. en.irct.ir/trial/52228 (first received 1 December 2020).
NCT02645006 {published data only}
    1. NCT02645006. Workshop for primary prevention of falls. Changing to never fall. CTNF. www.clinicaltrials.gov/study/NCT02645006 (first received 29 December 2015).
NCT02727374 {published data only}
    1. NCT02727374. Fear to Fall Reduction in Geriatric Patients who suffered previous falls (FFALL_GER). www.clinicaltrials.gov/study/NCT02727374 (first received 4 April 2016).
NCT04612842 {published data only}
    1. NCT04612842. Engaging older adults in fall prevention using motivational interviewing (MI). clinicaltrials.gov/ct2/show/NCT04612842 (first received 3 November 2020).

References to ongoing studies

ACTRN12621000440820 {published data only}
    1. ACTRN12621000440820. Own your balance study: effect of a self-managed online cognitive behavioural therapy program in older people with concerns about falling. anzctr.org.au/ACTRN12621000440820.aspx (first received 16 April 2021).
    1. Lim ML, Perram A, Radford K, Close J, Draper B, Lord SR, et al. Protocol of a 12-week eHealth programme designed to reduce concerns about falling in community-living older people: Own Your Balance randomised controlled trial. BMJ Open 2024;14(2):e078486. [DOI: 10.1136/bmjopen-2023-078486] - DOI - PMC - PubMed
Balderson 2023 {published data only}
    1. Balderson B, Gray SL, Fujii MM, Nakata KG, Williamson BD, Cook AJ, et al. A health-system-embedded deprescribing intervention targeting patients and providers to prevent falls in older adults (STOP-FALLS trial): study protocol for a pragmatic cluster-randomized controlled trial. Trials 2023;24:322. [DOI: 10.1186/s13063-023-07336-7] - DOI - PMC - PubMed
Frost 2022 {published data only}ISRCTN54268283
    1. Frost R, Avgerinou C, Goodman C, Clegg A, Hopkins J, Gould RL, et al. Clinical and cost-effectiveness of a personalised health promotion intervention enabling independence in older people with mild frailty ('HomeHealth') compared to treatment as usual: study protocol for a randomised controlled trial. BMC Geriatrics 2022;22:485. [DOI: 10.1186/s12877-022-03160-x] - DOI - PMC - PubMed
IRCT20211201053248N1 {published data only}
    1. IRCT20211201053248N1. The effect of cognitive-behavioral therapy on the stages of planning and predicting the time of movement in the elderly with fear of falling. trialsearch.who.int/Trial2.aspx?TrialID=IRCT20211201053248N1 (first received 19 January 2022). [IRCT20211201053248N1]
Khow 2018 {published data only}
    1. ACTRN12617001186347. The effects of health coaching with accelerometer feedback on physical inactivity in older people at risk of falls. trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12617001186347 (first received 11 August 2017). [ACTRN12617001186347]
    1. Khow KS, Dollard J, Bray K, Smyth C, Chehade M, Theou O, et al. A randomized controlled feasibility study to evaluate the effects of a goal-setting coaching intervention using feedback from an accelerometer on sedentary time in older people at risk of falls (SMART-MOVE): a study protocol. Pilot and Feasibility Studies 2018;4:173. [DOI: 10.1186/s40814-018-0366-5] - DOI - PMC - PubMed
Marquez‐Doren 2023 {published data only}
    1. Marquez-Doren F, Alcayaga-Rojas C, Bustamante-Troncoso C, Ibarra-Torres I, Lucchini-Raies C. A randomized control trial for a comprehensive fall prevention model for self-supporting older adults (PM-ACTIVAS): a study protocol. International Journal of Nursing and Health Care Research 2023;6(7):1448. [DOI: 10.29011/2688-9501.101448] - DOI
    1. NCT04313062. Falling prevention comprehensive model for older people self-caring (PMACTIVAS). clinicaltrials.gov/ct2/show/NCT04313062 (first received 18 March 2020).
NCT04717258 {published data only}
    1. NCT04717258. Safe and well visits by the fire and rescue service to prevent falls and improve quality of life in older people (FIREFLI). clinicaltrials.gov/ct2/show/NCT04717258 (first received 22 January 2021).
NCT05192408 {published data only}
    1. NCT05192408. Multi-component intervention for reducing fear of falling in community-dwelling older adults. clinicaltrials.gov/ct2/show/NCT05192408 (first received 14 January 2022).
RBR‐2gb34zr {published data only}
    1. RBR-2gb34zr. Educational activities and group physiotherapy to prevent falls in the elderly. ensaiosclinicos.gov.br/rg/RBR-2gb34zr (first received 2 November 2021).
TCTR20210806001 {published data only}
    1. TCTR20210806001. A randomised control trial of nurse-led fall prevention education to reduce fall risk among older adults attended geriatric clinics in Sarawak. www.thaiclinicaltrials.org/show/TCTR20210806001 (first received 6 August 2021). [TCTR20210806001]

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