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Review
. 2025 Oct 24:9:100442.
doi: 10.1016/j.ijnsa.2025.100442. eCollection 2025 Dec.

The quality and applicability of clinical practice guidelines for falls prevention, assessment and management across the lifespan: A systematic review

Amber Harnett  1 , Lyndsay Howitt  2 , Vithusa Kumarasamy  2 , Christine Buchanan  2 , Amy Burt  2 , Nafsin Nizum  2 , Shanoja Naik  2
Affiliations
Review

The quality and applicability of clinical practice guidelines for falls prevention, assessment and management across the lifespan: A systematic review

Amber Harnett et al. Int J Nurs Stud Adv. .

Abstract

Background: The burden of falls across the lifespan is substantial. Given the variety of clinical practice guidelines available for falls management, it is useful to understand the quality and clinical applicability of guidelines and their recommendations.

Objective: To assess the quality and applicability of clinical practice guidelines for falls prevention, assessment and management across the lifespan.

Design: Systematic review, reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data sources: CINAHL, Cochrane, Embase, MEDLINE, PsycINFO and grey literature databases were searched from January 2016 to April 2025.

Methods: Two investigators assessed the methodological quality of the guidelines and recommendations based on the eligibility criteria established a priori. Scaled domain scores were calculated for AGREE II and AGREE-REX.

Results: Eleven guidelines met the eligibility criteria and were included for analysis. Most provided recommendations for older adults with only two guidelines focused on adults. AGREE II scores ranged from 32 % to 83 %, while AGREE-REX scores ranged from 39 % to 56 %. Three guidelines were of high quality (≥70 %): (1) 2017 Registered Nurses' Association of Ontario, (2) 2025 National Institute for Health and Care Excellence, and (3) 2022 World Falls Guideline.

Conclusion: This systematic review identified gaps in evidence-based guidelines for falls prevention, particularly for individuals under 65. Variations in guideline quality suggest the need for refined development processes, emphasizing stakeholder involvement and applicability. Despite limitations in the current evidence, this review offers a foundation for future guideline development, highlighting the importance of developing inclusive, evidence-based guidelines to address falls for children and adults under the age of 65.

Registration: The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO registration CRD42023446557).

Tweetable abstract: Gaps in fall prevention, assessment, and management guidelines emphasize the need for evidence-based recommendations for children and adults under the age of 65.

Keywords: Accidental falls; Guidelines; Injury; Older adults; Patient safety; Risk management; Systematic review.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The authors declare they have no known competing financial interests, patents, or personal or professional relationships that could have appeared to influence the work reported in this paper. One of the guidelines assessed in this review was developed by the Registered Nurses’ Association of Ontario where the authors of this paper are employed. To avoid potential conflict, quality assessment of all guidelines was performed independently by two reviewers using a validated tool. None of the authors were involved in development of the Registered Nurses' Association of Ontario guideline. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
PRISMA flow chart illustrating the process of identify and selecting guidelines. Italicized text indicates the update search made for the current review.
See this image and copyright information in PMC

References

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