Yvonne L. Michael, ScD, SM; Evelyn P. Whitlock, MD, MPH; Jennifer S. Lin, MD, MCR; Rongwei Fu, PhD; Elizabeth A. O'Connor, PhD; Rachel Gold, PhD, MPH
Michael YL, Whitlock EP, Lin JS, Fu R, O'Connor EA, Gold R. Primary Care–Relevant Interventions to Prevent Falling in Older Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2010;153:815-825. doi: 10.7326/0003-4819-153-12-201012210-00008
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Published: Ann Intern Med. 2010;153(12):815-825.
Falls among older adults are both prevalent and preventable.
To describe the benefits and harms of interventions that could be used by primary care practitioners to prevent falling among community-dwelling older adults.
The reviewers evaluated trials from a good-quality systematic review published in 2003 and searched MEDLINE, the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL from the end of that review's search date to February 2010 to identify additional English-language trials.
Two reviewers independently screened 3423 abstracts and 638 articles to identify randomized, controlled trials (RCTs) of primary care–relevant interventions among community-dwelling older adults that reported falls or fallers as an outcome. Trials were independently critically appraised to include only good- or fair-quality trials; discrepancies were resolved by a third reviewer.
One reviewer abstracted data from 61 articles into standardized evidence tables that were verified by a second reviewer.
Overall, the included evidence was of fair quality. In 16 RCTs evaluating exercise or physical therapy, interventions reduced falling (risk ratio, 0.87 [95% CI, 0.81 to 0.94]). In 9 RCTs of vitamin D supplementation, interventions reduced falling (risk ratio, 0.83 [CI, 0.77 to 0.89]). In 19 trials involving multifactorial assessment and management, interventions with comprehensive management seemed to reduce falling, although overall pooled estimates were not statistically significant (risk ratio, 0.94 [CI, 0.87 to 1.02]). Limited evidence suggested that serious clinical harms were no more common for older adults in intervention groups than for those in control groups.
Interventions and methods of fall ascertainment were heterogeneous. Data on potential harms of interventions were scant and often not reported.
Primary care–relevant interventions exist that can reduce falling among community-dwelling older adults.
Agency for Healthcare Research and Quality.
This review addresses KQs 2 and 3. KQ = key question.
* Multifactorial assessment and management includes multifactor risk assessment, comprehensive geriatric assessment, and ≥2 of the following screenings for fall risk: vision, gait, mobility, strength, medication review, cognitive impairment, orthostatic hypotension, and environmental risks. Single clinical treatment (with or without screening) includes vision correction, medication optimization or adjustment, assistive device prescription, pharmacologic or nutritional interventions, treatment of orthostatic hypotension, urinary incontinence, and hip protectors. Clinical education or behavioral counseling includes exercise, fall risk reduction, and a home-hazard checklist. Home-hazard modification includes identifying and removing potential fall hazards, adding grab bars and handrails, and modifying the environment to improve mobility and safety. Exercise or physical therapy includes physical exercise, mobility and gait training, muscle strengthening, balance training, and training for recurrent fallers.
Appendix Table 1.
Articles may have been included for more than 1 KQ and more than 1 intervention. KQ = key question; PT = physical therapy; SER = systematic evidence review.
Appendix Table 2.
Appendix Table 3.
Appendix Table 4.
Appendix Table 5.
Appendix Table 6.
CG = control group; IG = intervention group.
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