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Cited by 928Balance, Gait, and Falls PreventionGeriatric Care and Nursing HomesPharmaceutical Practices and Patient Outcomes

Interventions for preventing falls in older people in care facilities and hospitals

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Cameron, Ian D, Gillespie, Lesley D, Robertson, M Clare, Murray, Geoff R, Hill, Keith D, Cumming, Robert G, Kerse, Ngaire·2012·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd005465.pub3PMC PMC6148705
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Abstract

BACKGROUND: Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of a review first published in 2010 and updated in 2012. OBJECTIVES: To assess the effects of interventions designed to reduce the incidence of falls in older people in care facilities and hospitals. SEARCH METHODS: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (August 2017); Cochrane Central Register of Controlled Trials (2017, Issue 8); and MEDLINE, Embase, CINAHL and trial registers to August 2017. SELECTION CRITERIA: Randomised controlled trials of interventions for preventing falls in older people in residential or nursing care facilities, or hospitals. DATA COLLECTION AND ANALYSIS: One review author screened abstracts; two review authors screened full-text articles for inclusion. Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction. We calculated rate ratios (RaR) with 95% confidence intervals (CIs) for rate of falls and risk ratios (RRs) and 95% CIs for outcomes such as risk of falling (number of people falling). We pooled results where appropriate. We used GRADE to assess the quality of evidence. MAIN RESULTS: Thirty-five new trials (77,869 participants) were included in this update. Overall, we included 95 trials (138,164 participants), 71 (40,374 participants; mean age 84 years; 75% women) in care facilities and 24 (97,790 participants; mean age 78 years; 52% women) in hospitals. The majority of trials were at high risk of bias in one or more domains, mostly relating to lack of blinding. With few exceptions, the quality of evidence for individual interventions in either setting was generally rated as low or very low. Risk of fracture and adverse events were generally poorly reported and, where reported, the evidence was very low-quality, which means that we are uncertain of the estimates. Only the falls outcomes for the main comparisons are reported here.Care facilitiesSeventeen trials compared exercise with control (typically usual care alone). We are uncertain of the effect of exercise on rate of falls (RaR 0.93, 95% CI 0.72 to 1.20; 2002 participants, 10 studies; I² = 76%; very low-quality evidence). Exercise may make little or no difference to the risk of falling (RR 1.02, 95% CI 0.88 to 1.18; 2090 participants, 10 studies; I² = 23%; low-quality evidence).There is low-quality evidence that general medication review (tested in 12 trials) may make little or no difference to the rate of falls (RaR 0.93, 95% CI 0.64 to 1.35; 2409 participants, 6 studies; I² = 93%) or the risk of falling (RR 0.93, 95% CI 0.80 to 1.09; 5139 participants, 6 studies; I² = 48%).There is moderate-quality evidence that vitamin D supplementation (4512 participants, 4 studies) probably reduces the rate of falls (RaR 0.72, 95% CI 0.55 to 0.95; I² = 62%), but probably makes little or no difference to the risk of falling (RR 0.92, 95% CI 0.76 to 1.12; I² = 42%). The population included in these studies had low vitamin D levels.Multifactorial interventions were tested in 13 trials. We are uncertain of the effect of multifactorial interventions on the rate of falls (RaR 0.88, 95% CI 0.66 to 1.18; 3439 participants, 10 studies; I² = 84%; very low-quality evidence). They may make little or no difference to the risk of falling (RR 0.92, 95% CI 0.81 to 1.05; 3153 participants, 9 studies; I² = 42%; low-quality evidence).HospitalsThree trials tested the effect of additional physiotherapy (supervised exercises) in rehabilitation wards (subacute setting). The very low-quality evidence means we are uncertain of the effect of additional physiotherapy on the rate of falls (RaR 0.59, 95% CI 0.26 to 1.34; 215 participants, 2 studies; I² = 0%), or whether it reduces the risk of falling (RR 0.36, 95% CI 0.14 to 0.93; 83 participants, 2 studies; I² = 0%).We are uncertain of the effects of bed and chair sensor alarms in hospitals, tested in two trials (28,649 participants) on rate of falls (RaR 0.60, 95% CI 0.27 to 1.34; I² = 0%; very low-quality evidence) or risk of falling (RR 0.93, 95% CI 0.38 to 2.24; I² = 0%; very low-quality evidence).Multifactorial interventions in hospitals may reduce rate of falls in hospitals (RaR 0.80, 95% CI 0.64 to 1.01; 44,664 participants, 5 studies; I² = 52%). A subgroup analysis by setting suggests the reduction may be more likely in a subacute setting (RaR 0.67, 95% CI 0.54 to 0.83; 3747 participants, 2 studies; I² = 0%; low-quality evidence). We are uncertain of the effect of multifactorial interventions on the risk of falling (RR 0.82, 95% CI 0.62 to 1.09; 39,889 participants; 3 studies; I² = 0%; very low-quality evidence). AUTHORS' CONCLUSIONS: In care facilities: we are uncertain of the effect of exercise on rate of falls and it may make little or no difference to the risk of falling. General medication review may make little or no difference to the rate of falls or ri

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  • A further four systematic reviews cited but did not include affected trial reports in their reviews as a result of existing concerns with data, or awaiting responses to enquiries about data.

    “A further four systematic reviews cited but did not include affected trial reports in their reviews as a result of existing concerns with data,44–46 or awaiting responses to enquiries about data.47”

    From An investigation into the impact and implications of published papers from retracted research: systematic search of affected literature (2019) · cites this paper as [45]

    The Studies awaiting classification section (page unavailable) says two studies awaited publication of full reports containing falls data, not responses to enquiries about data. The Excluded studies section (page unavailable) lists other reasons for exclusion. Searches for pending author responses and data concerns found no passage establishing the reason attributed to this review. (LLM, conf=0.72)

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  1. Rehabilitation Centers/ (6112) 15 ((long stay or acute or sub-acute or subacute or residential or hospital) adj3 (care or ward$1)).tw. (42017) 16 ((rehabilitation or geriatric) adj (ward$1 or hospital$1 or unit$1)).tw. (4826) 17 (hostel$1 or nursing home$).tw. (19323) 18 or/8-17 (336948) 19 and/7,18 (2095) 20
  2. Deeks JJ, Higgins JPT, Altman DG (editors). Chapter 9.4.4.3: Random-effects method. In: Higgins JPT, Green S (editors). Cochrane Handbook of Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org. Contributors Feedback from: Johannes C van der Wouden, Netherlands Reply from: Lesley Gillespie, M Clare Robertson, Ian Cameron (with advice from Xavier Griffin, Feedback Editor, Cochrane Bone, Joint and Muscle Trauma Group). References
  3. Scragg R. Do we need to take calcium with vitamin D supplements to prevent falls, fractures, and death? Current Opinion in Clinical Nutrition and Metabolic Care 2012;15(6):614-24.
  4. IOM (Institute of Medicine). Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press, 2011.
  5. W H A T ' S N E W Last assessed as up-to-date: 30 June 2012. Date Event Description 16 December 2014 Amended Removal of Rosendahl 2008 (exercise) from Analysis 9.3 (multifactorial) and correction of associated text in response to a personal communication (Lundin-Olsson 2014). 16 December 2014 Feedback has been incorporated Changes relate to feedback received 17 October 2014. Summary [of feed- back] and Reply entries were added to the Feedback section. There were no changes to the review in relation to the feedback

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Authors
Cameron, I. D., Gillespie, L. D., Robertson, M. C., Murray, G. R., Hill, K. D., Cumming, R. G., & Kerse, N.
Affiliations
  • The University of Sydney (AU)
  • University of Manchester (GB)
  • University of Otago (NZ)
  • Illawarra Shoalhaven Local Health District (AU)
  • Curtin University (AU)
  • University of Auckland (NZ)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2012-12-12
Volume
12
Pages
CD005465-CD005465
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd005465.pub3
PMC
PMC6148705
OpenAlex
W1960684477
Cited by
928
References
296
Citations by year
2026: 1 · 2025: 31 · 2024: 51 · 2023: 66 · 2022: 80 · 2021: 92 · 2020: 100 · 2019: 87 · 2018: 78 · 2017: 79 · 2016: 88 · 2015: 72 · 2014: 61 · 2013: 38 · 2012: 1
FWCI
5.98
Type
journal article
Language
en
Update notices
new_version (2018-09-07)
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • BIBSYS Brage (BIBSYS (Norway)) (acceptedVersion)
  • eSpace (Curtin University) (submittedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
Topics
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
  • Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords
fall prevention, older adults, nursing homes, hospitals, exercise intervention, balance training, gait training, walking speed, fall risk assessment, medication review, inpatient falls, risk of bias, quality of evidence, fracture risk, adverse events, injury risk, mortality risk
MeSH terms
Accidental Falls, Aged, Aged, 80 and over, Calcium, Dietary, Female, Hospitals, Humans, Male, Nursing Homes, Vitamin D, Vitamins, Exercise, Randomized Controlled Trials as Topic, Safety Management

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