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

The DOI matches its Crossref record; 295 of the 296 references it cites were found in a registry or an index.

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

Open access
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
Open this paper in CoChat — free accountOpen PDF

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

Overview

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1002/14651858.cd005465.pub3

Cites

295 of 295 references verified0 citation errors · 0 not checkable

Statistics

Verification

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Citations

Cites

6 retracted

Flagged first, then by citations

Show all 296 references

1 of the 296 references couldn’t be matched to a known paper.

Research works printed but not linked: 36

  1. Becker, 2000, Multifactorial intervention on falls and fractures in nursing homes (abstract), Age and Ageing, 29, 18
  2. Buettner, 2001, Efficacy of prescribed therapeutic recreation protocols on falls and injuries in nursing home residents with dementia (Research monograph)
  3. Burleigh, 2006, Does vitamin D stop hospital inpatients falling? - a randomised controlled trial [abstract], Age and Ageing, 35, i40
  4. Burleigh, 2006, Does vitamin D stop hospital inpatients falling? A randomized controlled trial [abstract], Internal Medicine Journal, 36, A165
  5. Norman, 2008, Dementia care mapping and patient-centred care in Australian residential homes: an economic evaluation of the CARE Study
  6. Dyer, 2003, Falls prevention in residential homes: a randomised controlled trial (abstract), Age and Ageing, 32, 16
  7. Flicker L MacInnis R Stein M Scherer S Mead K Nowson C Should all older people in residential care be supplemented with vitamin D to prevent falls? Results of a randomised trial [abstract] 14th National conference on falls and postural instability; 2003 Sept 8; London
  8. Flicker, 2004, Should all older people in residential care receive vitamin D to prevent falls? Results of a randomised trial [abstract], Journal of Bone and Mineral Research, 19(Suppl 1), S99
  9. Clague N Kerr KM Mockett SP A pilot randomised trial to assess the effects of inpatient physiotherapy on falls in the elderly (poster 49) Proceedings of the Chartered Society of Physiotherapy Annual Congress and Exhibition; 2003 Oct 17-19; Birmingham (UK) London Chartered Society of Physiotherapy 2003 81
  10. Jarvis, 2007, Pilot study to explore the feasibility of a randomised controlled trial to determine the dose effect of physiotherapy on patients admitted to hospital following a fall, Practical Evidence, 2, 4
  11. Millar, 1999, A trial of falls prevention [abstract], Age and Ageing, 28, 15
  12. Neyens, 2002, Development and implementation of a multifactorial intervention for psychogeriatric nursing home patients targeted on the prevention of falls and fall-related injuries, Tijdschrift voor Verpleeghuisgeneeskunde, 26, 24
  13. Rosendahl, 2009, Fall prediction and a high-intensity functional exercise programme to improve physical functions and to prevent falls among older people living in residential care facilities [thesis]
  14. Rosendahl, 2007, High-intensity functional exercise program for older people dependent in ADL: an RCT evaluating the effects on physical functions and falls [abstract], Physiotherapy, 93, S377
  15. March, 2009, A randomised controlled trial of increased sunlight exposure to reduce vitamin D deficiency and falls risk in the elderly [abstract], Journal of Bone and Mineral Research, 24, S73
  16. Shaw, 2001, Risk modification of falls in older patients with cognitive impaired and dementia attending a casualty department [thesis]
  17. Shaw, 2000, Can multidisciplinary intervention prevent falls in patients with cognitive impairment and dementia attending a casualty department (abstract), Age and Ageing, 29, 47
  18. Toulotte, 2003, Prevention of falls by physical training in frail demented and faller elderly subjects, Revue de Geriatrie, 28, 221
  19. Gaal, 2009, The design of the SAFE or SORRY? study: a cluster randomised trial on the development and testing of an evidence based inpatient safety program for the prevention of adverse events, BMC Health Services Research, 9, 58, 10.1186/1472-6963-9-58 · DOI
  20. Gaal, 2011, Fewer adverse events as a result of the SAFE or SORRY? programme in hospitals and nursing homes. part i: primary outcome of a cluster randomised trial, International Journal of Nursing Studies, 48, 1040, 10.1016/j.ijnurstu.2011.02.017 · DOI
  21. Gaal, 2011, The SAFE or SORRY? programme. part II: effect on preventive care, International Journal of Nursing Studies, 48, 1049, 10.1016/j.ijnurstu.2011.02.018 · DOI
  22. Gaal, 2010, The effect of the SAFE or SORRY? programme on patient safety knowledge of nurses in hospitals and nursing homes: a cluster randomised trial, International Journal of Nursing Studies, 47, 1117, 10.1016/j.ijnurstu.2010.02.001 · DOI
  23. ISRCTN45416155 Can a review of the medication of elderly nursing and residential home patients improve the quality of prescribing and residents' outcomes? controlled-trials.com/ISRCTN45416155
  24. Capezuti, 1995, The relationship between physical restraint removal and fall-related incidents and injuries among nursing home residents [thesis]
  25. Vassallo, 2001, Can intervention prevent falls and injury in geriatric wards? Hospital injury prevention (HIP) study [abstract], Age and Ageing, 30, 15
  26. Zhong, 2007, Quetiapine to treat agitation in dementia: a randomized, double blind, placebo-controlled study, Current Alzheimers Research, 4, 81, 10.2174/156720507779939805 · DOI
  27. MacRitchie, 2001, Reducing the incidence of falls among elderly nursing home residents: An evaluation of an ameliorative pilot program [thesis]
  28. Streim, 2012, Antidepressant discontinuation associated with cognitive decline in older adult residents of long-term care facilities [abstract], American Journal of Geriatric Psychiatry, 20, S148
  29. Higgins JPT Altman DG Sterne JAC (editors) Chapter 8.5: The Cochrane Collaboration’s tool for assessing risk of bias. 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
  30. Higgins JPT Deeks JJ Altman DG (editors) Chapter 16.3.4: Approximate analyses of cluster-randomized trials for meta-analysis: effective sample sizes. 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
  31. Deeks JJ Higgins JPT Altman DG (editors) Chapter 9.6.3.1 Is the effect different in different subgroups? 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
  32. Jensen, 2003, Fall and injury prevention in residential care-effects in residents with higher and lower levels of cognition, Journal of the American Geriatrics Society, 51, 627, 10.1034/j.1600-0579.2003.00206.x · DOI
  33. Lefebvre C Manheimer E Glanville J Chapter 6.4.11.1 The Cochrane Highly Sensitive Search Strategies for identifying randomized trials in MEDLINE. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011 Available from www.cochrane-handbook.org
  34. Norman, 2008, Dementia care mapping and patient-centred care in Australian residential homes: an economic evaluation of the CARE Study
  35. Rapp, 2008, Prevention of falls in nursing homes: subgroup analyses of a randomized fall prevention trial, Journal of the American Geriatrics Society, 56, 1092, 10.1111/j.1532-5415.2008.01739.x · DOI
  36. The Nordic Cochrane Centre, The Cochrane Collaboration Review Manager (RevMan) 2012

Cited by

Sorted by citations

Items 301–400 of 925

Related

See all

Metadata

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 › Medicine › Geriatrics and Gerontology › 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

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review