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Interventions for preventing falls in older people in care facilities and hospitals
Open accessAbstract
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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Research works printed but not linked: 36
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Cited by
Sorted by citations
World guidelines for falls prevention and management for older adults: a global initiative
Montero-Odasso, M., van der Velde, N., Martin, F. C., Petrovic, M., Tan, M. P., Ryg, J., Aguilar-Navarro, S., Alexander, N. B., Becker, C., Blain, H., et al. (2022) · Age and Ageing · doi:10.1093/ageing/afac205 · Cited by 1,756
Self-citationSkeletal and Extraskeletal Actions of Vitamin D: Current Evidence and Outstanding Questions
Bouillon, R., Marcocci, C., Carmeliet, G., Bikle, D. D., White, J. H., Dawson-Hughes, B. F., Lips, P. T. A. M., Munns, C. F., Lazaretti‐Castro, M., Giustina, A., et al. (2018) · Endocrine Reviews · doi:10.1210/er.2018-00126 · Cited by 1,257
Exercise to prevent falls in older adults: an updated systematic review and meta-analysis
Sherrington, C., Michaleff, Z. A., Fairhall, N., Paul, S. S., Tiedemann, A., Whitney, J., Cumming, R. G., Herbert, R. D., Close, J. C. T., & Lord, S. R. (2017) · British Journal of Sports Medicine · doi:10.1136/bjsports-2016-096547 · Cited by 1,095
Self-citationPhysical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management
Dent, E., Morley, J. E., Cruz-Jentoft, A. J., Woodhouse, L. J., Rodríguez‐Mañas, L., Fried, L. P., Woo, J., Aprahamian, I., Sanford, A. M., Lundy, J., et al. (2019) · The journal of nutrition health & aging · doi:10.1007/s12603-019-1273-z · Cited by 1,135
Theodoratou, E., Tzoulaki, I., Zgaga, L., & Ioannidis, J. P. A. (2014) · BMJ · doi:10.1136/bmj.g2035 · Cited by 956
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)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2012-12-12
- Volume
- 12
- Pages
- CD005465-CD005465
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- 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
- bronze
- doi.org
- 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.
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