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Cited by 43Down syndrome and intellectual disability researchBalance, Gait, and Falls PreventionInjury Epidemiology and Prevention

Incidence and prevalence of falls in adults with intellectual disability living in the community: a systematic review

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Ho, Portia, Bulsara, Max, Downs, Jenny, Patman, Shane, Bulsara, Caroline, Hill, Anne-Marie·2019·JBI Database of Systematic Reviews and Implementation Reports
DOI 10.11124/jbisrir-2017-003798
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Abstract

Objective: The objective of the review was too synthesize the best available evidence on the incidence and prevalence of falls among adults with intellectual disability (ID). Introduction: Falls among adults with ID frequently cause physical injury and may negatively impact on their quality of life. Studies investigating falls among people with ID have used differing methods and populations, making it difficult to determine the scope and extent of this problem. Inclusion criteria: This review considered all studies that included adults with ID aged 18 years and over and which reported percentage/numbers of individuals who fell, and the total number of falls and injurious falls sustained from a fall. Studies were included if they were conducted within community or residential settings. Studies that were conducted in hospitals were excluded. Cohort studies, case-control and cross-sectional studies were included. Studies that used an experimental design, both randomized controlled and quasi experimental design, were also included. Methods: A three-step search strategy was undertaken for published and unpublished literature in English from 1990 to 2017. An initial search of MEDLINE and CINAHL was undertaken before a more extensive search was conducted using keywords and index terms across 11 electronic databases. Two independent reviewers assessed the methodological quality of the included studies using the Joanna Briggs Institute standardized critical appraisal instrument for prevalence studies (Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data). Data was extracted using the Joanna Briggs Institute's standardized extraction tool. Data that directly reported or could be used to calculate the incidence and prevalence of falls were extracted. Quantitative data for the number (proportion) of people who fell were pooled in statistical meta-analysis using STATA version 14 (Stata Corp LLC, Texas, USA). Data measuring incidence of falls (rate of falls for the duration of the study) and incidence of injurious falls (rate of falls resulting in one or more injuries for the duration of the study) could not be pooled in meta-analysis, hence results have been presented in a narrative form including tables. Standard GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence assessment of outcomes is also reported. Results: Nine studies were eligible for inclusion in this review. Eight articles were observational cohort studies which reported on the incidence/prevalence of falls as outcome measures, and one article was a quasi-experimental study design. Overall the methodological quality of the included studies was considered moderate. The pooled proportion of people with ID who fell (four studies, 854 participants) was 39% (95% CI [0.35%-0.43%], very low GRADE evidence). The rate of falls (eight studies, 782 participants) ranged from 0.54 to 6.29 per person year (very low GRADE evidence). The rate of injurious falls (two studies, 352 participants) ranged from 0.33 to 0.68 per person year (very low GRADE evidence). Conclusions: Synthesized findings demonstrate that people with ID, who live in community or residential settings, may fall more frequently, and at a younger age, compared to general community populations. Studies should take a consistent approach to measuring and reporting falls outcomes. Further research is recommended to identify the impact of falls on health related outcomes for people with ID and subsequently evaluate falls interventions for their efficacy.

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  • A study with a JBI score of ≥6 was considered to be at low risk of bias.

    “In line with previous studies, a study with a score of ≥6 was considered to be at low risk of bias.21,22”

    From Adherence to PCSK9 Inhibitors in Clinical Practice (2026) · cites this paper as [21]

    The Methodological quality section says studies scoring 6–8 out of 9 on the JBI checklist were of acceptable quality for inclusion in the meta-analysis. It does not classify a score of ≥6 as low risk of bias: the Assessment of methodological quality section allowed studies scoring 5 into the review, and the GRADE Certainty Assessment and Results section rated risk of bias serious for every group of studies. (LLM, conf=0.88)

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Research works printed but not linked: 41

  1. Smulders E, Enkelaar L, Schoon Y, Geurts AC, van Schrojenstein Lantman-de Valk H, Weerdesteyn V. Falls prevention in persons with intellectual disabilities: Development, implementation, and process evaluation of a tailored multifactorial fall risk assessment and intervention strategy. Res Dev Disabil. 2013; 34(9):2788-98.
  2. Cox CR, Clemson L, Stancliffe RJ, Durvasula S, Sherrington C. Incidence of and risk factors for falls among adults with an intellectual disability. J Intellect Disabil Res. 2010; 54(12):1045- 57.
  3. Wagemans AMA, Cluitmans JJM. Falls and fractures: A major health risk for adults with intellectual disabilities in residential settings. J Policy Pract Intellect Disabil. 2006;3(2):136-8.
  4. Finlayson J, Morrison J, Jackson A, Mantry D, Cooper SA. Injuries, falls and accidents among adults with intellectual disabilities. Prospective cohort study. J Intellect Disabil Res. 2010;54(11):966-80.
  5. Hsieh K, Rimmer J, Heller T. Prevalence of falls and risk factors in adults with intellectual disability. Am J Intellect Dev Disabil. 2012;117(6):442-54.
  6. Pal J, Hale L, Mirfin-Veitch B, Claydon L. Injuries and falls among adults with intellectual disability: A prospective New Zealand cohort study. J Intellect Dev Disabil. 2014;39(1):35-44.
  7. Willgoss TG, Yohannes AM, Mitchell D. Review of risk factors and preventative strategies for falls-related injuries in people with intellectual disabilities. J Clin Nurs. 2010;19(15-16):2100-9.
  8. Cahill S, Stancliffe RJ, Clemson L, Durvasula S. Reconstructing the fall: Individual, behavioural and contexual factors associated with falls in individuals with intellectual disability. J Intellect Dev Disabil. 2014;58(4):321-32.
  9. Carmeli E, Iman B, Bachar A, Merrick J. Inflammation and oxidative stress as biomarkers of premature aging in person with intellectual disability. Res Dev Disabil. 2011; 33(2):369-75.
  10. Strydom A, Shooshtari S, Lee L, Raykar V, Torr J, Tsiouris J, et al. Dementia in older adults with intellectual disabilities -epidemiology, presentation, and diagnosis. J Policy Pract Intellect Disabil. 2010;7(2):96-110.
  11. Smulders E, Enkelaar L, Weerdesteyn V, Geurts AC, Schrojenstein Lantman-de Valk H. Falls in older persons with intellectual disabilities: fall rate, circumstances and consequences. J Intellect Disabil Res. 2013;57(12):1173-82.
  12. Grant HJ, Pickett W, Lam M, O'Connor M, Ouellette-Kuntz H. Falls among persons who have developmental disabilities in institutional and group home settings. J Dev Disabl. 2001;8(1):57-73.
  13. Salb J, Woodward C, Offenhäußer J, Becker C, Sieber C, Freiberger E. Prevalence and characteristics of falls in adults with intellectual disability living in a residential facility: A longitudinal study [PreFalllD]. Intellect Dev Disabil. 2015;53(3):228-39.
  14. Lamb SE, Jørstad-Stein EC, Hauer K, Becker C. Development of a common outcome data set for fall injury prevention trials: The prevention of falls network europe consensus. J Am Geriatr Soc. 2005;53(9):1618-22.
  15. McDonald KE, Kidney CA. What is right? Ethics in intellectual disabilities research. J Policy Pract Intellect Disabil. 2012;9(1):27-39.
  16. Lennox N, Taylor M, Rey-Conde T, Bain C, Purdie DM, Boyle F. Beating the barriers: recruitment of people with intellectual disability to participate in research. J Intellect Disabil Res 2005;49(4):296-305.
  17. Hauer K, Lamb SE, Jorstad EC, Todd C, Becker C, PROFANE-Group. Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. Age Ageing. 2006;35(1):5-10.
  18. Kwan MM-S, Close JCT, Wong AKW, Lord SR. Falls incidence, risk factors, and consequences in Chinese older people: a systematic review. J Am Geriatr Soc. 2011;59(3):536-43.
  19. Enkelaar L, Smulders E, van Schrojenstein Lantman-de Valk H, Geurts A, Weerdesteyn V. A review of balance and gait capacities in relation to falls in persons with intellectual disability Res Dev Disabil. 2012;33(1):291-306.
  20. Sherrard J, Ozanne-Smith J, Staines C. Prevention of unintentional injury to people with intellectual disability: a review of the evidence. J Intellect Disabil Res. 2004;48(7):639-45.
  21. Heinrich S, Rapp K, Rissmann U, Becker C, König HH. Cost of falls in old age: a systematic review. Osteoporos Int. 2010;21(6):891-902.
  22. Ho P, Patman S, Bulsara C, Downs J, Bulsara M, Hill A-M. Incidence and prevalence of falls in adults with intellectual disability living in the community: a systematic review protocol. JBI Database System Rev Implement Rep. 2017;15(7):1819-23.
  23. Hill A-M, Hoffmann T, McPhail S, Beer C, Hill KD, Oliver D, et al. Evaluation of the sustained effect of inpatient falls prevention education and predictors of falls after hospital discharge-- follow-up to a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2011;66(9):1001-12.
  24. Munn Z, Moola S, Lisy K, Riitano D, Tufanaru C. Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. Int J Evid Based Healthc. 2015;13(3):147-53.
  25. Goodwin VA, Abbott RA, Whear R, Bethel A, Ukoumunne OC, Thompson-Coon J, et al. Multiple component interventions for preventing falls and fall-related injuries among older people: systematic review and meta-analysis. BMC Geriatr. 2014;14:15.
  26. Carpenter GI, Demopoulos GR. Screening the elderly in the community: controlled trial of dependency surveillance using a questionnaire administered by volunteers. BMJ (Clinical Research Ed). 1990;300(6734):1253-6.
  27. Campbell AJ, Borrie MJ, Spears GF, Jackson SL, Brown JS, Fitzgerald JL. Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study. Age Ageing. 1990;19(2):136-41.
  28. Joanna Briggs Institute's System for the Unified Management, Assessment and Review of Information (JBI-SUMARI). Version 5, 2016 [cited 2017, Oct 14]. Available from https://www.jbisumari.org
  29. Van Hanegem E, Enkelaar L, Smulders E, Weerdesteyn V. Obstacle course training can improve mobility and prevent falls in people with intellectual disabilities. J Intellect Disabili Res. 2014;58(5):485-92.
  30. Miller JJ. The inverse of the freeman-tukey double arcsine transformation. Am Stat. 1978;32(4): 138.
  31. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557-60.
  32. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic review and meta-analysis: The PRISMA statement. Int J Surg. 2010;8(5):336-41.
  33. Milat AJ, Watson WL, Monger C, Barr M, Giffin M, Reid M. Prevalence, circumstances and consequences of falls among community-dwelling older people: results of the 2009 NSW Falls Prevention Baseline Survey. N S W Public Health Bull. 2011;22(3-4):43-8.
  34. Feder G, Cryer C, Donovan S, Carter Y. Guidelines for the prevention of falls in people over 65. BMJ. 2000;321(7267):1007-1011.
  35. Rubenstein LZ, Josephson KR, Robbins AS. Falls in the nursing home. Ann Intern Med. 1994; 121(6):442-51.
  36. Sherrard J, Tonge BJ, Ozanne-Smith J. Injury in young people with intellectual disability: descriptive epidemiology. Inj Prev. 2001; 7: 56-61 Reason for exclusion: This study collected epidemiological data on the number of injuries in people with ID. Falls data were reported in relation to the injuries sustained and not as the main focus of the study. Outcomes of interest were not documented clearly.
  37. Strauss D, Shavelle R, Anderson TW, Baumeister A. External causes of death among persons with developmental disability: The effect of residential placement. Am J Epidemiol. 1998;147(9):855-62. Reason for exclusion: The focus of this study was to look at causes of death. Falls were only recorded if it caused death. Therefore outcome of interest was not reported.
  38. Oppewal A, Hilgenkamp TIM, van Wijck R, Schoufour JD, Evenhuis HM. The predictive value of physical fitness for falls in older adults with intellectual disability. Res Dev Disabil. 2014;35:1317-25 Reason for exclusion: The outcome of interest was not documented clearly.
  39. Morgan PE, McGinley JL. Falls, fear of falling and falls risk in adults with cerebral palsy: A pilot observational study. Eur J Physiother. 2013;15(2):93-100 Reason for exclusion: Study included participants with Cerebral Palsy and not ID. The Abbreviated Mental Test score was used to score level of cognitive impairment. It was not clear if the subjects had intellectual disability fulling the DSM-5 criteria.
  40. Bruckner J, Herge, EA. Assessing the risk of falls in elders with mental retardation and developmental disabilities. Top Geriatr Rehabil. 2003;19(3):206-11 Reason for exclusion: The length of the observational period was not mentioned for the documented falls against each participant. Therefore, there was insufficient data to calculate the outcome of interest.
  41. Smulders E, Enkelaar L, Schoon Y, Geurts AC, van Schrojenstein Lantman-de Valk H, Weerdesteyn V. Falls prevention in persons with intellectual disabilities: Development, implementation, and process evaluation of a tailored multifactorial fall risk assessment and intervention strategy. Res Dev Disabil. 2013;34(9):2788-98.

Cited by

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Authors
Ho, P., Bulsara, M., Downs, J., Patman, S., Bulsara, C., & Hill, A.-M.
Affiliations
  • The University of Notre Dame Australia (AU)
  • The Kids Research Institute Australia (AU)
  • Curtin University (AU)
Corresponding author
Ho, Portia
ORCID
Venue
JBI Database of Systematic Reviews and Implementation Reports
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2019-03
Volume
17
Issue
3
Pages
390-413
ISSN
2202-4433 (ISSN-L)
DOI
10.11124/jbisrir-2017-003798
OpenAlex
W3132804339
Cited by
43
References
0
Citations by year
2026: 2 · 2025: 8 · 2024: 11 · 2023: 6 · 2022: 5 · 2021: 6 · 2020: 3 · 2019: 1
FWCI
0.62
Type
journal article
Language
en
Open access
Locations
  • The JBI Database of Systematic Reviews and Implementation Reports (publishedVersion)
  • PubMed (publishedVersion)
  • eSpace (Curtin University) (submittedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Down syndrome and intellectual disability research
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Injury Epidemiology and Prevention
Keywords
falls, intellectual disability, adults, community-dwelling adults, fall incidence, fall prevalence, injurious falls, fall-related injuries, quality of life, fall prevention, community-based intervention, residential settings, physical activity, falls in older adults, falls in children
MeSH terms
Accidental Falls, Adolescent, Adult, Aged, Aged, 80 and over, Developmental Disabilities, Cross-Sectional Studies, Evaluation Studies as Topic, Female, Humans, Male, Intellectual Disability, Middle Aged, Quality of Life, Residence Characteristics, Incidence, Prevalence, Case-Control Studies, Outcome Assessment, Health Care, Young Adult, Observational Studies as Topic, Non-Randomized Controlled Trials as Topic

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