Article type
Year
Abstract
Objective: To assemble the best evidence for effectiveness of programmes designed to reduce the incidence of falls in community dwelling or institutionalised elderly people.
Methods: A systematic review based on randomised controlled trials testing interventions aimed at reducing falls in elderly people was carried out. Trials were mainly identified via electronic databases using Cochrane methodology, journal searching or bibliographic review of relevant articles. No language restriction was applied. Trials which focused on intermediate outcomes or did not record fall rates were excluded. Pre-planned methodological assessment and data extraction instruments were used by two reviewers for each included study and the outcomes from individual trials were analysed. Pooling of results from groups of trials of similar design was carried out.
Results: Eighteen studies, including one pre-planned meta-analysis of a number of smaller studies, were included. A further 70 studies identified by the search strategy were excluded. Analysis of four trials which studied the effect of exercise alone did not confirm protection against falling (odds ratio 1.09, 95% CI 0.77-1.53). However, some protection was apparent from interventions which targeted multiple risk factors in individual patients (for falling, odds ratio 0.77, 95% CI 0.64-0.91; for sustaining a fall requiring medical care, odds ratio 0.71, 95% CI 0.50-1.00; for sustaining a fall resulting in injury, odds ratio 0.72, 95% CI 0.53-0.97). In interventions whose main target was environmental risk factors, there was also some evidence of protection (odds ratio 0.81, 95% CI 0.71-0.93).
Discussion: Health care purchasers and providers contemplating fall prevention programmes should consider interventions which are targeted to endogenous and environmental risk factors of individual patients.
Methods: A systematic review based on randomised controlled trials testing interventions aimed at reducing falls in elderly people was carried out. Trials were mainly identified via electronic databases using Cochrane methodology, journal searching or bibliographic review of relevant articles. No language restriction was applied. Trials which focused on intermediate outcomes or did not record fall rates were excluded. Pre-planned methodological assessment and data extraction instruments were used by two reviewers for each included study and the outcomes from individual trials were analysed. Pooling of results from groups of trials of similar design was carried out.
Results: Eighteen studies, including one pre-planned meta-analysis of a number of smaller studies, were included. A further 70 studies identified by the search strategy were excluded. Analysis of four trials which studied the effect of exercise alone did not confirm protection against falling (odds ratio 1.09, 95% CI 0.77-1.53). However, some protection was apparent from interventions which targeted multiple risk factors in individual patients (for falling, odds ratio 0.77, 95% CI 0.64-0.91; for sustaining a fall requiring medical care, odds ratio 0.71, 95% CI 0.50-1.00; for sustaining a fall resulting in injury, odds ratio 0.72, 95% CI 0.53-0.97). In interventions whose main target was environmental risk factors, there was also some evidence of protection (odds ratio 0.81, 95% CI 0.71-0.93).
Discussion: Health care purchasers and providers contemplating fall prevention programmes should consider interventions which are targeted to endogenous and environmental risk factors of individual patients.