What Works to Prevent Falls in Community-Dwelling Older Adults? Umbrella Review of Meta-analyses of Randomized Controlled Trials

• Published in: Physical therapy Vol. 95; no. 8; pp. 1095 - 1110
• Main Authors: Stubbs, Brendon, Brefka, Simone, Denkinger, Michael D
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01-08-2015
• Subjects: Accident Prevention; Accidental falls; Accidental Falls - prevention & control; Accidents; Age; Aged; Aged patients; Bias; Care and treatment; Clinical trials; Confidence intervals; Elderly patients; Falls; Falls (Accidents); Humans; Independent Living; Intervention; Long term health care; Meta-analysis; Meta-Analysis as Topic; Middle Aged; Nursing home patients; Older people; Physical therapists; Prevention; Quality; Randomized Controlled Trials as Topic; Ratios; Studies
• ISSN: 0031-9023; 1538-6724; 1538-6724
• DOI: 10.2522/ptj.20140461

Preventing falls is an international priority. There is a need to synthesize the highest-quality falls prevention evidence in one place for clinicians.
The aim of this study was to conduct an umbrella review of meta-analyses of randomized controlled trials (RCTs) of falls prevention interventions in community-dwelling older adults.
The MEDLINE, EMBASE, CINAHL, AMED, BNI, PsycINFO, Cochrane Library, PubMed, and PEDro databases were searched.
Meta-analyses with one pooled analysis containing ≥3 RCTs that investigated any intervention to prevent falls in community-dwelling older adults aged ≥60 years were eligible. Sixteen meta-analyses, representing 47 pooled analyses, were included.
Two authors independently extracted data.
Data were narratively synthesized. The methodological quality of the meta-analyses was moderate. Three meta-analyses defined a fall, and 3 reported adverse events (although minor). There is consistent evidence that exercise reduces falls (including the rate, risk, and odds of falling), with 13/14 pooled analyses (93%) from 7 meta-analyses demonstrating a significant reduction. The methodological quality of meta-analyses investigating exercise were medium/high, and effect sizes ranged from 0.87 (relative risk 95% confidence interval=0.81, 0.94; number of studies=18; number of participants=3,568) to 0.39 (rate ratio 95% confidence interval=0.23, 0.66; number of meta-analyses=6). There is consistent evidence that multifactorial interventions reduce falls (5/6, 83% reported significant reduction). There is conflicting evidence regarding the influence of vitamin D supplementation (7/12, 58.3% reported significant reduction).
Meta-analyses often used different methods of analysis, and reporting of key characteristics (eg, participants, heterogeneity, publication bias) was often lacking. There may be some overlap among included meta-analyses.
There is consistent evidence that exercise and individually tailored multifactorial interventions are effective in reducing falls in community-dwelling older adults.