Abstract
BackgroundFalls are common events in older people, which cause considerable morbidity and mortality. Non-pharmacological interventions are an important approach to prevent falls. There are a large number of systematic reviews of non-pharmacological interventions, whose evidence needs to be synthesized in order to facilitate evidence-based clinical decision making.ObjectivesTo systematically examine reviews and meta-analyses that evaluated non-pharmacological interventions to prevent falls in older adults in the community, care facilities and hospitals.MethodsWe searched the electronic databases Pubmed, the Cochrane Database of Systematic Reviews, EMBASE, CINAHL, PsycINFO, PEDRO and TRIP from January 2009 to March 2015, for systematic reviews that included at least one comparative study, evaluating any non-pharmacological intervention, to prevent falls amongst older adults. The quality of the reviews was assessed using AMSTAR and ProFaNE taxonomy was used to organize the interventions.ResultsFifty-nine systematic reviews were identified which consisted of single, multiple and multifactorial non-pharmacological interventions to prevent falls in older people. The most frequent ProFaNE defined interventions were exercises either alone or combined with other interventions, followed by environment/assistive technology interventions comprising environmental modifications, assistive and protective aids, staff education and vision assessment/correction. Knowledge was the third principle class of interventions as patient education. Exercise and multifactorial interventions were the most effective treatments to reduce falls in older adults, although not all types of exercise were equally effective in all subjects and in all settings. Effective exercise programs combined balance and strength training. Reviews with a higher AMSTAR score were more likely to contain more primary studies, to be updated and to perform meta-analysis.ConclusionsThe aim of this overview of reviews of non-pharmacological interventions to prevent falls in older people in different settings, is to support clinicians and other healthcare workers with clinical decision-making by providing a comprehensive perspective of findings.
Highlights
Falls are common in older people, with one in three older people falling at least once during a year [1]
Reviews with a higher AMSTAR score were more likely to contain more primary studies, to be updated and to perform meta-analysis. The aim of this overview of reviews of non-pharmacological interventions to prevent falls in older people in different settings, is to support clinicians and other healthcare workers with clinical decision-making by providing a comprehensive perspective of findings
Fall prevention programs targeting various risk factors have been carried out with older people living at home, in care facilities and in hospitals and consist of single, multiple and multifactorial interventions
Summary
Falls are common in older people, with one in three older people falling at least once during a year [1]. The propensity of older adults to fall increases with age, more than doubling between 70 and 80 years of age [2]. Fall-related injuries rise with age, with an increased risk of fracture, which in more than half of the cases occur to the hip [3]. Fear of falling in older people can be measured with the Falls Efficacy Scale-International [6]. Fall prevention programs targeting various risk factors have been carried out with older people living at home, in care facilities (e.g., long-term, residential, nursing homes) and in hospitals (acute and sub-acute wards) and consist of single, multiple and multifactorial interventions. Non-pharmacological interventions are an important approach to prevent falls. There are a large number of systematic reviews of non-pharmacological interventions, whose evidence needs to be synthesized in order to facilitate evidence-based clinical decision making
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