Abstract
With the global population aging, falls and fall-related injuries are ubiquitous, and several clinical practice guidelines for falls prevention and management for individuals 60 years or older have been developed. A systematic evaluation of the recommendations and agreement level is lacking. To perform a systematic review of clinical practice guidelines for falls prevention and management for adults 60 years or older in all settings (eg, community, acute care, and nursing homes), evaluate agreement in recommendations, and identify potential gaps. A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analyses statement methods for clinical practice guidelines on fall prevention and management for older adults was conducted (updated July 1, 2021) using MEDLINE, PubMed, PsycINFO, Embase, CINAHL, the Cochrane Library, PEDro, and Epistemonikos databases. Medical Subject Headings search terms were related to falls, clinical practice guidelines, management and prevention, and older adults, with no restrictions on date, language, or setting for inclusion. Three independent reviewers selected records for full-text examination if they followed evidence- and consensus-based processes and assessed the quality of the guidelines using Appraisal of Guidelines for Research & Evaluation II (AGREE-II) criteria. The strength of the recommendations was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation scores, and agreement across topic areas was assessed using the Fleiss κ statistic. Of 11 414 records identified, 159 were fully reviewed and assessed for eligibility, and 15 were included. All 15 selected guidelines had high-quality AGREE-II total scores (mean [SD], 80.1% [5.6%]), although individual quality domain scores for clinical applicability (mean [SD], 63.4% [11.4%]) and stakeholder (clinicians, patients, or caregivers) involvement (mean [SD], 76.3% [9.0%]) were lower. A total of 198 recommendations covering 16 topic areas in 15 guidelines were identified after screening 4767 abstracts that proceeded to 159 full texts. Most (≥11) guidelines strongly recommended performing risk stratification, assessment tests for gait and balance, fracture and osteoporosis management, multifactorial interventions, medication review, exercise promotion, environment modification, vision and footwear correction, referral to physiotherapy, and cardiovascular interventions. The strengths of the recommendations were inconsistent for vitamin D supplementation, addressing cognitive factors, and falls prevention education. Recommendations on use of hip protectors and digital technology or wearables were often missing. None of the examined guidelines included a patient or caregiver panel in their deliberations. This systematic review found that current clinical practice guidelines on fall prevention and management for older adults showed a high degree of agreement in several areas in which strong recommendations were made, whereas other topic areas did not achieve this level of consensus or coverage. Future guidelines should address clinical applicability of their recommendations and include perspectives of patients and other stakeholders.
Highlights
This systematic review found that current clinical practice guidelines on fall prevention and management for older adults showed a high degree of agreement in several areas in which strong recommendations were made, whereas other topic areas did not achieve this level of consensus or coverage
Several medical societies and organizations in different countries have created clinical practice guidelines for fall prevention and management.[13,14,15,16,17,18,19,20,21,22,23,24,25,26,27]. These guidelines are typically based on systematic reviews of the available evidence and consensus by experts in the fields of geriatric medicine, rehabilitation medicine, and physiotherapy, among others.[28,29]
Several of these clinical practice guidelines for fall prevention have been published, little is known about the level of agreement between the recommendations made by them
Summary
Falls and fall-related injuries are common for older adults,[1] with approximately 30% of adults 60 years of age or older falling each year.[2,3,4] Falls are more likely for older adults with greater frailty severity and among those living in nursing homes.[5,6] Consequences of falls include injuries,[7] fractures,[8] problems with mobility, depression, loss of independence,[9,10] and a substantial economic burden on health care systems.[11] Falls and their concomitant injuries represent a worldwide phenomenon.[12] several medical societies and organizations in different countries have created clinical practice guidelines for fall prevention and management.[13,14,15,16,17,18,19,20,21,22,23,24,25,26,27] These guidelines are typically based on systematic reviews of the available evidence and consensus by experts in the fields of geriatric medicine, rehabilitation medicine, and physiotherapy, among others.[28,29] several of these clinical practice guidelines for fall prevention have been published, little is known about the level of agreement between the recommendations made by them. Clinicians face the challenge of selecting high-quality guidelines based on robust methods with internally and externally validated recommendations applicable to their setting in informing their practice.[30,31]
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