Clinical Question: What is the best way to prevent falls in older adults?

Setting: Outpatient (any)

Study Design: Meta-analysis (randomized controlled trials)

Synopsis: The investigators conducting this meta-analysis on fall prevention in older adults performed a broad and thorough literature search, finding 40 randomized trials that compared an intervention group with usual care or a control group. Two of the authors independently reviewed and extracted information from the studies. None of the studies directly assessed the relative effectiveness of the different interventions. A multifactorial program on risk assessment and management of falls was the most effective. In this approach, patients at a high risk for falls, or who already had experienced a fall, underwent systematic screening, including a medication review.

Falls were prevented over six to 18 months by the various study interventions, with one additional person being fall-free for every 11 persons undergoing the assessment and appropriate intervention (number needed to treat [NNT] = 11). The monthly fall rate also was significantly lower (i.e., 11.8 fewer falls per 100 persons per month; NNT = 16). Exercise programs were effective; falls were prevented in one patient for every 16 exercising patients (NNT = 16), and the monthly rate of falls also decreased by 2.7 falls per 100 exercising patients per month. There was no difference in benefit among the various types of exercise programs. Home visits to check for environmental hazards and educational interventions, such as posters or pamphlets (which were evaluated in only two studies), were not effective.

Bottom Line: A multifactorial risk assessment and management program that includes attention to potential hazards of medication therapy is effective in decreasing the risk of falls. An exercise program also decreases the risk of falling. Simple education and inspection of the home for hazards alone were ineffective interventions. (Level of Evidence: 1a)