Clinical Question

Are there specific interventions that are effective in reducing the risk of injurious falls in older adults?

Bottom Line

Exercise alone; exercise combined with vision assessment and treatment; exercise combined with vision assessment and treatment, and environmental assessment and modification; and clinic-level quality improvement strategies combined with multifactorial assessment and treatment, calcium supplementation, and vitamin D supplementation are all effective interventions for reducing the risk of injurious falls in older adults. (Level of Evidence = 1a)

Synopsis

These investigators thoroughly searched multiple databases including Medline, Embase, the Cochrane Register, Ageline, and reference lists of relevant trials and reviews for randomized controlled trials that examined fall-prevention interventions for adults 65 years or older. Study authors were also contacted for unpublished studies or additional data. Two investigators independently reviewed all potential studies for inclusion criteria and methodologic quality using standard risk-of-bias scoring tools. Conflicts were resolved by consensus agreement with a third reviewer. The primary outcome of interest was the number of injurious falls and fall-related hospitalizations. A total of 283 randomized trials and 20 companion reports (N = 159,910 participants) met inclusion criteria. The overall risk of bias among the studies was moderate, with an unclear risk of bias for allocation concealment, contamination, and selective outcome reporting. A funnel plot analysis found no evidence of publication bias.

Four interventions were significantly associated with a reduced risk of injurious falls compared with usual care: exercise alone; combined exercise and vision assessment and treatment; combined exercise, vision assessment and treatment, and environmental assessment and modification; and combined clinic-level quality improvement strategies, multifactorial assessment and treatment, calcium supplementation, and vitamin D supplementation. Combined exercise and vision assessment and treatment was the most effective intervention. In a subgroup analysis, the best intervention for reducing the risk of hip fracture was combined osteoporosis treatment, calcium supplementation, and vitamin D supplementation.

Study design: Meta-analysis (randomized controlled trials)

Funding source: Foundation

Setting: Various (meta-analysis)

Reference:TriccoACThomasSMVeronikiAAet alComparisons of interventions for preventing falls in older adults: a systematic review and meta-analysis. JAMA2017;318(17):1687–1699.