Multifactorial falls prevention programmes for older adults presenting to the emergency department with a fall

Systematic review and meta-analysis

Renata Teresa Morello, Sze Ee Soh, Kate Behm, Amy Egan, Darshini Ayton, Keith Hill, Leon Flicker, Christopher D. Etherton-Beer, Glenn Arendts, Nicholas Waldron, Julie Redfern, Terrence Haines, Judy Lowthian, Samuel R. Nyman, Peter Cameron, Nicola Fairhall, Anna Lucia Barker

Research output: Contribution to journalReview ArticleResearchpeer-review

Abstract

Objective: To determine whether multifactorial falls prevention interventions are effective in preventing falls, fall injuries, emergency department (ED) re-presentations and hospital admissions in older adults presenting to the ED with a fall. Design: Systematic review and meta-analyses of randomised controlled trials (RCTs). Data sources: Four health-related electronic databases (Ovid MEDLINE, CINAHL, EMBASE, PEDro and The Cochrane Central Register of Controlled Trials) were searched (inception to June 2018). Study selection: RCTs of multifactorial falls prevention interventions targeting community-dwelling older adults (≥60 years) presenting to the ED with a fall with quantitative data on at least one review outcome. Data extraction: Two independent reviewers determined inclusion, assessed study quality and undertook data extraction, discrepancies resolved by a third. Data synthesis: 12 studies involving 3986 participants, from six countries, were eligible for inclusion. Studies were of variable methodological quality. Multifactorial interventions were heterogeneous, though the majority included education, referral to healthcare services, home modifications, exercise and medication changes. Meta-analyses demonstrated no reduction in falls (rate ratio = 0.78; 95% CI: 0.58 to 1.05), number of fallers (risk ratio = 1.02; 95% CI: 0.88 to 1.18), rate of fractured neck of femur (risk ratio = 0.82; 95% CI: 0.53 to 1.25), fall-related ED presentations (rate ratio = 0.99; 95% CI: 0.84 to 1.16) or hospitalisations (rate ratio = 1.14; 95% CI: 0.69 to 1.89) with multifactorial falls prevention programmes. Conclusions: There is insufficient evidence to support the use of multifactorial interventions to prevent falls or hospital utilisation in older people presenting to ED following a fall. Further research targeting this population group is required.

Original languageEnglish
JournalInjury Prevention
DOIs
Publication statusAccepted/In press - 9 Jul 2019

Keywords

  • accidental falls
  • elderly
  • emergency department
  • fall prevention
  • systematic review

Cite this

@article{518c8dc4e96f49e3951218a5a995a75c,
title = "Multifactorial falls prevention programmes for older adults presenting to the emergency department with a fall: Systematic review and meta-analysis",
abstract = "Objective: To determine whether multifactorial falls prevention interventions are effective in preventing falls, fall injuries, emergency department (ED) re-presentations and hospital admissions in older adults presenting to the ED with a fall. Design: Systematic review and meta-analyses of randomised controlled trials (RCTs). Data sources: Four health-related electronic databases (Ovid MEDLINE, CINAHL, EMBASE, PEDro and The Cochrane Central Register of Controlled Trials) were searched (inception to June 2018). Study selection: RCTs of multifactorial falls prevention interventions targeting community-dwelling older adults (≥60 years) presenting to the ED with a fall with quantitative data on at least one review outcome. Data extraction: Two independent reviewers determined inclusion, assessed study quality and undertook data extraction, discrepancies resolved by a third. Data synthesis: 12 studies involving 3986 participants, from six countries, were eligible for inclusion. Studies were of variable methodological quality. Multifactorial interventions were heterogeneous, though the majority included education, referral to healthcare services, home modifications, exercise and medication changes. Meta-analyses demonstrated no reduction in falls (rate ratio = 0.78; 95{\%} CI: 0.58 to 1.05), number of fallers (risk ratio = 1.02; 95{\%} CI: 0.88 to 1.18), rate of fractured neck of femur (risk ratio = 0.82; 95{\%} CI: 0.53 to 1.25), fall-related ED presentations (rate ratio = 0.99; 95{\%} CI: 0.84 to 1.16) or hospitalisations (rate ratio = 1.14; 95{\%} CI: 0.69 to 1.89) with multifactorial falls prevention programmes. Conclusions: There is insufficient evidence to support the use of multifactorial interventions to prevent falls or hospital utilisation in older people presenting to ED following a fall. Further research targeting this population group is required.",
keywords = "accidental falls, elderly, emergency department, fall prevention, systematic review",
author = "Morello, {Renata Teresa} and Soh, {Sze Ee} and Kate Behm and Amy Egan and Darshini Ayton and Keith Hill and Leon Flicker and Etherton-Beer, {Christopher D.} and Glenn Arendts and Nicholas Waldron and Julie Redfern and Terrence Haines and Judy Lowthian and Nyman, {Samuel R.} and Peter Cameron and Nicola Fairhall and Barker, {Anna Lucia}",
year = "2019",
month = "7",
day = "9",
doi = "10.1136/injuryprev-2019-043214",
language = "English",
journal = "Injury Prevention",
issn = "1353-8047",
publisher = "BMJ Publishing Group Ltd",

}

Multifactorial falls prevention programmes for older adults presenting to the emergency department with a fall : Systematic review and meta-analysis. / Morello, Renata Teresa; Soh, Sze Ee; Behm, Kate; Egan, Amy; Ayton, Darshini; Hill, Keith; Flicker, Leon; Etherton-Beer, Christopher D.; Arendts, Glenn; Waldron, Nicholas; Redfern, Julie; Haines, Terrence; Lowthian, Judy; Nyman, Samuel R.; Cameron, Peter; Fairhall, Nicola; Barker, Anna Lucia.

In: Injury Prevention, 09.07.2019.

Research output: Contribution to journalReview ArticleResearchpeer-review

TY - JOUR

T1 - Multifactorial falls prevention programmes for older adults presenting to the emergency department with a fall

T2 - Systematic review and meta-analysis

AU - Morello, Renata Teresa

AU - Soh, Sze Ee

AU - Behm, Kate

AU - Egan, Amy

AU - Ayton, Darshini

AU - Hill, Keith

AU - Flicker, Leon

AU - Etherton-Beer, Christopher D.

AU - Arendts, Glenn

AU - Waldron, Nicholas

AU - Redfern, Julie

AU - Haines, Terrence

AU - Lowthian, Judy

AU - Nyman, Samuel R.

AU - Cameron, Peter

AU - Fairhall, Nicola

AU - Barker, Anna Lucia

PY - 2019/7/9

Y1 - 2019/7/9

N2 - Objective: To determine whether multifactorial falls prevention interventions are effective in preventing falls, fall injuries, emergency department (ED) re-presentations and hospital admissions in older adults presenting to the ED with a fall. Design: Systematic review and meta-analyses of randomised controlled trials (RCTs). Data sources: Four health-related electronic databases (Ovid MEDLINE, CINAHL, EMBASE, PEDro and The Cochrane Central Register of Controlled Trials) were searched (inception to June 2018). Study selection: RCTs of multifactorial falls prevention interventions targeting community-dwelling older adults (≥60 years) presenting to the ED with a fall with quantitative data on at least one review outcome. Data extraction: Two independent reviewers determined inclusion, assessed study quality and undertook data extraction, discrepancies resolved by a third. Data synthesis: 12 studies involving 3986 participants, from six countries, were eligible for inclusion. Studies were of variable methodological quality. Multifactorial interventions were heterogeneous, though the majority included education, referral to healthcare services, home modifications, exercise and medication changes. Meta-analyses demonstrated no reduction in falls (rate ratio = 0.78; 95% CI: 0.58 to 1.05), number of fallers (risk ratio = 1.02; 95% CI: 0.88 to 1.18), rate of fractured neck of femur (risk ratio = 0.82; 95% CI: 0.53 to 1.25), fall-related ED presentations (rate ratio = 0.99; 95% CI: 0.84 to 1.16) or hospitalisations (rate ratio = 1.14; 95% CI: 0.69 to 1.89) with multifactorial falls prevention programmes. Conclusions: There is insufficient evidence to support the use of multifactorial interventions to prevent falls or hospital utilisation in older people presenting to ED following a fall. Further research targeting this population group is required.

AB - Objective: To determine whether multifactorial falls prevention interventions are effective in preventing falls, fall injuries, emergency department (ED) re-presentations and hospital admissions in older adults presenting to the ED with a fall. Design: Systematic review and meta-analyses of randomised controlled trials (RCTs). Data sources: Four health-related electronic databases (Ovid MEDLINE, CINAHL, EMBASE, PEDro and The Cochrane Central Register of Controlled Trials) were searched (inception to June 2018). Study selection: RCTs of multifactorial falls prevention interventions targeting community-dwelling older adults (≥60 years) presenting to the ED with a fall with quantitative data on at least one review outcome. Data extraction: Two independent reviewers determined inclusion, assessed study quality and undertook data extraction, discrepancies resolved by a third. Data synthesis: 12 studies involving 3986 participants, from six countries, were eligible for inclusion. Studies were of variable methodological quality. Multifactorial interventions were heterogeneous, though the majority included education, referral to healthcare services, home modifications, exercise and medication changes. Meta-analyses demonstrated no reduction in falls (rate ratio = 0.78; 95% CI: 0.58 to 1.05), number of fallers (risk ratio = 1.02; 95% CI: 0.88 to 1.18), rate of fractured neck of femur (risk ratio = 0.82; 95% CI: 0.53 to 1.25), fall-related ED presentations (rate ratio = 0.99; 95% CI: 0.84 to 1.16) or hospitalisations (rate ratio = 1.14; 95% CI: 0.69 to 1.89) with multifactorial falls prevention programmes. Conclusions: There is insufficient evidence to support the use of multifactorial interventions to prevent falls or hospital utilisation in older people presenting to ED following a fall. Further research targeting this population group is required.

KW - accidental falls

KW - elderly

KW - emergency department

KW - fall prevention

KW - systematic review

UR - http://www.scopus.com/inward/record.url?scp=85068854145&partnerID=8YFLogxK

U2 - 10.1136/injuryprev-2019-043214

DO - 10.1136/injuryprev-2019-043214

M3 - Review Article

JO - Injury Prevention

JF - Injury Prevention

SN - 1353-8047

ER -