Reducing falls in older adults recently discharged from hospital

a systematic review and meta-analysis

Chiara Naseri, Terry Haines, Christopher Etherton-Beer, Steven McPhail, Meg E Morris, Leon Flicker, Julie Netto, Jacqueline Francis-Coad, Den-Ching Angel Lee, Ronald Shorr, Anne-Marie Hill

Research output: Contribution to journalReview ArticleResearchpeer-review

9 Citations (Scopus)

Abstract

Background
older adults are known to have increased falls rates and functional decline following hospital discharge, with substantial economic healthcare costs. This systematic review aimed to synthesise the evidence for effective falls prevention interventions in older adults recently discharged from hospital.

Methods
literature searches of six databases of quantitative studies conducted from 1990 to June 2017, reporting falls outcomes of falls prevention interventions for community-dwelling older adults discharged from hospital were included. Study quality was assessed using a standardised JBI critical appraisal tool (MAStARI) and data pooled using Rev-Man Review Manager®

Results
sixteen studies (total sample size N = 3,290, from eight countries, mean age 77) comprising 12 interventions met inclusion criteria. We found home hazard modification interventions delivered to those with a previous falls history (1 study), was effective in reducing the number of falls (RR 0.63, 95%CI 0.43, 0.93, Low GRADE evidence). Home exercise interventions (3 studies) significantly increased the proportion of fallers (OR 1.74, 95%CI 1.17, 2.60, Moderate GRADE evidence), and did not significantly reduce falls rate (RR 1.27, 95%CI 0.99, 1.62, Very Low GRADE evidence) or falls injury rate (RR 1.16, 95%CI, 0.83,1.63, Low GRADE evidence). Nutritional supplementation for malnourished older adults (1 study) significantly reduced the proportion of fallers (HR 0.41, 95% CI 0.19, 0.86, Low GRADE evidence).

Conclusion
the recommended falls prevention interventions for older adults recently discharged from hospital are to provide home hazard minimisation particularly if they have a recent previous falls history and consider nutritional supplementation if they are malnourished.
Original languageEnglish
Pages (from-to)512-519
Number of pages8
JournalAge and Ageing
Volume47
Issue number4
DOIs
Publication statusPublished - 1 Jan 2018

Keywords

  • After hospital discharge
  • Falls outcomes
  • Falls prevention interventions
  • Older people
  • Systematic review

Cite this

Naseri, C., Haines, T., Etherton-Beer, C., McPhail, S., Morris, M. E., Flicker, L., ... Hill, A-M. (2018). Reducing falls in older adults recently discharged from hospital: a systematic review and meta-analysis. Age and Ageing, 47(4), 512-519. https://doi.org/10.1093/ageing/afy043
Naseri, Chiara ; Haines, Terry ; Etherton-Beer, Christopher ; McPhail, Steven ; Morris, Meg E ; Flicker, Leon ; Netto, Julie ; Francis-Coad, Jacqueline ; Lee, Den-Ching Angel ; Shorr, Ronald ; Hill, Anne-Marie. / Reducing falls in older adults recently discharged from hospital : a systematic review and meta-analysis. In: Age and Ageing. 2018 ; Vol. 47, No. 4. pp. 512-519.
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title = "Reducing falls in older adults recently discharged from hospital: a systematic review and meta-analysis",
abstract = "Backgroundolder adults are known to have increased falls rates and functional decline following hospital discharge, with substantial economic healthcare costs. This systematic review aimed to synthesise the evidence for effective falls prevention interventions in older adults recently discharged from hospital.Methodsliterature searches of six databases of quantitative studies conducted from 1990 to June 2017, reporting falls outcomes of falls prevention interventions for community-dwelling older adults discharged from hospital were included. Study quality was assessed using a standardised JBI critical appraisal tool (MAStARI) and data pooled using Rev-Man Review Manager{\circledR}Resultssixteen studies (total sample size N = 3,290, from eight countries, mean age 77) comprising 12 interventions met inclusion criteria. We found home hazard modification interventions delivered to those with a previous falls history (1 study), was effective in reducing the number of falls (RR 0.63, 95{\%}CI 0.43, 0.93, Low GRADE evidence). Home exercise interventions (3 studies) significantly increased the proportion of fallers (OR 1.74, 95{\%}CI 1.17, 2.60, Moderate GRADE evidence), and did not significantly reduce falls rate (RR 1.27, 95{\%}CI 0.99, 1.62, Very Low GRADE evidence) or falls injury rate (RR 1.16, 95{\%}CI, 0.83,1.63, Low GRADE evidence). Nutritional supplementation for malnourished older adults (1 study) significantly reduced the proportion of fallers (HR 0.41, 95{\%} CI 0.19, 0.86, Low GRADE evidence).Conclusionthe recommended falls prevention interventions for older adults recently discharged from hospital are to provide home hazard minimisation particularly if they have a recent previous falls history and consider nutritional supplementation if they are malnourished.",
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author = "Chiara Naseri and Terry Haines and Christopher Etherton-Beer and Steven McPhail and Morris, {Meg E} and Leon Flicker and Julie Netto and Jacqueline Francis-Coad and Lee, {Den-Ching Angel} and Ronald Shorr and Anne-Marie Hill",
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Naseri, C, Haines, T, Etherton-Beer, C, McPhail, S, Morris, ME, Flicker, L, Netto, J, Francis-Coad, J, Lee, D-CA, Shorr, R & Hill, A-M 2018, 'Reducing falls in older adults recently discharged from hospital: a systematic review and meta-analysis', Age and Ageing, vol. 47, no. 4, pp. 512-519. https://doi.org/10.1093/ageing/afy043

Reducing falls in older adults recently discharged from hospital : a systematic review and meta-analysis. / Naseri, Chiara; Haines, Terry; Etherton-Beer, Christopher; McPhail, Steven; Morris, Meg E; Flicker, Leon; Netto, Julie; Francis-Coad, Jacqueline; Lee, Den-Ching Angel; Shorr, Ronald; Hill, Anne-Marie.

In: Age and Ageing, Vol. 47, No. 4, 01.01.2018, p. 512-519.

Research output: Contribution to journalReview ArticleResearchpeer-review

TY - JOUR

T1 - Reducing falls in older adults recently discharged from hospital

T2 - a systematic review and meta-analysis

AU - Naseri, Chiara

AU - Haines, Terry

AU - Etherton-Beer, Christopher

AU - McPhail, Steven

AU - Morris, Meg E

AU - Flicker, Leon

AU - Netto, Julie

AU - Francis-Coad, Jacqueline

AU - Lee, Den-Ching Angel

AU - Shorr, Ronald

AU - Hill, Anne-Marie

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Backgroundolder adults are known to have increased falls rates and functional decline following hospital discharge, with substantial economic healthcare costs. This systematic review aimed to synthesise the evidence for effective falls prevention interventions in older adults recently discharged from hospital.Methodsliterature searches of six databases of quantitative studies conducted from 1990 to June 2017, reporting falls outcomes of falls prevention interventions for community-dwelling older adults discharged from hospital were included. Study quality was assessed using a standardised JBI critical appraisal tool (MAStARI) and data pooled using Rev-Man Review Manager®Resultssixteen studies (total sample size N = 3,290, from eight countries, mean age 77) comprising 12 interventions met inclusion criteria. We found home hazard modification interventions delivered to those with a previous falls history (1 study), was effective in reducing the number of falls (RR 0.63, 95%CI 0.43, 0.93, Low GRADE evidence). Home exercise interventions (3 studies) significantly increased the proportion of fallers (OR 1.74, 95%CI 1.17, 2.60, Moderate GRADE evidence), and did not significantly reduce falls rate (RR 1.27, 95%CI 0.99, 1.62, Very Low GRADE evidence) or falls injury rate (RR 1.16, 95%CI, 0.83,1.63, Low GRADE evidence). Nutritional supplementation for malnourished older adults (1 study) significantly reduced the proportion of fallers (HR 0.41, 95% CI 0.19, 0.86, Low GRADE evidence).Conclusionthe recommended falls prevention interventions for older adults recently discharged from hospital are to provide home hazard minimisation particularly if they have a recent previous falls history and consider nutritional supplementation if they are malnourished.

AB - Backgroundolder adults are known to have increased falls rates and functional decline following hospital discharge, with substantial economic healthcare costs. This systematic review aimed to synthesise the evidence for effective falls prevention interventions in older adults recently discharged from hospital.Methodsliterature searches of six databases of quantitative studies conducted from 1990 to June 2017, reporting falls outcomes of falls prevention interventions for community-dwelling older adults discharged from hospital were included. Study quality was assessed using a standardised JBI critical appraisal tool (MAStARI) and data pooled using Rev-Man Review Manager®Resultssixteen studies (total sample size N = 3,290, from eight countries, mean age 77) comprising 12 interventions met inclusion criteria. We found home hazard modification interventions delivered to those with a previous falls history (1 study), was effective in reducing the number of falls (RR 0.63, 95%CI 0.43, 0.93, Low GRADE evidence). Home exercise interventions (3 studies) significantly increased the proportion of fallers (OR 1.74, 95%CI 1.17, 2.60, Moderate GRADE evidence), and did not significantly reduce falls rate (RR 1.27, 95%CI 0.99, 1.62, Very Low GRADE evidence) or falls injury rate (RR 1.16, 95%CI, 0.83,1.63, Low GRADE evidence). Nutritional supplementation for malnourished older adults (1 study) significantly reduced the proportion of fallers (HR 0.41, 95% CI 0.19, 0.86, Low GRADE evidence).Conclusionthe recommended falls prevention interventions for older adults recently discharged from hospital are to provide home hazard minimisation particularly if they have a recent previous falls history and consider nutritional supplementation if they are malnourished.

KW - After hospital discharge

KW - Falls outcomes

KW - Falls prevention interventions

KW - Older people

KW - Systematic review

UR - http://www.scopus.com/inward/record.url?scp=85050316632&partnerID=8YFLogxK

U2 - 10.1093/ageing/afy043

DO - 10.1093/ageing/afy043

M3 - Review Article

VL - 47

SP - 512

EP - 519

JO - Age and Ageing

JF - Age and Ageing

SN - 0002-0729

IS - 4

ER -