Interventions for preventing falls and fall-related fractures in community-dwelling older adults: A systematic review and network meta-analysis.

Content Provider	Europe PMC
Author	Dautzenberg, Lauren Beglinger, Shanthi Tsokani, Sofia Zevgiti, Stella Raijmann, Renee C. M. A. Rodondi, Nicolas Scholten, Rob J. P. M. Rutjes, Anne W. S. Di Nisio, Marcello Emmelot‐Vonk, Marielle Tricco, Andrea C. Straus, Sharon E. Thomas, Sonia Bretagne, Lisa Knol, Wilma Mavridis, Dimitris Koek, Huiberdina L.
Abstract	AbstractObjectiveTo compare the effectiveness of single, multiple, and multifactorial interventions to prevent falls and fall‐related fractures in community‐dwelling older persons.MethodsMEDLINE, Embase, and Cochrane Central Register of Controlled Trials were systematically searched for randomized controlled trials (RCTs) evaluating the effectiveness of fall prevention interventions in community‐dwelling adults aged ≥65 years, from inception until February 27, 2019. Two large RCTs (published in 2020 after the search closed) were included in post hoc analyses. Pairwise meta‐analysis and network meta‐analysis (NMA) were conducted.ResultsNMA including 192 studies revealed that the following single interventions, compared with usual care, were associated with reductions in number of fallers: exercise (risk ratio [RR] 0.83; 95% confidence interval [CI] 0.77–0.89) and quality improvement strategies (e.g., patient education) (RR 0.90; 95% CI 0.83–0.98). Exercise as a single intervention was associated with a reduction in falls rate (RR 0.79; 95% CI 0.73–0.86). Common components of multiple interventions significantly associated with a reduction in number of fallers and falls rate were exercise, assistive technology, environmental assessment and modifications, quality improvement strategies, and basic falls risk assessment (e.g., medication review). Multifactorial interventions were associated with a reduction in falls rate (RR 0.87; 95% CI 0.80–0.95), but not with a reduction in number of fallers (RR 0.95; 95% CI 0.89–1.01). The following single interventions, compared with usual care, were associated with reductions in number of fall‐related fractures: basic falls risk assessment (RR 0.60; 95% CI 0.39–0.94) and exercise (RR 0.62; 95% CI 0.42–0.90).ConclusionsIn keeping with Tricco et al. (2017), several single and multiple fall prevention interventions are associated with fewer falls. In addition to Tricco, we observe a benefit at the NMA‐level of some single interventions on preventing fall‐related fractures.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC8518387&blobtype=pdf
Page Count	12
ISSN	00028614
Journal	Journal of the American Geriatrics Society [J Am Geriatr Soc]
Volume Number	69
DOI	10.1111/jgs.17375
PubMed Central reference number	PMC8518387
Issue Number	10
PubMed reference number	34318929
e-ISSN	15325415
Language	English
Publisher	John Wiley & Sons, Inc.
Publisher Date	2021-07-28
Publisher Place	Hoboken, USA
Access Restriction	Open
Rights License	This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. © 2021 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.
Subject Keyword	community‐dwelling fall‐related fractures falls older adults
Content Type	Text
Resource Type	Article
Subject	Geriatrics and Gerontology