Interventions for preventing falls in older people in care facilities and hospitals
Background Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of a review first published in 2010 and updated in 2012. Objectives To assess the effects of interventions designed to reduce the incidence of falls...
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| Veröffentlicht in: | Cochrane database of systematic reviews 2018-09, Vol.2020 (1), p.CD005465 |
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| creator | Cameron, Ian D Dyer, Suzanne M Panagoda, Claire E Murray, Geoffrey R Hill, Keith D Cumming, Robert G Kerse, Ngaire Cameron, Ian D |
| description | Background
Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of a review first published in 2010 and updated in 2012.
Objectives
To assess the effects of interventions designed to reduce the incidence of falls in older people in care facilities and hospitals.
Search methods
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (August 2017); Cochrane Central Register of Controlled Trials (2017, Issue 8); and MEDLINE, Embase, CINAHL and trial registers to August 2017.
Selection criteria
Randomised controlled trials of interventions for preventing falls in older people in residential or nursing care facilities, or hospitals.
Data collection and analysis
One review author screened s; two review authors screened full‐text articles for inclusion. Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction. We calculated rate ratios (RaR) with 95% confidence intervals (CIs) for rate of falls and risk ratios (RRs) and 95% CIs for outcomes such as risk of falling (number of people falling). We pooled results where appropriate. We used GRADE to assess the quality of evidence.
Main results
Thirty‐five new trials (77,869 participants) were included in this update. Overall, we included 95 trials (138,164 participants), 71 (40,374 participants; mean age 84 years; 75% women) in care facilities and 24 (97,790 participants; mean age 78 years; 52% women) in hospitals. The majority of trials were at high risk of bias in one or more domains, mostly relating to lack of blinding. With few exceptions, the quality of evidence for individual interventions in either setting was generally rated as low or very low. Risk of fracture and adverse events were generally poorly reported and, where reported, the evidence was very low‐quality, which means that we are uncertain of the estimates. Only the falls outcomes for the main comparisons are reported here.
Care facilities
Seventeen trials compared exercise with control (typically usual care alone). We are uncertain of the effect of exercise on rate of falls (RaR 0.93, 95% CI 0.72 to 1.20; 2002 participants, 10 studies; I² = 76%; very low‐quality evidence). Exercise may make little or no difference to the risk of falling (RR 1.02, 95% CI 0.88 to 1.18; 2090 participants, 10 studies; I² = 23%; low‐quality evidence).
There is low‐quality evidence that general medication review |
| doi_str_mv | 10.1002/14651858.CD005465.pub4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6148705</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2101275348</sourcerecordid><originalsourceid>FETCH-LOGICAL-p2554-31932b8ec3155966bd8c50f2101cc3e3eb76f11540442d0cad305288c8f5a9153</originalsourceid><addsrcrecordid>eNpVUctOwzAQtBCIQuEXUI5cUvxMnQsSlKeExAGQuFmOs6FGbhzstIi_x6EU0ZM9mvHMrBehE4InBGN6RnghiBRyMrvCWCQw6ZYV30EHA5EPzO7Pvcx5yV5H6DDGd4xZUdLpPhoxTEoiBD9AT_dtD2EFbW99G7PGh6wL8IPbt6zRzsXMtpl3NSQGfOdgwEYHSKyxzvYWYqbbOpv72Nleu3iE9tLDCMe_5xi93Fw_z-7yh8fb-9nFQ97RlJ0zUjJaSTAsVSmLoqqlEbihBBNjGDCopkVDiOCYc1pjo2uGBZXSyEboVJ-N0fnaN42-gNqk0kE71QW70OFLeW3VNtPauXrzK1UQLqd4MDj9NQj-YwmxVwsbDTinW_DLqIYqdCoYl0l68j_rL2Tzk0lwuRZ8WgdfyngzD8lGEayGhanNwtRmYUM3vo3YN76cjDw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2101275348</pqid></control><display><type>article</type><title>Interventions for preventing falls in older people in care facilities and hospitals</title><source>MEDLINE</source><source>Cochrane Library</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Cameron, Ian D ; Dyer, Suzanne M ; Panagoda, Claire E ; Murray, Geoffrey R ; Hill, Keith D ; Cumming, Robert G ; Kerse, Ngaire ; Cameron, Ian D</creator><creatorcontrib>Cameron, Ian D ; Dyer, Suzanne M ; Panagoda, Claire E ; Murray, Geoffrey R ; Hill, Keith D ; Cumming, Robert G ; Kerse, Ngaire ; Cameron, Ian D</creatorcontrib><description>Background
Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of a review first published in 2010 and updated in 2012.
Objectives
To assess the effects of interventions designed to reduce the incidence of falls in older people in care facilities and hospitals.
Search methods
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (August 2017); Cochrane Central Register of Controlled Trials (2017, Issue 8); and MEDLINE, Embase, CINAHL and trial registers to August 2017.
Selection criteria
Randomised controlled trials of interventions for preventing falls in older people in residential or nursing care facilities, or hospitals.
Data collection and analysis
One review author screened s; two review authors screened full‐text articles for inclusion. Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction. We calculated rate ratios (RaR) with 95% confidence intervals (CIs) for rate of falls and risk ratios (RRs) and 95% CIs for outcomes such as risk of falling (number of people falling). We pooled results where appropriate. We used GRADE to assess the quality of evidence.
Main results
Thirty‐five new trials (77,869 participants) were included in this update. Overall, we included 95 trials (138,164 participants), 71 (40,374 participants; mean age 84 years; 75% women) in care facilities and 24 (97,790 participants; mean age 78 years; 52% women) in hospitals. The majority of trials were at high risk of bias in one or more domains, mostly relating to lack of blinding. With few exceptions, the quality of evidence for individual interventions in either setting was generally rated as low or very low. Risk of fracture and adverse events were generally poorly reported and, where reported, the evidence was very low‐quality, which means that we are uncertain of the estimates. Only the falls outcomes for the main comparisons are reported here.
Care facilities
Seventeen trials compared exercise with control (typically usual care alone). We are uncertain of the effect of exercise on rate of falls (RaR 0.93, 95% CI 0.72 to 1.20; 2002 participants, 10 studies; I² = 76%; very low‐quality evidence). Exercise may make little or no difference to the risk of falling (RR 1.02, 95% CI 0.88 to 1.18; 2090 participants, 10 studies; I² = 23%; low‐quality evidence).
There is low‐quality evidence that general medication review (tested in 12 trials) may make little or no difference to the rate of falls (RaR 0.93, 95% CI 0.64 to 1.35; 2409 participants, 6 studies; I² = 93%) or the risk of falling (RR 0.93, 95% CI 0.80 to 1.09; 5139 participants, 6 studies; I² = 48%).
There is moderate‐quality evidence that vitamin D supplementation (4512 participants, 4 studies) probably reduces the rate of falls (RaR 0.72, 95% CI 0.55 to 0.95; I² = 62%), but probably makes little or no difference to the risk of falling (RR 0.92, 95% CI 0.76 to 1.12; I² = 42%). The population included in these studies had low vitamin D levels.
Multifactorial interventions were tested in 13 trials. We are uncertain of the effect of multifactorial interventions on the rate of falls (RaR 0.88, 95% CI 0.66 to 1.18; 3439 participants, 10 studies; I² = 84%; very low‐quality evidence). They may make little or no difference to the risk of falling (RR 0.92, 95% CI 0.81 to 1.05; 3153 participants, 9 studies; I² = 42%; low‐quality evidence).
Hospitals
Three trials tested the effect of additional physiotherapy (supervised exercises) in rehabilitation wards (subacute setting). The very low‐quality evidence means we are uncertain of the effect of additional physiotherapy on the rate of falls (RaR 0.59, 95% CI 0.26 to 1.34; 215 participants, 2 studies; I² = 0%), or whether it reduces the risk of falling (RR 0.36, 95% CI 0.14 to 0.93; 83 participants, 2 studies; I² = 0%).
We are uncertain of the effects of bed and chair sensor alarms in hospitals, tested in two trials (28,649 participants) on rate of falls (RaR 0.60, 95% CI 0.27 to 1.34; I² = 0%; very low‐quality evidence) or risk of falling (RR 0.93, 95% CI 0.38 to 2.24; I² = 0%; very low‐quality evidence).
Multifactorial interventions in hospitals may reduce rate of falls in hospitals (RaR 0.80, 95% CI 0.64 to 1.01; 44,664 participants, 5 studies; I² = 52%). A subgroup analysis by setting suggests the reduction may be more likely in a subacute setting (RaR 0.67, 95% CI 0.54 to 0.83; 3747 participants, 2 studies; I² = 0%; low‐quality evidence). We are uncertain of the effect of multifactorial interventions on the risk of falling (RR 0.82, 95% CI 0.62 to 1.09; 39,889 participants; 3 studies; I² = 0%; very low‐quality evidence).
Authors' conclusions
In care facilities: we are uncertain of the effect of exercise on rate of falls and it may make little or no difference to the risk of falling. General medication review may make little or no difference to the rate of falls or risk of falling. Vitamin D supplementation probably reduces the rate of falls but not risk of falling. We are uncertain of the effect of multifactorial interventions on the rate of falls; they may make little or no difference to the risk of falling.
In hospitals: we are uncertain of the effect of additional physiotherapy on the rate of falls or whether it reduces the risk of falling. We are uncertain of the effect of providing bed sensor alarms on the rate of falls or risk of falling. Multifactorial interventions may reduce rate of falls, although subgroup analysis suggests this may apply mostly to a subacute setting; we are uncertain of the effect of these interventions on risk of falling.</description><identifier>ISSN: 1469-493X</identifier><identifier>EISSN: 1465-1858</identifier><identifier>EISSN: 1469-493X</identifier><identifier>DOI: 10.1002/14651858.CD005465.pub4</identifier><identifier>PMID: 30191554</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject><![CDATA[Accidental Falls ; Accidental Falls - prevention & control ; Accidental Falls - statistics & numerical data ; Aged ; Aged, 80 and over ; Bones of appendicular skeleton ; Calcium, Dietary ; Calcium, Dietary - administration & dosage ; Complementary & alternative medicine ; Exercise ; Fall prevention in the elderly ; Falls prevention & balance ; Falls prevention & balance in older people ; Female ; Fracture of bones of the appendicular skeleton (reviews/protocols are also listed under headings for specific bones) ; Fractures ; Hospitals ; Hospitals - statistics & numerical data ; Humans ; Male ; Medicine General & Introductory Medical Sciences ; Nursing Homes ; Nursing Homes - statistics & numerical data ; Orthopaedics & trauma ; Prevention ; Randomized Controlled Trials as Topic ; Reviews, for which we provide editorial support, whose scope lies only partly within that of the Bone, Joint and Muscle Trauma Group ; Safety Management ; Vitamin D ; Vitamin D - administration & dosage ; Vitamins ; Vitamins - administration & dosage]]></subject><ispartof>Cochrane database of systematic reviews, 2018-09, Vol.2020 (1), p.CD005465</ispartof><rights>Copyright © 2020 The Authors. Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30191554$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cameron, Ian D</creatorcontrib><creatorcontrib>Dyer, Suzanne M</creatorcontrib><creatorcontrib>Panagoda, Claire E</creatorcontrib><creatorcontrib>Murray, Geoffrey R</creatorcontrib><creatorcontrib>Hill, Keith D</creatorcontrib><creatorcontrib>Cumming, Robert G</creatorcontrib><creatorcontrib>Kerse, Ngaire</creatorcontrib><creatorcontrib>Cameron, Ian D</creatorcontrib><title>Interventions for preventing falls in older people in care facilities and hospitals</title><title>Cochrane database of systematic reviews</title><addtitle>Cochrane Database Syst Rev</addtitle><description>Background
Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of a review first published in 2010 and updated in 2012.
Objectives
To assess the effects of interventions designed to reduce the incidence of falls in older people in care facilities and hospitals.
Search methods
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (August 2017); Cochrane Central Register of Controlled Trials (2017, Issue 8); and MEDLINE, Embase, CINAHL and trial registers to August 2017.
Selection criteria
Randomised controlled trials of interventions for preventing falls in older people in residential or nursing care facilities, or hospitals.
Data collection and analysis
One review author screened s; two review authors screened full‐text articles for inclusion. Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction. We calculated rate ratios (RaR) with 95% confidence intervals (CIs) for rate of falls and risk ratios (RRs) and 95% CIs for outcomes such as risk of falling (number of people falling). We pooled results where appropriate. We used GRADE to assess the quality of evidence.
Main results
Thirty‐five new trials (77,869 participants) were included in this update. Overall, we included 95 trials (138,164 participants), 71 (40,374 participants; mean age 84 years; 75% women) in care facilities and 24 (97,790 participants; mean age 78 years; 52% women) in hospitals. The majority of trials were at high risk of bias in one or more domains, mostly relating to lack of blinding. With few exceptions, the quality of evidence for individual interventions in either setting was generally rated as low or very low. Risk of fracture and adverse events were generally poorly reported and, where reported, the evidence was very low‐quality, which means that we are uncertain of the estimates. Only the falls outcomes for the main comparisons are reported here.
Care facilities
Seventeen trials compared exercise with control (typically usual care alone). We are uncertain of the effect of exercise on rate of falls (RaR 0.93, 95% CI 0.72 to 1.20; 2002 participants, 10 studies; I² = 76%; very low‐quality evidence). Exercise may make little or no difference to the risk of falling (RR 1.02, 95% CI 0.88 to 1.18; 2090 participants, 10 studies; I² = 23%; low‐quality evidence).
There is low‐quality evidence that general medication review (tested in 12 trials) may make little or no difference to the rate of falls (RaR 0.93, 95% CI 0.64 to 1.35; 2409 participants, 6 studies; I² = 93%) or the risk of falling (RR 0.93, 95% CI 0.80 to 1.09; 5139 participants, 6 studies; I² = 48%).
There is moderate‐quality evidence that vitamin D supplementation (4512 participants, 4 studies) probably reduces the rate of falls (RaR 0.72, 95% CI 0.55 to 0.95; I² = 62%), but probably makes little or no difference to the risk of falling (RR 0.92, 95% CI 0.76 to 1.12; I² = 42%). The population included in these studies had low vitamin D levels.
Multifactorial interventions were tested in 13 trials. We are uncertain of the effect of multifactorial interventions on the rate of falls (RaR 0.88, 95% CI 0.66 to 1.18; 3439 participants, 10 studies; I² = 84%; very low‐quality evidence). They may make little or no difference to the risk of falling (RR 0.92, 95% CI 0.81 to 1.05; 3153 participants, 9 studies; I² = 42%; low‐quality evidence).
Hospitals
Three trials tested the effect of additional physiotherapy (supervised exercises) in rehabilitation wards (subacute setting). The very low‐quality evidence means we are uncertain of the effect of additional physiotherapy on the rate of falls (RaR 0.59, 95% CI 0.26 to 1.34; 215 participants, 2 studies; I² = 0%), or whether it reduces the risk of falling (RR 0.36, 95% CI 0.14 to 0.93; 83 participants, 2 studies; I² = 0%).
We are uncertain of the effects of bed and chair sensor alarms in hospitals, tested in two trials (28,649 participants) on rate of falls (RaR 0.60, 95% CI 0.27 to 1.34; I² = 0%; very low‐quality evidence) or risk of falling (RR 0.93, 95% CI 0.38 to 2.24; I² = 0%; very low‐quality evidence).
Multifactorial interventions in hospitals may reduce rate of falls in hospitals (RaR 0.80, 95% CI 0.64 to 1.01; 44,664 participants, 5 studies; I² = 52%). A subgroup analysis by setting suggests the reduction may be more likely in a subacute setting (RaR 0.67, 95% CI 0.54 to 0.83; 3747 participants, 2 studies; I² = 0%; low‐quality evidence). We are uncertain of the effect of multifactorial interventions on the risk of falling (RR 0.82, 95% CI 0.62 to 1.09; 39,889 participants; 3 studies; I² = 0%; very low‐quality evidence).
Authors' conclusions
In care facilities: we are uncertain of the effect of exercise on rate of falls and it may make little or no difference to the risk of falling. General medication review may make little or no difference to the rate of falls or risk of falling. Vitamin D supplementation probably reduces the rate of falls but not risk of falling. We are uncertain of the effect of multifactorial interventions on the rate of falls; they may make little or no difference to the risk of falling.
In hospitals: we are uncertain of the effect of additional physiotherapy on the rate of falls or whether it reduces the risk of falling. We are uncertain of the effect of providing bed sensor alarms on the rate of falls or risk of falling. Multifactorial interventions may reduce rate of falls, although subgroup analysis suggests this may apply mostly to a subacute setting; we are uncertain of the effect of these interventions on risk of falling.</description><subject>Accidental Falls</subject><subject>Accidental Falls - prevention & control</subject><subject>Accidental Falls - statistics & numerical data</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Bones of appendicular skeleton</subject><subject>Calcium, Dietary</subject><subject>Calcium, Dietary - administration & dosage</subject><subject>Complementary & alternative medicine</subject><subject>Exercise</subject><subject>Fall prevention in the elderly</subject><subject>Falls prevention & balance</subject><subject>Falls prevention & balance in older people</subject><subject>Female</subject><subject>Fracture of bones of the appendicular skeleton (reviews/protocols are also listed under headings for specific bones)</subject><subject>Fractures</subject><subject>Hospitals</subject><subject>Hospitals - statistics & numerical data</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine General & Introductory Medical Sciences</subject><subject>Nursing Homes</subject><subject>Nursing Homes - statistics & numerical data</subject><subject>Orthopaedics & trauma</subject><subject>Prevention</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Reviews, for which we provide editorial support, whose scope lies only partly within that of the Bone, Joint and Muscle Trauma Group</subject><subject>Safety Management</subject><subject>Vitamin D</subject><subject>Vitamin D - administration & dosage</subject><subject>Vitamins</subject><subject>Vitamins - administration & dosage</subject><issn>1469-493X</issn><issn>1465-1858</issn><issn>1469-493X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>RWY</sourceid><sourceid>EIF</sourceid><recordid>eNpVUctOwzAQtBCIQuEXUI5cUvxMnQsSlKeExAGQuFmOs6FGbhzstIi_x6EU0ZM9mvHMrBehE4InBGN6RnghiBRyMrvCWCQw6ZYV30EHA5EPzO7Pvcx5yV5H6DDGd4xZUdLpPhoxTEoiBD9AT_dtD2EFbW99G7PGh6wL8IPbt6zRzsXMtpl3NSQGfOdgwEYHSKyxzvYWYqbbOpv72Nleu3iE9tLDCMe_5xi93Fw_z-7yh8fb-9nFQ97RlJ0zUjJaSTAsVSmLoqqlEbihBBNjGDCopkVDiOCYc1pjo2uGBZXSyEboVJ-N0fnaN42-gNqk0kE71QW70OFLeW3VNtPauXrzK1UQLqd4MDj9NQj-YwmxVwsbDTinW_DLqIYqdCoYl0l68j_rL2Tzk0lwuRZ8WgdfyngzD8lGEayGhanNwtRmYUM3vo3YN76cjDw</recordid><startdate>20180907</startdate><enddate>20180907</enddate><creator>Cameron, Ian D</creator><creator>Dyer, Suzanne M</creator><creator>Panagoda, Claire E</creator><creator>Murray, Geoffrey R</creator><creator>Hill, Keith D</creator><creator>Cumming, Robert G</creator><creator>Kerse, Ngaire</creator><creator>Cameron, Ian D</creator><general>John Wiley & Sons, Ltd</general><scope>7PX</scope><scope>RWY</scope><scope>ZYTZH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20180907</creationdate><title>Interventions for preventing falls in older people in care facilities and hospitals</title><author>Cameron, Ian D ; Dyer, Suzanne M ; Panagoda, Claire E ; Murray, Geoffrey R ; Hill, Keith D ; Cumming, Robert G ; Kerse, Ngaire ; Cameron, Ian D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p2554-31932b8ec3155966bd8c50f2101cc3e3eb76f11540442d0cad305288c8f5a9153</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Accidental Falls</topic><topic>Accidental Falls - prevention & control</topic><topic>Accidental Falls - statistics & numerical data</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Bones of appendicular skeleton</topic><topic>Calcium, Dietary</topic><topic>Calcium, Dietary - administration & dosage</topic><topic>Complementary & alternative medicine</topic><topic>Exercise</topic><topic>Fall prevention in the elderly</topic><topic>Falls prevention & balance</topic><topic>Falls prevention & balance in older people</topic><topic>Female</topic><topic>Fracture of bones of the appendicular skeleton (reviews/protocols are also listed under headings for specific bones)</topic><topic>Fractures</topic><topic>Hospitals</topic><topic>Hospitals - statistics & numerical data</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine General & Introductory Medical Sciences</topic><topic>Nursing Homes</topic><topic>Nursing Homes - statistics & numerical data</topic><topic>Orthopaedics & trauma</topic><topic>Prevention</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Reviews, for which we provide editorial support, whose scope lies only partly within that of the Bone, Joint and Muscle Trauma Group</topic><topic>Safety Management</topic><topic>Vitamin D</topic><topic>Vitamin D - administration & dosage</topic><topic>Vitamins</topic><topic>Vitamins - administration & dosage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cameron, Ian D</creatorcontrib><creatorcontrib>Dyer, Suzanne M</creatorcontrib><creatorcontrib>Panagoda, Claire E</creatorcontrib><creatorcontrib>Murray, Geoffrey R</creatorcontrib><creatorcontrib>Hill, Keith D</creatorcontrib><creatorcontrib>Cumming, Robert G</creatorcontrib><creatorcontrib>Kerse, Ngaire</creatorcontrib><creatorcontrib>Cameron, Ian D</creatorcontrib><collection>Wiley-Blackwell Cochrane Library</collection><collection>Cochrane Library</collection><collection>Cochrane Library (Open Aceess)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cochrane database of systematic reviews</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cameron, Ian D</au><au>Dyer, Suzanne M</au><au>Panagoda, Claire E</au><au>Murray, Geoffrey R</au><au>Hill, Keith D</au><au>Cumming, Robert G</au><au>Kerse, Ngaire</au><au>Cameron, Ian D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Interventions for preventing falls in older people in care facilities and hospitals</atitle><jtitle>Cochrane database of systematic reviews</jtitle><addtitle>Cochrane Database Syst Rev</addtitle><date>2018-09-07</date><risdate>2018</risdate><volume>2020</volume><issue>1</issue><spage>CD005465</spage><pages>CD005465-</pages><issn>1469-493X</issn><eissn>1465-1858</eissn><eissn>1469-493X</eissn><abstract>Background
Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of a review first published in 2010 and updated in 2012.
Objectives
To assess the effects of interventions designed to reduce the incidence of falls in older people in care facilities and hospitals.
Search methods
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (August 2017); Cochrane Central Register of Controlled Trials (2017, Issue 8); and MEDLINE, Embase, CINAHL and trial registers to August 2017.
Selection criteria
Randomised controlled trials of interventions for preventing falls in older people in residential or nursing care facilities, or hospitals.
Data collection and analysis
One review author screened s; two review authors screened full‐text articles for inclusion. Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction. We calculated rate ratios (RaR) with 95% confidence intervals (CIs) for rate of falls and risk ratios (RRs) and 95% CIs for outcomes such as risk of falling (number of people falling). We pooled results where appropriate. We used GRADE to assess the quality of evidence.
Main results
Thirty‐five new trials (77,869 participants) were included in this update. Overall, we included 95 trials (138,164 participants), 71 (40,374 participants; mean age 84 years; 75% women) in care facilities and 24 (97,790 participants; mean age 78 years; 52% women) in hospitals. The majority of trials were at high risk of bias in one or more domains, mostly relating to lack of blinding. With few exceptions, the quality of evidence for individual interventions in either setting was generally rated as low or very low. Risk of fracture and adverse events were generally poorly reported and, where reported, the evidence was very low‐quality, which means that we are uncertain of the estimates. Only the falls outcomes for the main comparisons are reported here.
Care facilities
Seventeen trials compared exercise with control (typically usual care alone). We are uncertain of the effect of exercise on rate of falls (RaR 0.93, 95% CI 0.72 to 1.20; 2002 participants, 10 studies; I² = 76%; very low‐quality evidence). Exercise may make little or no difference to the risk of falling (RR 1.02, 95% CI 0.88 to 1.18; 2090 participants, 10 studies; I² = 23%; low‐quality evidence).
There is low‐quality evidence that general medication review (tested in 12 trials) may make little or no difference to the rate of falls (RaR 0.93, 95% CI 0.64 to 1.35; 2409 participants, 6 studies; I² = 93%) or the risk of falling (RR 0.93, 95% CI 0.80 to 1.09; 5139 participants, 6 studies; I² = 48%).
There is moderate‐quality evidence that vitamin D supplementation (4512 participants, 4 studies) probably reduces the rate of falls (RaR 0.72, 95% CI 0.55 to 0.95; I² = 62%), but probably makes little or no difference to the risk of falling (RR 0.92, 95% CI 0.76 to 1.12; I² = 42%). The population included in these studies had low vitamin D levels.
Multifactorial interventions were tested in 13 trials. We are uncertain of the effect of multifactorial interventions on the rate of falls (RaR 0.88, 95% CI 0.66 to 1.18; 3439 participants, 10 studies; I² = 84%; very low‐quality evidence). They may make little or no difference to the risk of falling (RR 0.92, 95% CI 0.81 to 1.05; 3153 participants, 9 studies; I² = 42%; low‐quality evidence).
Hospitals
Three trials tested the effect of additional physiotherapy (supervised exercises) in rehabilitation wards (subacute setting). The very low‐quality evidence means we are uncertain of the effect of additional physiotherapy on the rate of falls (RaR 0.59, 95% CI 0.26 to 1.34; 215 participants, 2 studies; I² = 0%), or whether it reduces the risk of falling (RR 0.36, 95% CI 0.14 to 0.93; 83 participants, 2 studies; I² = 0%).
We are uncertain of the effects of bed and chair sensor alarms in hospitals, tested in two trials (28,649 participants) on rate of falls (RaR 0.60, 95% CI 0.27 to 1.34; I² = 0%; very low‐quality evidence) or risk of falling (RR 0.93, 95% CI 0.38 to 2.24; I² = 0%; very low‐quality evidence).
Multifactorial interventions in hospitals may reduce rate of falls in hospitals (RaR 0.80, 95% CI 0.64 to 1.01; 44,664 participants, 5 studies; I² = 52%). A subgroup analysis by setting suggests the reduction may be more likely in a subacute setting (RaR 0.67, 95% CI 0.54 to 0.83; 3747 participants, 2 studies; I² = 0%; low‐quality evidence). We are uncertain of the effect of multifactorial interventions on the risk of falling (RR 0.82, 95% CI 0.62 to 1.09; 39,889 participants; 3 studies; I² = 0%; very low‐quality evidence).
Authors' conclusions
In care facilities: we are uncertain of the effect of exercise on rate of falls and it may make little or no difference to the risk of falling. General medication review may make little or no difference to the rate of falls or risk of falling. Vitamin D supplementation probably reduces the rate of falls but not risk of falling. We are uncertain of the effect of multifactorial interventions on the rate of falls; they may make little or no difference to the risk of falling.
In hospitals: we are uncertain of the effect of additional physiotherapy on the rate of falls or whether it reduces the risk of falling. We are uncertain of the effect of providing bed sensor alarms on the rate of falls or risk of falling. Multifactorial interventions may reduce rate of falls, although subgroup analysis suggests this may apply mostly to a subacute setting; we are uncertain of the effect of these interventions on risk of falling.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>30191554</pmid><doi>10.1002/14651858.CD005465.pub4</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1469-493X |
| ispartof | Cochrane database of systematic reviews, 2018-09, Vol.2020 (1), p.CD005465 |
| issn | 1469-493X 1465-1858 1469-493X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6148705 |
| source | MEDLINE; Cochrane Library; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Accidental Falls Accidental Falls - prevention & control Accidental Falls - statistics & numerical data Aged Aged, 80 and over Bones of appendicular skeleton Calcium, Dietary Calcium, Dietary - administration & dosage Complementary & alternative medicine Exercise Fall prevention in the elderly Falls prevention & balance Falls prevention & balance in older people Female Fracture of bones of the appendicular skeleton (reviews/protocols are also listed under headings for specific bones) Fractures Hospitals Hospitals - statistics & numerical data Humans Male Medicine General & Introductory Medical Sciences Nursing Homes Nursing Homes - statistics & numerical data Orthopaedics & trauma Prevention Randomized Controlled Trials as Topic Reviews, for which we provide editorial support, whose scope lies only partly within that of the Bone, Joint and Muscle Trauma Group Safety Management Vitamin D Vitamin D - administration & dosage Vitamins Vitamins - administration & dosage |
| title | Interventions for preventing falls in older people in care facilities and hospitals |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-29T18%3A17%3A17IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Interventions%20for%20preventing%20falls%20in%20older%20people%20in%20care%20facilities%20and%20hospitals&rft.jtitle=Cochrane%20database%20of%20systematic%20reviews&rft.au=Cameron,%20Ian%20D&rft.date=2018-09-07&rft.volume=2020&rft.issue=1&rft.spage=CD005465&rft.pages=CD005465-&rft.issn=1469-493X&rft.eissn=1465-1858&rft_id=info:doi/10.1002/14651858.CD005465.pub4&rft_dat=%3Cproquest_pubme%3E2101275348%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2101275348&rft_id=info:pmid/30191554&rfr_iscdi=true |