Setting; study | Study design | No. of studies in review | Total no. of participants | Intervention | Outcome |
---|---|---|---|---|---|
Community | |||||
Thomas et al.20 | Systematic review of RCTs and controlled trials with masked assessment of outcome | 7 | 1 503 | Otago Exercise Programme v. usual care or social visits |
|
Clemson et al.21 | Meta-analysis of RCTs | 6 | 3 298 | Home assessment and modification, including hazard reduction, behavioural changes, footwear, ADLs, instrumental ADLs, mobility, home visits, home modifications, vision assessment | Lower risk of falls associated with home assessment (relative risk 0.79, 95% CI 0.65 to 0.97) |
Gillespie et al.22 | Systematic review of RCTs and quasi-RCTs | 111 | 55 303 | Exercise interventions combined with 13 other approaches, including education, home safety intervention, and supplementation with vitamin D and calcium |
|
Gillespie et al.23 | Systematic review of RCTs and quasi-RCTs | 159 | 79 193 | Numerous approaches, including single interventions (59 trials) and multifactorial approaches (40 trials) |
|
Zijlstra et al.24 | Systematic review of RCTs | 19 | Unavailable | Home-based multifactorial programs and single interventions (i.e., tai chi, exercise, hip protector intervention) | Reduction in fear of falling among older adults living in the community |
Orr et al.25 | Systematic review of RCTs | 29 | 2 174 | Progressive resistive training v. usual daily activity, usual care or activities that enhance blinding of intervention | Intervention needs further evaluation; limited evidence that progressive resistive training in isolation improves balance |
Michael et al.26 | Systematic review of RCTs | 47 | 152 | Various primary care interventions to prevent falls in people at higher risk of falling, including comprehensive multifactorial assessment and management, exercise and physical therapy interventions, and vitamin D supplementation |
|
Campbell and Robertson27 | Meta-regression of RCTs | 14 | 5 968 | Single and multifactorial interventions** | For populations at risk, targeted single interventions were as effective as multifactorial interventions; possibly more acceptable and more cost-effective Reduction of falls similar with single and multicomponent interventions:
|
Nursing care facilities | |||||
Cameron et al.28,* | Systematic review of RCTs | 41 | 25 422 | Multifactorial interventions (combinations of exercise, medications, environmental modification, knowledge, and measures to address other factors such as incontinence, fluid intake, nutrition, psychological concerns, vitamin D levels) and single-factor interventions (e.g., medications, exercise, knowledge) |
|
Cusimano et al.29† | RCTs | 5 | 2 395 | Multifaceted programs (i.e., combinations of education, environmental modification, home assessments, review of drug regimen, exercise sessions and programs, personal educational consultation, gait aid maintenance, vision assessment, use of hip protectors) | Some efficacy described for multifaceted programs. No combined data of the trials. |
Hospital, acute care | |||||
de Morton et al.30 | Systematic review of RCTs and controlled clinical trials | 9 | 4 223 | Multidisciplinary interventions; only those that included exercise were compared with “usual hospital care” | Small but significant increase in discharge home from hospital with multidisciplinary interventions (relative risk 1.08, 95% CI 1.03 to 1.14; number needed to treat 16, 95% CI 11 to 43) |
Mixed setting (community, institutions, acute care hospitals) | |||||
Kalyani et al.31 | Meta-analysis of RCTs | 10 | 2 932 | Vitamin D (200–1000 IU daily) v. calcium or placebo |
|
Bischoff-Ferrari et al.32‡ | Meta-analysis of RCTs | 8†† | 2 426 | Vitamin D (700–1000 IU daily) |
|
Murad et al.33 | Meta-analysis of RCTs | 26 | 45 782 | Vitamin D (200–1000 IU daily) | Reduction in risk of at least 1 fall (OR 0.86, 95% CI 0.77 to 0.96), not significant in vitamin D supplementation without co-administration of calcium |
Low et al.34§ | Meta-analysis of RCTs | 7 | 1 972 | Tai chi as single intervention | Potential reduction in fall rate or risk of falls among older adults; no pooled data |
Sitjà-Rabert et al.35§ | Meta-analysis of RCTs | 16‡‡ | 957 | Whole-body vibration programs |
|
Gates et al.36¶ | Meta-analysis of RCTs and quasi-RCTs | 19 | 6 397 | Multifactorial fall prevention programs§§ |
|
Vaapio et al.37 | Systematic review of RCTs | 12 | 2 357 | Fall prevention intervention with assessment of quality of life |
|
Fairhall et al.38§ | Systematic review and meta-analysis of RCTs | 19 | 3 616 | Exercise interventions, with measurement of participation in intervention and effect on participation in life roles |
|
Note: ADLs = activities of daily living, CI = confidence interval, RCT = randomized controlled trial.
↵* Nursing care facilities and hospitals (acute and subacute [subacute defined as care provided to patients still in need of medical and nursing services]), analyzed separately.
↵† Residential care, including nursing homes.
↵‡ Community rehabilitation and acute care hospitals.
↵§ Community and long-term care settings.
↵¶ Emergency department, primary care and community settings.
↵** Includes various combinations of home assessments, comprehensive geriatric assessments, hospital-based medical assessments, diagnostic home visits, Stepping On program (group sessions for balance and strengthening exercises, home and community environmental and behavioural safety measures, encouragement of regular review of vision and medications, follow-up home visit by occupational therapist), specific exercise program (i.e., physiotherapy and occupational therapy, tai chi and balance training, Otago Exercise Programme), medication withdrawal v. social visits or no intervention or usual care.
↵†† 2 RCTs examined active forms of vitamin D.
↵‡‡ 16 studies included in the qualitative synthesis and 10 studies included in the quantitative synthesis (meta-analysis).
↵§§ Includes various combinations of occupational therapy, home assessment, risk assessment, geriatric assessment, gait and balance exam, cardiovascular assessment, drug review, vision, psychological assessment, personal care aids, self-management group session, counselling, motivational video, standardized and individualized fall prevention, other assessments including foot, positional transfer, function, lower limb disability, alcohol use, hearing v. “usual care” or no intervention.
↵¶¶ Hedges’ g calculates effect size and measures based on a standardized difference.