Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials

Abstract Objective To assess the relative effectiveness of interventions to prevent falls in older adults to either a usual care group or control group. Table 2 Components of multifactorial falls risk assessment Trial Orthostatic blood pressure Vision Balance and gait Drug review Instrumental activities of daily living or activities of daily living Cognitive evaluation Environmental hazards Other Carpenter 1990w4 No No No No Yes No No Fabacher 1994w13 Yes Yes Yes Yes Yes Yes Yes Assessment of hearing and depression Rubenstein 1990w30 Yes Yes Yes Yes Yes Yes Yes Neurological and musculoskeletal examination, laboratory tests, 24 hour heart monitor Tinetti 1994w37 Yes No Yes Yes No No Yes Muscle strength and range of motion Wagner 1994w39 No Yes No Yes No No Yes Hearing, assessment of alcohol misuse, assessment of physical activity Gallagher 1996w15 Yes Yes Yes Yes Yes Yes Yes List of health problems Coleman 1999w7 No No No Yes No No No Self management skills, health assessment Close 1999w6 Yes Yes Yes Yes Yes Yes Yes Affect, carotid sinus studies (if clinical suspicion) McMurdo 2000w21 Yes Yes No Yes No No No Review of lighting in environment Van Haastregt 2000w38 No No No Yes Yes Yes Yes Physical health, psychosocial functioning Millar 1999w24 Yes Yes No Yes No No No Review of lighting in environment Crome 2000w8* Jensen 2002w17 No Yes Yes Yes Yes Yes Yes Hearing, review of lighting in environment, assistive device (for example, cane, walker), review of use of device, and repair of device if needed See table A on bmj.com for details of references. * No specific components stated. Design Systematic review and meta-analyses. Data sources Medline, HealthSTAR, Embase, the Cochrane Library, other health related databases, and the reference lists from review articles and systematic reviews. Data extraction Components of falls intervention: multifactorial falls risk assessment with management programme, exercise, environmental modifications, or education. Results 40 trials were identified. A random effects analysis combining trials with risk ratio data showed a reduction in the risk of falling (risk ratio 0.88, 95% confidence interval 0.82 to 0.95), whereas combining trials with incidence rate data showed a reduction in the monthly rate of falling (incidence rate ratio 0.80, 0.72 to 0.88). The effect of individual components was assessed by meta-regression. A multifactorial falls risk assessment and management programme was the most effective component on risk of falling (0.82, 0.72 to 0.94, number needed to treat 11) and monthly fall rate (0.63, 0.49 to 0.83; 11.8 fewer falls in treatment group per 100 patients per month). Exercise interventions also had a beneficial effect on the risk of falling (0.86, 0.75 to 0.99, number needed to treat 16) and monthly fall rate (0.86, 0.73 to 1.01;2.7). Conclusions Interventions to prevent falls in older adults are effective in reducing both the risk of falling and the monthly rate of falling. The most effective intervention was a multifactorial falls risk assessment and management programme. Exercise programmes were also effective in reducing the risk of falling.