Title: Exercise for preventing falls in older people living in the community
Funder: Department of Health and Social Care

Abstract: Relevant NICE guidance CG161 Falls prevention in older people. This guideline was most recently updated in 2013, but most of the recommendations date back to 2004. The most recent surveillance review of this guideline was published in January 2016. At that time, it was clear that there were a large number of new trials, particularly of falls risk prevention interventions in community dwelling older people. Without an overview of the trials, it was hard to interpret whether any update of the guideline would be needed, but experts thought there may be sufficient evidence to make more specific recommendations about the content and duration of interventions. It was noted that a relevant Cochrane review was being updated, and so it was decided to wait for the updated Cochrane review in order to better inform a decision on what areas of the guideline require updating. Relevant Cochrane reviews The Cochrane review identified in the NICE surveillance process has now been split into two protocols: Multifactorial and multiple component interventions protocol published June 2016 Exercise for preventing falls in older people living in the community protocol published November 2016 Previous correspondence with the relevant Cochrane group suggested that each of these might have some 40 new trials to assess. Of these two areas, the NICE surveillance review suggested that the area of exercise interventions might be the most likely area for changes in recommendations. Therefore, of these, the review on exercise seems to be the higher priority, although it would be useful to have both. Alignment of questions Population CG161 set the definition of older people as 65 or over, whereas the Cochrane review uses a cut off of 60 or above. Unless there is much evidence specifically in the age group 60 to 65 this is unlikely to cause too much of a problem. However, it would be useful to have an indication of which trials would be excluded if the age limit was raised to 65. We note the proposed subgroup analysis of higher vs lower baseline risk of falls and wonder if age is intended as one of the proxies for this risk. Further stratification by age, for example at 75 years, might make the review even more helpful. Interventions and comparison The Cochrane reviews are very broad and so it is unlikely that they will exclude relevant interventions. With multiple possible interventions and many trials, it is likely that any proposed update to the guideline would consider using network meta-analysis to compare interventions. The Cochrane protocols plan to do pairwise comparisons of classes, so this could feed into an NMA later. Outcomes The Cochrane reviews focus on falls, but the two protocols have slightly different sets of outcomes. The one on multifactorial interventions includes hospital admission and HRQoL as outcomes, which would certainly be useful for any guideline update. Neither protocol mentions mortality as an outcome, which is usually an outcome in guidelines in this age group. In addition, data on resource use for the interventions e.g. staff time would be helpful for cost effectiveness consideration.


Research activity codes: 6.7 PHYSICAL
Health categories: GENERIC HEALTH RELEVANCE