Evaluation of Clinical Practice Guidelines on Fall Prevention and Management for Older Adults
Authors: Montero-Odasso Manuel M. , Kamkar Nellie , Pieruccini-Faria Frederico , Osman Abdelhady , Sarquis-Adamson Yanina , Close Jacqueline , Hogan David B. , Hunter Susan Winifred , Kenny Rose Anne , Lipsitz Lewis A. , Lord Stephen R. , Madden Kenneth M. , Petrovic Mirko , Ryg Jesper , Speechley Mark , Sultana Munira , Tan Maw Pin , van der Velde N. , Verghese Joe , Masud Tahir ,   Task Force on Global Guidelines for Falls in Older Adults, Petrovic Mirko , Nieuwboer Alice , Vlaeyen Ellen , Milisen Koen , Ryg Jesper , Kenny Rose Anne , Bourke Robert , Hartikainen Sirpa , Van der Cammen Tischa , Van der Velde Nathalie , Masud Tahir , Todd Chris , Martin Finbarr C. , Marsh David R. , Lamb Sallie , Frith James , Logan Pip , Skelton Dawn , Blain Hubert , Anweiller Cedric , Freiberger Ellen , Becker Clemens , Cesari Matteo , Casas-Herrero Alvaro , Jara Javier Perez , Bouzòn Christina Alonzo , Welmer Ana-Karim , Birnghebuam Stephanie , Kressig Reto , Montero-Odasso Manuel , Speechley Mark , McIlroy Bill , Hunter Susan , Camicioli Richard , Madden Kenneth , Norris Mireille , Watt Jennifer , Mallet Louise , Hogan David B. , Verghese Joe , Sejdic Ervin , Ferrucci Luigi , Lipsitz Lewis , Ganz David A. , Alexander Neil B. , Giber Fabiana , Schapira Marcelo , Jauregui Ricardo , Melgar-Cuellar Felipe , Carvalho de Abreu Daniela Cristina , Lourenço Roberto Alves , Pierrucini Monica , Ceriani Alejandro , Marín-Larraín Pedro , Gac Espinola Homero , Gómez-Montes José Fernando , Cano-Gutierrez Carlos Alberto , Ramirez Ulate Xinia , Picado Ovares José Ernesto , Buendia Patricio Gabriel , Tito  Susana Lucia , Martínez Padilla Diego , Aguilar-Navarro Sara G. , Mimenza  Alberto , Moctezum Rogelio , Avila-Funes Alberto , Gutiérrez-Robledo Luis Miguel , Cornejo Alemán Luis Manuel , Aguilera Caona Edgar , Carbajal  Juan Carlos , Parodi José F. , Sgaravatti Aldo , Lord Stephen , Sherrington Cathie , Said Cathy , Cameron Ian , Morris Meg , Duque Gustavo , Close Jacqueline , Kerse Ngaire , Tan Maw Pin , Duan Leilei , Sakurai Ryota , Hooi Wong Chek , Negahban Hossein , Won Won Chang , Hausdorff Jeffrey , Kalula Sebastiana , Kobusingye Olive 
Published: December 2021

Importance

With the global population aging, falls and fall-related injuries are ubiquitous, and several clinical practice guidelines for falls prevention and management for individuals 60 years or older have been developed. A systematic evaluation of the recommendations and agreement level is lacking.

Objectives

To perform a systematic review of clinical practice guidelines for falls prevention and management for adults 60 years or older in all settings (eg, community, acute care, and nursing homes), evaluate agreement in recommendations, and identify potential gaps.

Evidence Review

A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analyses statement methods for clinical practice guidelines on fall prevention and management for older adults was conducted (updated July 1, 2021) using MEDLINE, PubMed, PsycINFO, Embase, CINAHL, the Cochrane Library, PEDro, and Epistemonikos databases. Medical Subject Headings search terms were related to falls, clinical practice guidelines, management and prevention, and older adults, with no restrictions on date, language, or setting for inclusion. Three independent reviewers selected records for full-text examination if they followed evidence- and consensus-based processes and assessed the quality of the guidelines using Appraisal of Guidelines for Research &amp;amp; Evaluation II (AGREE-II) criteria. The strength of the recommendations was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation scores, and agreement across topic areas was assessed using the Fleiss κ statistic.

Findings

Of 11 414 records identified, 159 were fully reviewed and assessed for eligibility, and 15 were included. All 15 selected guidelines had high-quality AGREE-II total scores (mean [SD], 80.1% [5.6%]), although individual quality domain scores for clinical applicability (mean [SD], 63.4% [11.4%]) and stakeholder (clinicians, patients, or caregivers) involvement (mean [SD], 76.3% [9.0%]) were lower. A total of 198 recommendations covering 16 topic areas in 15 guidelines were identified after screening 4767 abstracts that proceeded to 159 full texts. Most (≥11) guidelines strongly recommended performing risk stratification, assessment tests for gait and balance, fracture and osteoporosis management, multifactorial interventions, medication review, exercise promotion, environment modification, vision and footwear correction, referral to physiotherapy, and cardiovascular interventions. The strengths of the recommendations were inconsistent for vitamin D supplementation, addressing cognitive factors, and falls prevention education. Recommendations on use of hip protectors and digital technology or wearables were often missing. None of the examined guidelines included a patient or caregiver panel in their deliberations.

Conclusions and Relevance

This systematic review found that current clinical practice guidelines on fall prevention and management for older adults showed a high degree of agreement in several areas in which strong recommendations were made, whereas other topic areas did not achieve this level of consensus or coverage. Future guidelines should address clinical applicability of their recommendations and include perspectives of patients and other stakeholders.