Evaluation of Clinical Practice Guidelines on Fall Prevention and Management for Older Adults: A Systematic Review
Creators: name: Alice, Nieuwboer
name: Vlaeyen, Ellen
name: Milisen, Koen
name: Bourke, Robert
name: Hartikainen, Sirpa
name: Van der Cammen, Tischa
name: Todd, Chris
name: Martin, Finbarr C
name: Marsh, David R
name: Frith, James
name: Logan, Pip
name: Skelton, Dawn
name: Blain, Hubert
name: Anweiller, Cedric
name: Freiberger, Ellen
name: Clemens And Becker
name: Cesari, Matteo
name: Casas-Herrero, Alvaro
name: Bouzòn, Christina Alonzo
name: Welmer, Ana-Karim
name: Birnghebuam, Stephanie
name: Kressig, Reto
name: Montero-Odasso, Manuel
name: McIlroy, Bill
name: Camicioli, Richard
name: Norris, Mireille
name: Watt, Jennifer
name: Mallet, Louise
name: Hogan, David B
name: Ervin, Sejdic
name: Ferruci, Luigi
name: Ganz, David A
name: Alexander, Neil B
name: Giber, Fabiana
name: Schapira, Marcelo
name: Jauregui, Ricardo
name: Melgar-Cuellar, Felipe
name: de Abreu, Daniela Cristina Carvalho
name: Lourenço, Roberto Alves
name: Pierrucini, Monica
name: Ceriani, Alejandro
name: Marín-Larraín, Pedro
name: Gómez-Montes, José Fernando
name: Cano-Gutierrez, Carlos Alberto
name: Ulate, Xinia Ramirez
name: Ovares, José Ernesto Picado
name: Buendia, Patricio Gabriel
name: Tito, Susana Lucia
name: Padilla, Diego Martínez
name: Aguilar-Navarro, Sara G
name: Mimenza, Alberto
name: Moctezum, Rogelio
name: Avila-Funes, Alberto
name: Gutiérrez-Robledo, Luis Miguel
name: Alemán, Luis Manuel Cornejo
name: Caona, Edgar Aguilera
name: Carbajal, Juan Carlos
name: Parodi, José F
name: Sgaravatti, Aldo
name: Sherrington, Cathie
name: Said, Cathy
name: Cameron, Ian
name: Morris, Meg
name: Duque, Gustavo
name: Kerse, Ngaire
name: Duan, Leilei
name: Sakurai, Ryota
name: Wong, Chek Hooi
name: Negahban, Hossein
name: Won, Chang Won
name: Hausdorff, Jeffrey
name: Kalula, Sebastiana
name: Kobusingye, Olive
Publisher: name: La Trobe
Year: 2022
Subjects: classificationCode: 32
subject: Biomedical and clinical sciences
classificationCode: 42
subject: Health sciences
subject: FOS: Health sciences
classificationCode: 4203
subject: Health services and systems

description: 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; 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.