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