Background: Falls represent an important source of preventable morbidity and mortality in older adults, the fastest growing segment of the U.S. population. We undertook a systematic review of falls interventions applicable to primary care populations to inform the U.S. Preventive Services Task Force’s (USPSTF’s) updated recommendation on preventing falls in older adults.
Purpose: To assess the benefits and harms of interventions for reducing falls and improving health outcomes in older adults in primary care settings, including multifactorial assessment and management, exercise/physical therapy, single clinical treatment of nutritional risks and visual deficits, hip protectors, home hazard modification, and clinical education/behavioral counseling.
Data Sources: We searched the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, MEDLINE, Health Technology Assessments, and the National Institute of Health and Clinical Excellence for systematic reviews in 2007. We searched MEDLINE, Cochrane Central Registry of Trials, and the Cumulative Index to Nursing and Allied Health Literature (January 2002 to February 2009), limiting to English language only. We examined reference lists of relevant systematic reviews and other articles and considered references supplied by experts.
Study Selection: Randomized clinical trials meeting inclusion/exclusion criteria, of at least fair quality according to USPSTF criteria, and reporting falls outcomes.
Data Extraction: We abstracted data into standardized evidence tables, with data abstraction checked by another investigator. Two investigators evaluated all studies against pre-specified, design-specific USPSTF criteria for trials. Differences were resolved by consensus. Excluded studies are listed in the exclusion tables, with reasons for exclusion.
Data Synthesis: We included 47 intervention trials with a total of 23,980 participants. Fourteen trials (16 intervention arms) addressed multifactorial assessment and management (n=5,570). Seven comprehensive multifactorial interventions reduced falls among primarily high-risk older adults, while nine noncomprehensive interventions did not. Seventeen trials (21 intervention arms) (n=3,985) of exercise/physical therapy interventions significantly reduced falls, with some suggestion that benefits were primarily among participants selected at higher-than-average risk for falling. Eight trials (n=5,216) of vitamin D supplementation among participants with mean ages of 71–77 years showed significantly reduced falls. Four trials (n=1,437) addressing visual acuity and cataract correction among adults with mean ages of 76–80 years found no reduction in falls. Two trials (n=4,769) with high-risk female participants with mean ages of 78–83 years found no benefit on falls or falls injuries with hip protector use. Small single trials of medication management, protein supplementation, and behavioral counseling showed no benefit. Limited data were available on intervention-associated harms or health outcomes in addition to falls.
Limitations: The body of research is of fair quality and rarely reports important health outcomes, such as falls-related injuries. Available studies do not clarify the best way to identify higher risk community-dwelling older adults for evidence-based interventions due to heterogeneity in tested approaches.
Conclusions: There is strong evidence that several types of primary care applicable falls interventions (i.e., comprehensive multifactorial assessment and management, exercise/physical therapy interventions, and vitamin D supplementation) reduce falls among those selected to be at higher risk for falling. Harms of these interventions appear to be minimal, but future research should confirm this assertion.