Prehospital emergency services screening and referral to reduce falls in community-dwelling older adults: a systematic review

Emerg Med J. 2016 May;33(5):345-50. doi: 10.1136/emermed-2015-204815. Epub 2016 Jan 11.


Background: Falls represent an increasing source of geriatric morbidity and mortality. Prehospital emergency services may be uniquely suited to screen and refer subsets of high-risk older adults to fall prevention programmes. This systematic review assesses the effectiveness of such screening and referral programmes.

Methods: We searched PubMed, Embase, CINAHL, Web of Science, Scopus, the Cochrane Library and OTseeker for English-language peer-reviewed randomised trials, non-randomised trials and cohort studies evaluating prehospital fall risk screening and referral programmes for community-dwelling adults ≥60 years of age. Risk of bias was assessed using the Cochrane Collaboration's tool. Primary outcomes included the risk and rate of falling. Secondary outcomes included successful follow-up to address fall risks and adverse events.

Results: From 6187 unique records, 6 studies were included. Screening varied from using semistructured risk assessments to recording chief complaints. All studies were at high risk of bias. One unblinded trial of a multifactorial fall prevention programme demonstrated a 14.3% (95% CI 6.1% to 22.5%) absolute reduction in annual fall risk and a relative fall incidence of 0.45 (95% CI 0.35 to 0.58). The probability of successful follow-up varied from 9.8% to 81.0%. No studies demonstrated any attributable adverse events.

Conclusions: No high-quality evidence demonstrates that prehospital services reduce falls in community-dwelling older adults. Screening by prehospital personnel using semistructured risk assessments appears feasible, but it is unclear whether this is superior to referral based on fall-related chief complaints.

Trial registration number: PROSPERO 2012:CRD42012002782.

Keywords: accident prevention; accidental falls; geriatrics; paramedics, extended roles; prehospital care.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Accidental Falls / prevention & control*
  • Accidental Falls / statistics & numerical data
  • Aged
  • Bias
  • Community Health Services / methods
  • Emergency Medical Services*
  • Health Services for the Aged / organization & administration
  • Humans
  • Mass Screening / organization & administration*
  • Referral and Consultation / organization & administration*
  • Risk Assessment / methods*